Hello Guest, Welcome to Apnea Board !
As a guest, you are limited to certain areas of the board and there are some features you can't use.
To post a message, you must create a free account using a valid email address.

or Create an Account

New Posts   Today's Posts

med. necessity form--what it means
When a sleep doc writes a prescription for a machine for a patient, he/she also needs to fill out/sign a medical necessity form for insurance purposes, and that is the usual procedure. I just learned this from my DME's billing department.
The doc's script will allow the DME to give you a machine, mask, etc., but that separate med. necessity form is what is needed for the DME to file for the pt.'s insurance coverage. If the med. necessity form is not signed and returned to the DME, the DME must bill the pt. for the full cost of the machine, etc.
This came to my attention when I discovered that the sleep center failed to get a signed med. necessity form over to my DME. It should have happened nine months ago when I got my machine, but has yet to be accomplished. Meanwhile, my DME account shows that I'm paid up. Because of that, my DME has not been issuing me any monthly bills. Knowing there are no free lunches, I called the DME to ask about my acct. and how it's showing that I owe nothing.
My DME's billing dept. rep. told me that they're now going after that med. necessity form that they need to file with medicare. When they receive it now, what will I owe--20% of the full cost of my machine's total price? The DME doesn't know; it depends on how Medicare decides to bill--either the full 20% will be due, or they could start the 13 month rent-to-own pay procedure now even though it would be later than the usual time period.
The good news, according to my DME, is that it is quite unusual for the sleep center and doc to not submit the med. necessity form at the time the doc writes the script for a pt's new machine. So, hopefully, others will not face this situation.
Post Reply Post Reply

Donate to Apnea Board  

Possibly Related Threads...
Thread Author Replies Views Last Post
  Sample CPAP Prescription Form JesseLee 20 654 06-01-2018, 10:45 PM
Last Post: SuperSleeper
  I think this means I’m not so bad? honeybadger79 4 239 05-30-2018, 08:12 AM
Last Post: honeybadger79
Rainbow MyAir New TOS - Form to Opt Out kiwii 0 259 03-07-2018, 07:30 AM
Last Post: kiwii
Information [Mod Note] Do you want us to know when you die? [Apnea Board Postmortem Form] SuperSleeper 3 802 02-12-2018, 12:55 PM
Last Post: SuperSleeper
  [Diagnosis] Need advice please about the necessity of getting a machine LarryPer123 10 739 06-01-2017, 06:30 PM
Last Post: LarryPer123
  [Diagnosis] Pulse Oximeter a way to rule in or out some form of apnea? BethMort 13 1,248 05-24-2017, 01:27 AM
Last Post: kwhenrykerr
  Encore Pro Shows Cheynes Stokes Respiration in wave form Hmm888 11 3,010 05-06-2016, 05:32 AM
Last Post: pupcamper

Forum Jump:

New Posts   Today's Posts

About Apnea Board

Apnea Board is an educational web site designed to empower Sleep Apnea patients.