1855 Cassat Ave. Ste. 6, Jacksonville, FL 32210   |   Weekdays: 9:00AM – 5:00PM | Weekends: Closed

Billing

There are several reasons why you may be receiving a bill for your equipment:

  1. You have not yet met the deductible for your plan. Once your deductible is met your insurance will kick in and being to pay for your equipment. Contact your insurance company for an explanation of benefits. 
  2. Your insurance does not cover 100% of the cost of your equipment and you are being billed for the remainder. For instance, Medicare only pays for 80% of the cost of medical equipment. This includes walkers, wheelchairs, hospital beds, stationary and portable oxygen, cpap machines and supplies. If you do not have a secondary insurance to make up for the remaining 20% you should expect to receive a bill for that amount. 
  3. Your insurance changed and it hasn’t been updated in our system yet. If you have recently made a change to your insurance plan, changed insurance companies, or moved to a new address and didn’t notify us of the change you will receive a bill for your equipment. Many items bill as “capped rental” which means the insurance company pays for the cost of your equipment over a period of 13 months (rental period). The billing during this period is automatic so, if there is a change in billing during that time our system will automatically generate a bill for the unpaid portion. If this happens, simply contact us to update your account and the bill will be waived. 

You were asked to sign an ABN (Advanced Beneficiary Notice) which states that you are being given this equipment at the request of your healthcare provider without a prior authorization from your insurance company. Usually this only happens with medical equipment that is considered ‘immediately necessary’ or ‘urgent’ such as medical oxygen or ventilators, but sometimes includes post-op walkers, wheelchairs and hospital beds used for fall prevention and recovery. If your insurance company for some reason determines the equipment that was provided is not “medically necessary” (denied coverage) you should expect to receive a bill for this equipment. In this case, you should contact us to find out why your insurance company denied coverage or ask if it is possible for the equipment to be picked up to have the charge removed. In the case of CPAP and oxygen you may still be billed for the time the equipment was used because of the expenses involved in delivery, useage, and depreciation of equipment. Some equipment (such as 3-in-1 commodes and used cpap masks and other supplies) cannot be returned for health and safety reasons.

Category: Billing

If you have changed insurance companies, switched plans or coverage or have recently moved please contact our office. You may have received a bill due to this change taking place. If this is the case, as long as your plan’s coverage has not changed, your bill will be waived.

Category: Billing

When you order cpap supplies we are required to bill each item separately. Here is an example of the items listed on your bill for cpap resupply: 

  • Mask Frame
  • Mask Cushions (up to 3 per order)

Or 

  • Nasal Pillows (up to 3 per order
  • Headgear 
  • Standard or Heated Tubing
  • Water Tank or Reservoir
  • Mask Filters (if applicable) 
  • CPAP machine filters (6) 
Category: Billing

To transfer service to Mayhugh’s from another provider we will need all the documentation from your previous provider. This can be requested by us or sent by your doctor, but the easiest way is for you to request this from your current DME provider as they are likely to have the most up to date paperwork needed to bill your insurance. 

To transfer service from Mayhugh’s in the event that you have moved out of our service area, simply provide the name and fax number of your new provider along with a request that your paperwork be transferred. 

If you are in possession of rented equipment we will ask that you make an appointment to have it picked up or drop it off yourself. We will provide you with a pickup ticket that your new company will need to begin billing the equipment they provide you.

Category: Billing

Certain medical equipment such as cpap machines, wheelchairs, and nebulizer machines are billed by Medicare using what is called “capped rental”. Capped rental means Medicare pays for the total cost of your equipment over a period of 13 months. During that time the equipment is considered a “rental”. If for some reason you no longer need that piece of equipment before the 13 month period is up, you’ll simply return the equipment to us and no more payments will be collected. After 13 months you own the equipment. 

*As a side note: if you’re thinking about selling or otherwise discarding your equipment at the end of your capped rental period, you should know that Medicare also has a rule that says you’re only allowed one “same or similar” item in a 5 year period. So if you think you’ll ever need it again, it’s probably best to keep it.

Category: Billing

CPAP

Most insurance companies have a “compliance period” of 90 days from the time you receive your new device. A compliance period is set up by an insurance company to be sure you’re using and benefiting from the equipment they are providing for you. If for some reason you decide to stop using your cpap/bipap equipment regularly during that time, your insurance company may decided to stop paying, or require you to start the process all over again with a new sleep study in order to qualify. 

