Announcement

Collapse
No announcement yet.

Paperwork : So much much back and forth - just for a cushion

Collapse
X
 
  • Filter
  • Time
  • Show
Clear All
new posts

  • Paperwork : So much much back and forth - just for a cushion

    Naivety on my part maybe!

    Never really tracked the process before.

    1: Get a prescription from your doctor to see the PT seating specialist for a cushion.
    2: See PT seating specialist numerous times to figure which cushion works for you. took 3 90 minute appointments + demo's (first pt appointment 1st Nov 2018)
    3: See DME with PT seating specialist to order cushion.
    4: DME has to get LMN(Letter of medical necessity from PT)
    5: DME has to get prescription from Doctor.
    6: Doctor has to sign final forms for DME. - whatever these are ? (waiting on this)

    to be continued............

  • #2
    Now imagine a similar process except you have the pleasure of paying out of pocket every time you see the PT or the doctor...

    Comment


    • #3
      Ridiculous... they are literally killing us with paperwork attrition.
      I learnt today that each stage has to be completed within a certain time frame or the paper work becomes invalid and has to be re-done, re-signed etc.



      Originally posted by funklab View Post
      Now imagine a similar process except you have the pleasure of paying out of pocket every time you see the PT or the doctor...

      Comment


      • #4
        I started my new chair and new cushion process in Feb 2018. It is now July 2019 and I JUST got my cushion (got my chair in April 19). I got a RIDE cushion and it was so terribly too high for me that it had to be altered. They basically just shaved off the bottom and that took nearly 4 months to get done. The time suck and the co-pays for every visit and measurement have broken me. Thankfully, all worked out in the end but it should never take this long to get new equipment. I'm a post-flap patient (2 years ) so it wasn't a good gamble for me to be on an old and defunct cushion all this time. I hope your case gets sorted quickly, I'll send some positive energy your way!

        Comment


        • #5
          No matter where we are, what health system there is, everyone is clipping the ticket.
          Example: this is a while back when I required a new cushion. Numerous letters back and forth between my OT and the health supply provider ( another private agency contracted to the Health Department). We worked out a moderate hourly calculation, including my time. to arrive at an estimated cost for the communication; it was near $1000. For a decent cushion that cost less than the time/paperwork necessary to arrive at a satisfactory conclusion.
          So, regardless if it is insurance, ACC or whatever health system in place, every effective dollar becomes pennies before we arrive at a conclusion.
          An economist could possibly point out the benefits of squandering money like that.
          I know that my budget cannot sustain such waste.

          Originally posted by funklab View Post
          Now imagine a similar process except you have the pleasure of paying out of pocket every time you see the PT or the doctor...
          Either way, you pay as an individual or we all pay collectively by increased premiums and taxes. It is the bloated inefficiency/gravy train/ticket clicking that kills it for most.
          Last edited by slow_runner; 07-18-2019, 05:35 PM.

          Comment


          • #6
            Other than waiting my process was transparent to me. Using Medicare, I don't need referrals to specialists, I just go. One meeting with OT/ATP and DME, they managed all the paperwork behind the scenes with the my D.O., one follow up meeting to tweak specs after initial CAD and prior authorization changes needed from Medicare, and after 10 months the chair, cushion, backrest, and smart drive showed up at my door, delivered by DME. Other than the wait and the round of prior auth denials for stuff (like the titanium) the process was really easy on my part. Tycon Medical in Tidewater VA area.
            "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

            "Even what those with the greatest reputation for knowing it all claim to understand and defend are but opinions..." -Heraclitus, Fragments

            Comment


            • #7
              My first medicare/mediaid chair/cushion, when I was in Seattle, pretty much mirrored your experience, folks just did their job, not saying Seattle is anything great, but in comparison. Now I am really jealous of your experience.
              The amount of work I've had to do for this cushion alone is just beyond ridiculous, you would think I was in a different country. The expectations of folks here is so low, I really don't get it.

              If I ever get a new chair, I'll be sure to make the effort and travel up to Seattle for the next chair.


              Originally posted by Oddity View Post
              Other than waiting my process was transparent to me. Using Medicare, I don't need referrals to specialists, I just go. One meeting with OT/ATP and DME, they managed all the paperwork behind the scenes with the my D.O., one follow up meeting to tweak specs after initial CAD and prior authorization changes needed from Medicare, and after 10 months the chair, cushion, backrest, and smart drive showed up at my door, delivered by DME. Other than the wait and the round of prior auth denials for stuff (like the titanium) the process was really easy on my part. Tycon Medical in Tidewater VA area.

