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solid dme to just bill my ins for tilite--anthem in network provider

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    solid dme to just bill my ins for tilite--anthem in network provider

    ok, im getting jerked off from my local dme, whom i'll name later. been dealing w/ them on my new zr for 3mths.

    as always i did all the work, specing etc, got everything handled from my doc they just faxed it in to my ins. ok got everything approved. so order, no wait they want 50% deposit on the entire cost of the chair roughly 3k b4 they will order. fuck that, in 20 yrs i have never heard of such nonsense.

    so anyway, i can get the approval transfered into any dme name so i need a good one , out of ohio is fine, i do all my own work on them. just need paper pushed, order the chair and get ins billing handled. i have anthem.

    im going straight to the owner of the dme co. monday, ill have my say, then i will post the name of everyone involved. its a small world here in ohio.............
    Last edited by fuentejps; 4 Apr 2009, 1:33 PM.
    Bike-on.com rep
    John@bike-on.com
    c4/5 inc funtioning c6. 28 yrs post.
    sponsored handcycle racer

    #2
    you're getting a TiLite?
    Get involved in politics as if your life depended on it, because it does. -- Justin Dart

    I shall not tolerate ignorance or hate speech on this site.

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      #3
      another zr
      Bike-on.com rep
      John@bike-on.com
      c4/5 inc funtioning c6. 28 yrs post.
      sponsored handcycle racer

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        #4
        Unlike you I fought with the insurance company for 7 MONTHS before they would approve an ultra-lightweight chair for me (I have an HMO) and once it got approved it has been smooth sailing. I went through National Seating and Mobility out of Anaheim, California, but I know they have multiple locations around the US. IDK if they have one near you, but you can look, their website is http://www.nsm-seating.com/index.htm.
        My new chair (TiLite Aero Z) has been ordered (insurance approved a K5 chair, otherwise I would have gone titanium) and shipped from Washington on the 30th (Monday). By now it should be at NSM to have final assembly and I am scheduled for delivery on 4/15.
        I hope you are able to get things straightened out with the seating company. I would assume since they have an approval from the insurance company that you wouldn't need to pay that 3K before they order your chair. I could understand if you have a co-pay or co-insurance that they would like to have a portion of that before ordering, but not a portion of the whole chair itself!! That is just ridiculous. Maybe after this is all done you could report them to the Better Business Bureau? Good luck with them on Monday!
        Mandy
        ~Mandy~
        SCI as a result of spinal surgery
        TiLite Aero Z!!!

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          #5
          many thx.

          any others guys.
          Bike-on.com rep
          John@bike-on.com
          c4/5 inc funtioning c6. 28 yrs post.
          sponsored handcycle racer

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            #6
            The Carolina Mobility office in Chesapeake, VA is pretty good. The guy selling and spec' ing the manual chairs in Chesapeake has been pushing for one for 20 years, T4 or 5, I think. Bad thing I've heard is that they aren't particularly speedy, but they handle the bureaucracy. I'm pretty sure anyone handling the paper for you will want a premium for the service. 50% down is steep, but they deserve something for this service, no? Anyway, his name is Chris Daley, perhaps he'd have something to offer:

            Carolina Seating and Mobility
            Chesapeake, VA 23320
            644 Independence
            Parkway Suite 400
            Phone: 757-966-7964
            Fax: 757-966-7965
            "I have great faith in fools; self-confidence my friends call it." - Edgar Allen Poe

            "If you only know your side of an issue, you know nothing." -John Stuart Mill, On Liberty

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              #7
              in 21 years i have never put anything down on a chair, never. the most is my copay on delivery, which is never more than 1k.
              Bike-on.com rep
              John@bike-on.com
              c4/5 inc funtioning c6. 28 yrs post.
              sponsored handcycle racer

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                #8
                I use Connecticut Rehab (now called ATG Rehab). Never once had to pay up front for anything. Good guys there.
                "Unless someone like you cares a whole awful lot nothing's going to get better. It's not." - Dr. Seuss

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                  #9
                  i have anthem
                  If you registered user at www.Anthem.com , you can go into the "Fnd a Provider" look up, after signing on. It allows you to narrow the search by selecting only DME's and you can have them sorted by distance to any zip code.

                  Good Luck...

                  Joe

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                    #10
                    Copay at time of delivery sounds perfectly reasonable to me. 50% of co-pay might even be reasonable to take on the work, but not if the guy down the streeto isn't charging this! Payment upon delivery is what Carolina Mobility did for my first chair. Chris did spec me out in a chair too big. He has since told me that is the most reliable decision when dealing with a new para as most of us gain weight during the lifespan of a first chair and typically need size up before Medicare will pay, which is where most para's end up. I trust him enough to recommend him, but he is a DME. Buyer beware.
                    "I have great faith in fools; self-confidence my friends call it." - Edgar Allen Poe

                    "If you only know your side of an issue, you know nothing." -John Stuart Mill, On Liberty

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                      #11
                      Update. Im making progress w/ the dme ppl. Ill update when/if resolved
                      Bike-on.com rep
                      John@bike-on.com
                      c4/5 inc funtioning c6. 28 yrs post.
                      sponsored handcycle racer

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                        #12
                        In lieu of money up front, DME here will ask the pt to sign an ABN which just says in the event the insurance doesn't cover the costs then you the will. This protects the DME (know that concerns you little) BUT it gets the chair ordered. Since you feel confident that your chair should be covered then it should merely be a formality. NOW if you order a chair that is not covered by your insurance then this holds you to paying for it. But from what you say, same chair, etc, etc, should be no problem. Just a thought- plus while the DME is wasting your time from getting the chair, this at least gets the process going.
                        Good Luck, Pam OTR/L

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