A typical “minimum compliance requirement” is 70% within a consecutive 30-day period in the first 90 days or at least 4 hours per night; 5 days per week (20 hours minimum per week) for 30 days in a row. 

Your usage compliance is tracked by software on your cpap device or (for older equipment) using an SD card inside the machine. You will likely have an appointment scheduled with your sleep doctor, pulmonologist or primary care doctor at or around the 30 day mark. Before the appointment your doctor will download your 30 day compliance report which will show helpful data to determine if you are using your equipment properly. If you’re having issues with your equipment that is affecting your compliance your doctor can help make suggestions at that time. 

Mayhugh’s Medical has a robust compliance program for CPAP and BiPAP equipment which includes: 

  • Personal one-on-one setup and education for every new customer. 
  • In-home setup and education for physically disabled customers and customers that live outside of our normal delivery area. 
  • 70-day compliance monitoring for all new patients with live US-based one-on-one phone calls from CPAP experts to help you resolve any problems you’re having with machine usage, settings or mask fit issues. 
  • Automatic registration to the online portal (Resmed AirView or Respironics DreamMapper) and smartphone app for all new setups allowing you to view and track your compliance data in real time. 
  • 30-Day Mask Fit Guarantee. If you are unsatisfied with your current mask for any reason, you can swap it out for any other mask for free during the first 30 days.
Category: CPAP

Oxygen

DISCLAIMER: If you are having any problem with your oxygen equipment that is causing the oxygen concentrator to display a warning light, contact us 904-379-0408 before attempting to do any service yourself. Never try to fix your concentrator yourself or you may void the warranty on the equipment. Mayhugh’s employs delivery technicians that are available 24/7 to take care of any equipment issues you may be experiencing. 

That said, there are a few things you may be able to do yourself to troubleshoot some typical issues customers sometimes face with oxygen concentrators. 

Your portable oxygen concentrator is designed to deliver oxygen only while you are inhaling. You may have heard this called “Pulse” or “Bolsa”. 

If your oxygen concentrator is not dispensing oxygen try the following steps: 

  1. Be sure the machine is turned on and properly charged  – locate the power button and press until lights on the device turn on and the concentrator motor can be heard running. Be sure there are no warning lights or continuous beeping. If there are any warning lights or alarms sounding, call us to service your equipment 904-379-0408. 
  2. Breathe through your nose – though this may seem obvious, it is easy to forget. Many people breathe through their mouths on a regular basis which will cause most portable concentrators to give a warning alarm which is designed to remind you to take a breath through your nose. The machine is designed to sense when the user inhales in order to dispense the right amount of oxygen. 
  3. Check the tubing – Tubing can easily become kinked or stuck under chair legs from moving around. Check to be sure there are no kinks in tubing. While the machine is on, run your fingers slowly along the length of the tubing to check if any air is escaping from holes that may have formed from regular usage or pets. 
  4. Change out tubing – If the tubing is found to be faulty, change out the tubing with a new one. We typically supply each customer with 3-4 tubing and cannulas. Our suggestion is to replace these every 2 weeks.
  5. Look for error messages on display screen – Take note of any specific error or warning messages being displayed on the screen usually located on the top of the machine. This will help our technicians diagnose any issues with your equipment once we arrive. 
  6. Contact Us – Mayhugh’s is available 24/7. Just call 904-379-0408 to request oxygen service. If a call is made after normal business hours you will be connected to our call service who will alert the on-call delivery tech who will reach out to you based on the information you provide them. Be sure to always give us the best number to reach you as we will need to contact you directly before a driver can be dispatched. If you don’t receive a call back from a driver in a reasonable amount of time (1-2 hours) please call again. You may also try sending us a contact request using our contact form here. Please note: This service is only available to current customers.
Category: Oxygen

DISCLAIMER: If you are having any problem with your oxygen equipment that is causing the oxygen concentrator to display a warning light, contact us 904-379-0408 before attempting to do any service yourself. Never try to fix your concentrator yourself or you may void the warranty on the equipment. Mayhugh’s employs delivery technicians that are available 24/7 to take care of any equipment issues you may be experiencing. 

