Menu
Cart 0

Medicare & Insurance

MEDICARE - INSURANCE & DURABLE MEDICAL EQUIPMENT (DME)

Will Medicare or my Insurance pay for DURABLE MEDICAL EQUIPMENT?

Customers often come to us here at Adventura Sickroom Supply (AKA/ Didimedical.com) and ask us the following question. Will Medicare pay for home Durable Medical Equipment? That is an excellent question and an important one, too, for anyone looking to purchase a Durable Medical Equipment. Because we get asked this question so much, today we decided to try explaining to you why it is highly unlikely or difficult, at best, to get a high end Durable Medical Equipment through Medicare or any other insurance funding channel. If you have found our company and reading this article, then chances are, you have probably already discovered how difficult it is to find an Insurance or Medicare equipment company that carries high end Durable Medical Equipment, much less, the model best suited for you and your lifestyle. You may be frustrated from being told "NO".

We  are here to help!

Will Medicare help pay for a high end Durable Medical Equipment? Unfortunately, the answer isn't a simple yes or no. Medicare has always paid a certain amount for Durable Medical Equipment. However, in recent years, that amount has continued to be reduced. In fact, in the summer of 2013, Medicare reduced payment for many types of high end Durable Medical Equipment almost 50%. Most private insurance companies base their prices on what Medicare allows.

Due to this recent Medicare reduction in payment and Durable Medical Competitive Bidding is why we hear so many customers say their equipment supplier told them Medicare does not cover the item they desire. Or the supplier will ask the customer to sign an Advanced Beneficiary Notice (ABN Notice), which states that the supplier does not believe the item will be covered by Medicare. At that point many suppliers have you sign an ABN notice and charge the customer full retail. Some suppliers still tell you they are accepting medicare, even though they are charging you the full retail price. The truth is these suppliers can't afford to provide you a expensive NEW equipment sometimes costing hundreds or thousands of dollars when they can get by setting you up with the least costly alternative to do the job. On many items Medicare pays the supplier on a limited rental basis, after so many rental payments the supplier must leave the equipment and service it for a set number of years and or, until the patient qualifies for replacement equipment. Note the equipment you start with may be used from the start.

Even more frustrating, Medicare made things a lot tougher by implementing their National Competitive Bidding (NCB) process for medical equipment supply companies in most areas of the country. Companies with the lowest bid were those awarded Medicare contracts. This means the Medicare rental fee for equipment, that is reimbursed to the equipment companies, has been reduced even lower. You also have less equipment companies to choose from because bidders who were not among the lowest priced are excluded from the market and not allowed to even bill Medicare on your behalf at whatever the bid rate is. Now there is less and less financial motivation for equipment supply companies to provide you with NEW QUALITY PRODUCTS.

"Link to Medicare.gov Competitive Bidding Program"
Unfortunatley for the above reasons we are unable to accept or even bill Medicare on your behalf. We can provide you with a bill once you have paid for your products or services that may be honored by some private insurance companies, but you are completely and totatly responsible for obtaining reimbursement, when and if applicable. Also remember no insurance company or medicare will reimburse you without a qualifying physicians prescription RX.

Our Mission: Is to provide our customers with personalized service; in a caring, clean, and comfortable environment. Our goal is to assist patients, physicians, and caregivers; obtain the necessary products and services, needed to manage the patient comfortably at home.

To Our New Internet Customers: It is important to us that you know even though you may not be sitting in front of us; we still care. We will do our utmost to help you find the goods and services you need to make your life easier and more comfortable.

We Hope you Feel Better Soon !!!!!!


Adventura Sickroom Supply, Inc.
954-458-1959

136 South Federal Highway, Hallandale Florida 33009

We Speak English, French and Spanish

Open: Monday-Friday 9 – 5:30 , Saturday 10 – 2. Closed Sunday