Frequently Asked Questions
Q: My doctor wrote me a prescription for an item. Why do you need more documentation?
A: Your doctor has evaluated your condition and prescribed an item of Durable Medical Equipment that he or she believes would be beneficial to treating or managing your condition. Most of the time a prescription is not considered sufficient by most insurers to determine the medical necessity of that particular item. Equipment suppliers are required to maintain documentation in our files regarding your specific medical condition and subsequent medical necessity. We will review the available documentation to ensure that all applicable criteria have been met and that your equipment will be covered by your insurance.
Q: My doctor wrote me a prescription for a shower chair. Why won’t my insurance cover it?
A: Most insurances consider a shower chair a convenience item, and not used for the treatment of a specific condition.
Q: How soon can I have the equipment delivered?
A: After Reliable Medical Services has received and reviewed any required documentation, we can schedule a delivery time frame. This process can take some time; from receiving the necessary information from your doctor to verifying your insurance and determining the best product that will meet your needs. We will be in contact with you throughout the entire process so that you are well informed.
Q: How do I know if my insurance will cover the equipment?
A: We will verify your insurance coverage for a specific piece of equipment. Please remember that your insurance will not guarantee that your claim will be paid. If your insurance denies payment for an item, you must accept the financial responsibility for the item.
Q: How much will I have to pay?
A: We will verify your co-insurance and or co-pay amount if any, while verifying your insurance eligibility. We will let you know the estimate of the portion you may be responsible for. Your co-insurance and or co-pay amount will be due at the time you receive the item.
Q: Why am I required to rent certain items for 13 months? I just want to purchase it.
A: Most insurances dictate whether an item of Durable Medical Equipment item is a “capped rental item” or an item that can be purchased up front. We will verify with your insurance if they require the item that you are requesting be rented or purchased.
Q: I like a certain brand. Can I receive the brand I prefer?
A: We can order almost any brand of supply that you request. However, there may be an additional cost that would be your responsibility, depending on your insurance coverage.
Q: I have a prescription for a Nebulizer. Where can I get the medication?
A: You can obtain your medication to be used with your nebulizer machine from any licensed pharmacy.
Q: I need replacement parts for my Nebulizer. Can you order them?
A: In most cases, yes. We will need to know the manufacturer and the model number of your machine. If your machine has a serial number, please provide that information as well. We can then order the appropriate parts you need.
Q: My nebulizer mask needs to be replaced. Why do I need to have a prescription?
A: Any item that is used to administer or contain medications is restricted by the FDA. We will need a valid prescription from your physician before we can sell the item to you.
Q: Can you order replacement parts for my CPAP machine or mask?
A: In most cases. We work directly with ResMed and Respironics. If you provide us the serial number of your CPAP machine, we can order the replacement parts.
Q: Do I need a prescription to buy replacement parts?
A: Most often you do not need a prescription to purchase replacement parts. However, some replacement parts do require a prescription, such as CPAP masks, Tubings, Nebulizer masks, tubing etc.
Q: Can you bill my insurance for replacement parts?
A: In most cases, we can bill your insurance plan for replacement parts. We will need to have a valid prescription from your physician in order to submit the claim.
Q: Can you repair my CPAP machine?
A: We are able to send your machine to the manufacturer for an evaluation. Once we receive the information from the manufacturer, we will contact you for authorization to have the factory repair your item and return it to us.
Q: I have a prescription for a wheelchair. How do I get one?
A: We have a wide variety of manufacturers to choose from. You can either purchase a wheelchair, or in many cases we can bill your insurance. We also have short term rental wheelchairs available.
Q: What documents do you need to have my wheelchair covered by my insurance?
A: We need the following documents to determine your medical necessity for a wheelchair: a valid prescription, medical records and a Certificate of Medical Necessity. We will contact your doctor on your behalf to obtain these documents. We will thoroughly review your records to make sure that you meet all the required coverage criteria.
Q: I need replacement parts for my wheelchair. Can you order them?
A: In most cases, yes. We will need to know the manufacturer and the model number of your chair. If your chair has a serial number, please provide that information as well. We can then order the appropriate parts you need.
Q: Can you repair my wheelchair?
A: Reliable Medical Services can have a technician assess your wheelchair for any needed repairs. There may be a charge for this assessment and any parts that will need to be ordered.
Medicare Non-Covered Items
The following items are not considered Medical Equipment and/or are considered Convenience Items for personal use:
- Bath Seats or Stools
- Raised Toilet Seats
- Grab Bars
- Telephone Alert Systems / Emergency Contact Systems
- Electric Air Cleaners / Air Purifiers
- Incontinence Supplies – Briefs / Pads
- Automatic Blood Pressure Monitors
Commonly Used Terms / Abbreviations
- Subscriber – The individual who is the policy holder.
- Co-Insurance – The amount that the patient is responsible to pay, typically a percentage of the allowed amount.
- Deductible – The amount that the patient must pay before the insurance policy will pay.
- Allowable – The amount that the insurance company will pay for a service/product.
- DME – Durable Medical Equipment. Items that are used typically within a home environment to assist a person with a medical condition.
- HCPC – Health Care Procedure Code. Every item of medical equipment is assigned a code to identify the product being billed to the insurer.
- DX or ICD9 – Diagnosis Codes. Every medical condition is assigned a specific numeric code. This code must be included on claims submitted to Insurance payors to identify the condition necessitating the equipment or supplies provided.
- Medical Necessity – Documentation of the medical condition requiring the supplies or equipment. This may take the form of medical records, office visit notes, therapy evaluations, x-rays, lab reports or other documents. Just because your physician prescribes an item for you, may not necessarily mean that the item is medically necessary for the treatment/management of your condition.
- Capped Rental – Some items of DME, (such as wheelchairs, hospital beds, and CPAP machines) be provided on a rental basis for 13 months. At the end of the 13 months, the title of the equipment is then transferred to the patient and the equipment becomes their property. The patient is then responsible for arranging for any maintenance or service that is required.
- CMN – Certificate of Medical Necessity. A CMN is completed by your physician to document the medical necessity of the equipment being ordered.
- ABN – Advanced Beneficiary Notice. This notice is provided to a customer if RMS believes that your insurance may not cover a specific item for a specific reason. This form may also be used if RMS provides an item that is considered an “upgraded” item instead of the standard item deemed necessary by your insurance.
- Participating Providers – The provider has a contract with an Insurance payor and accepts their allowable to provide services to the payor’s subscribers.
- EOB – Explanation of Benefits. This is a document provided by the Insurance payor that details the claim filed. It will include the billed amount, the allowed amount, any co-insurance amount to be paid by the patient, and any non-covered charges