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MEDICAID FAQ
What is this program? Medicaid is a joint Federal and State program that helps pay medical costs for some people with limited incomes and resources. Most of your health care costs are covered if you have Medicare and Medicaid. Medicaid programs vary from state to state. People with Medicaid may get coverage for services such as nursing home and home health care, that aren’t fully covered by Medicare. For more information about Medicaid, call your State Medical Assistance office. |
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Medicare/Medicaid |
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Copyright © 2007 Progressive Medical Equipment, LLC. All rights reserved. |
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I had a walker 5 or 6 years ago but I need a new one that folds up, will Medicare cover the new one? Medicare will deny payment on a second walker as same or similar equipment.
Will Medicare pay for a four-wheeled walker (rollator)? If you have not received a walker under Medicare previously, Medicare will pay up to 80% of the allowed amount of a standard wheeled-walker toward the rollator. The patient is responsible for the additional upgrade cost, which is usually between $60-$100.
My mother is in a nursing facility and needs a wheelchair. Will Medicare pay for her chair? Medicare does not pay a medical equipment company for items billed while the patient is in a nursing facility or hospital. Missouri Medicaid may provide custom equipment through a prior authorization process. See your Progressive Medical Equipment rep for more details. If Medicaid is not an option, the facility may have equipment available for your mother to use. You will need to check with the facility on their policies and available equipment. Once the patient discharges to her home, Progressive Medical Equipment can provide equipment to her.
What happens if my family member is deceased and I have equipment in my home? You will need to contact the medical equipment company that provided the equipment. If you don’t know the company’s name, you can call 1-800-Medicare and they can tell you the provider name and phone number.
Can payment arrangements be considered for the 20% patient responsibility amount or special items? Yes, we will work with you to make payment arrangements. Please call our office at 913-894-4400. |
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My patient is discharging from our facility. Can he have a better cushion? Medicare coverage is based on patient’s diagnosis. For pressure relieving and/or positioning cushions ask your Progressive Medical rep or call our office at 913-894-4400. Check Medicare guidelines for exact coverage.
What qualifies my patient for positioning equipment (i.e. backs, lat supports, etc.) on a rental chair? Medicare coverage is based on patient’s diagnosis. For positioning equipment coverage ask your PME rep or call our office at 913-894-4400. Check Medicare guidelines for exact coverage.
Who does the paperwork? Progressive Medical Equipment will handle the paperwork. We will need to get evaluations and signatures from the patient’s attending doctor and/or therapist. Once we get the medical information, we will complete and process the forms and billing with appropriate insurance/private parties. |
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How long does it take to get a wheelchair paid for by Missouri Medicaid? The process normally takes approximately 8-10 weeks.
What steps are involved in getting a wheelchair (in-facility coverage)? The first step is getting an assessment of the patient’s medical condition, positioning and seating needs. We will then complete the necessary paperwork and submit to the patient’s physician for the needed doctor signature. After gaining the doctor’s signature, we will then submit the paperwork to Missouri Medicaid and wait for their response. Once we gain approval from MO Medicaid, we will order the patient’s chair and deliver it upon arrival. |
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Will the patient, family or facility be responsible for payment (in-facility coverage)? In some circumstances the patient will be responsible for payment of the equipment. A prior authorization request is submitted to MO Medicaid in which Medicaid authorizes an approved payment amount prior to order/delivery of equipment. Ask your Progressive Medical Equipment rep for more details or call us at 913-894-4400.
Does Missouri Medicaid really pay for custom wheelchairs for individuals in a facility? Yes, if the patient meets the required medical guidelines for MO Medicaid.
I had equipment delivered to me at my home upon being discharged from the hospital. Will MO Medicaid cover the cost for the equipment? If your MO Medicaid is active on date of equipment receipt they will usually pay the additional 20% not covered by Medicare should the patient have Medicare Part B. If you do not have Medicare or any other insurance, a prior authorization or medical necessity form is needed to gain approval for payment on covered equipment.
What will MO Medicaid cover for patients going home? MO Medicaid covers power & manual wheelchairs and oxygen for patients going home.
What does the Kansas Medicaid program cover? The KS Medicaid coverage is quite different from Missouri. Please check with the Kansas Department of Social and Rehabilitation Services for details. |
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For Medicare coverage on DME at home, Medicare part B is required. |
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Mobility Products FAQ |
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MEDICARE—Consumer FAQ
Will Medicare pay for my equipment? Medicare will pay 80% of their allowed amount for covered equipment. You are responsible for 20% of Medicare-approved amounts, which may be covered by your secondary insurance. You must pay an annual $135 (in 2008) deductible for Part B services and supplies before Medicare begins to pay its share.
Why didn’t Medicare cover my January bill? At the first of each year, the Medicare deductible amount is due. You will need to meet this deductible prior to Medicare paying their share of medical expenses. |
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Progressive Medical Equipment Phone: 913-894-4400 Fax: 913-894-4405 E-mail: mmartin@pmekc.com |
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To contact us: |
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Quick Reference |
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St. Louis office: 5988 Mid Rivers Mall Drive St. Charles, MO 63304 Phone: 314-256-9640 |