              Comment


              • #8
                Guess I was lucky when my Roho went bad (3 yrs old). 1 trip to PT, requested same cushion, they (PT/DME) did an eval. A few weeks later, my cushion was shipped to my door. My daughter put the cover on it for me. Supplier was Numotion. Maybe the DME and hospitals relationship might have had an impact. Also, maybe that I didn't need a special contour.
                Medicare paper work showed retail was over $1000 (cushion only), Medicare allowed $350 (same price as Ebay and other sources).
                Medicare will allow a new cushion every 2 years. I won't wait till it goes bad next time.
                Attack life, it's going to kill you anyway
                Steve Mcqueen (Mr Cool)

                Comment


                • #9
                  If I'm in desperate need of a new cushion (torn seam on my J2/leaking goo), I find the quickest way is to pay out-of-pocket and get a replacement from Sport-Aid. NuMotion charged my insurance something like 3x over the retail price so my 20% co-pay from insurance wasn't that far off from what I paid at SportAid. And I didn't have to wait 6+ months to get it.
                  T12 Complete since 1982. TiLite Tx

                  Comment


                  • #10
                    This is either the worst insurance ever, you've got your facts mixed up, or you're being scammed. 20% of whatever a DME wants to charge isn't a benefit worth paying for.

                    (edit: The Medicare allowable amount for a new skin protecting cushion (Roho, Stimulite, etc. HCPCS E2624) is $331.37 in my region. It varies across the country but it's between ~$250-350 everywhere. Our 20% copay is ONLY 20% of this allowable charge, not 20% of whatever the DME wants to bill. ~$66 is all we should pay.)


                    Originally posted by rshadd View Post
                    If I'm in desperate need of a new cushion (torn seam on my J2/leaking goo), I find the quickest way is to pay out-of-pocket and get a replacement from Sport-Aid. NuMotion charged my insurance something like 3x over the retail price so my 20% co-pay from insurance wasn't that far off from what I paid at SportAid. And I didn't have to wait 6+ months to get it.
                    Last edited by Oddity; 07-19-2019, 08:46 AM.
                    "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

                    "Even what those with the greatest reputation for knowing it all claim to understand and defend are but opinions..." -Heraclitus, Fragments

                    Comment


                    • #11
                      My experience after my regular dealer went to a national company was seamless while old owner was there as Manager. But, next go around I usually got my new chair within 2 to 3 months, besides when gotten 21st Century then took longer cause they said they built per order.
                      Anyway, first time after old owner left guy collected all paperwork and 3 months passed I called dealership. The guy handling it was on vacation and they knew nothing about my chair. Three weeks called back and guy was out due to sickness in family and check back in week. Then was told they had not placed order and need change chair I wanted or accept a "Demo" chair. I said "NO!" to demo.
                      Then told that doctor Face-to-Face was out of date.
                      That was my last dealing with them.
                      Called couple other places and 2 of them even though their company names were not a national company found they were really owned by one.
                      Figured not worth hassel at time cause my health was in dumps. Mama been usung a backup chair so bought her a used one off Craigslist. I still recycling my backups. Quintam Q-6 Edge the joystick quit working but picked up brand new stick on E-bay for less than a service call would been from dealer. It was plug and play (knock wood) still working.
                      Mama needs new seat cushion but not sure worth dealing with any dealer or just buy new one out-of-pocket.
                      I gave up!

                      Comment


                      • #12
                        I just buy my stuff on eBay. No running around and aggravation.

                        Comment


                        • #13
                          Originally posted by Oddity View Post
                          This is either the worst insurance ever, you've got your facts mixed up, or you're being scammed. 20% of whatever a DME wants to charge isn't a benefit worth paying for.

                          (edit: The Medicare allowable amount for a new skin protecting cushion (Roho, Stimulite, etc. HCPCS E2624) is $331.37 in my region. It varies across the country but it's between ~$250-350 everywhere. Our 20% copay is ONLY 20% of this allowable charge, not 20% of whatever the DME wants to bill. ~$66 is all we should pay.)
                          Yea, Rshadd got ripped off somehow.
                          Also, opting for supplemental insurance is something to consider. I got the kind that has no copay or deductible for anything. $400 a month, a bit expensive. However, with a new Permobil on the way, the insurance will basically pay for it self this year because I won't have to pay 20% of a big ticket item.
                          Attack life, it's going to kill you anyway
                          Steve Mcqueen (Mr Cool)

                          Comment


                          • #14
                            Originally posted by Gearhead View Post
                            Yea, Rshadd got ripped off somehow.
                            Also, opting for supplemental insurance is something to consider. I got the kind that has no copay or deductible for anything. $400 a month, a bit expensive. However, with a new Permobil on the way, the insurance will basically pay for it self this year because I won't have to pay 20% of a big ticket item.
                            I would bet Rshadd has private insurance. They have their own rules about allowable amounts and what the co-pay applies to. If it is actually Medicare or a Medicaid plan, then yeah, might be a ripoff.
                            Co-founder & CTO of MYOLYN - FES Technology for People with Paralysis - Empowering People to Move

                            Comment


                            • #15
                              Definitely possible but unlikely. Even with private insurance no insurance company would accept a bill for 3x a retail price. Prices are contractual obligations between payer and provider, so it's hard to imagine a payer signing a contract that allows them to be billed (and have to pay) whatever the hell a DME wants to charge.

                              Originally posted by Matt Bellman View Post
                              I would bet Rshadd has private insurance. They have their own rules about allowable amounts and what the co-pay applies to. If it is actually Medicare or a Medicaid plan, then yeah, might be a ripoff.
                              "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

                              "Even what those with the greatest reputation for knowing it all claim to understand and defend are but opinions..." -Heraclitus, Fragments

                              Comment

                              Working...
                              X