That said, there are a few things you may be able to do yourself to troubleshoot some typical issues customers sometimes face with oxygen concentrators. 

Yellow or Red Light typically means “Low Oxygen Purity” or “Needs Service” depending on the brand and model you were given. 

If your oxygen concentrator is showing a yellow or red light try the following steps: 

  1. Check the cabinet filter – this is a 3″-4″ removable filter located on the rear side of the machine behind removable door. Open the door with a butter knife or other blunt object, remove the filter to check for dust or pet hair, clean with soap and water removing any debris that may be clogging air flow. If filter appears to be clean move on to next step. 
  2. Check the tubing – Tubing can easily become kinked or stuck under chair legs from moving around. Check to be sure there are no kinks in tubing. While the machine is on, run your fingers slowly along the length of the tubing to check if any air is escaping from holes that may have formed from regular usage or pets. 
  3. Change out tubing – If the tubing is found to be faulty, change out the tubing with a new one. We typically supply each customer with 3-4 tubing and cannulas. Our suggestion is to replace these every 2 weeks.
  4. Contact Us – Mayhugh’s is available 24/7. Just call 904-379-0408 to request oxygen service. If a call is made after normal business hours you will be connected to our call service who will alert the on-call delivery tech who will reach out to you based on the information you provide them. Be sure to always give us the best number to reach you as we will need to contact you directly before a driver can be dispatched. If you don’t receive a call back from a driver in a reasonable amount of time (1-2 hours) please call again. You may also try sending us a contact request using our contact form here. Please note: This service is only available to current customers.
Category: Oxygen

Referrals

Referrals:  How To Place an Order For A Patient - What is Required?

To place an order on behalf of a patient that is being used to bill any insurance we will need the following 7 requirements to be met. Medicare refers to this as “Detailed Written Order”, or DWO for short and those requirements are: 

  • Patient Name
  • Start Date (usually the day the order is written) 
  • Specific type of equipment (see our “easy order form” for specific equipment verbiage
  • Prescribing Dr. Name (printed)
  • Date Signed
  • Prescribing Dr. Signature 
  • NPI number

*If your office or hospital does not have it’s own ERM for electronically sending prescriptions, please consider using Mayhugh’s Easy Order form to fulfill all these requirements in a single document. If you don’t see the type of equipment you’re trying to order feel free to write it in anywhere on the document. 

Along with those 7 elements we also require: 

  • Patient Demographics 
  • Patient’s Height & Weight
  • Insurance information 
  • Office notes from most recent visit

These 4 items DWO, Demos, Insurance info and Office Notes are sufficient for most orders of standard medical equipment (Walkers, Rollators, Wheelchairs, Hospital beds, Commodes etc.) 

For 24 hour (continuous) and Portable Oxygen

  • ’6 minute walk’ test 

Or 

  • ’At Rest On Room Air’ test 

*These tests must show an SPO2 desaturation of 88% or lower without supplemental oxygen (on room air) and then an oxygen titration showing the level of oxygen required to bring the patient back to ‘normal’ SPO2 levels. 

*If your facility does not conduct these tests, you can order them to be performed at the patient’s home by our partner testing company. 

If your patient does not desaturate with either of these tests and you’re still considering oxygen therapy, they may qualify for Nocturnal Oxygen therapy with an overnight oximetry test. This test can be easily performed in the patient’s home using a simple bracelet device. This self administered test is delivered by us to the patient and picked up the next day after testing is complete. The results of the test are automatically transmitted wirelessly by the device at which time the order can be written. 

To order an overnight oximetry test, simply send us an order and using our Easy Order Form or your own EMR ordering system. 

For CPAP Equipment and Supplies (New Customers):

  • DWO listing the specific type of equipment (ie Nasal Mask, Cushions, Tubing, Headgear & Filters or Try our CPAP Order form for specific verbiage)
  • Patient Demographics 
  • Insurance info
  • Sleep Study (performed within the last year)
  • Office notes dated prior to sleep study where cpap therapy is mentioned 

For Bi-Level (BiPAP) therapy

  • A sleep study showing the patient failed using cpap therapy
  • A lab-based BiPAP titration with recommended settings (cannot be a home study) 

Or 

For Trilogy Ventilators:  

  • DWO listing the specific settings or stated “titrate to patient’s height and weight” (Use our Trilogy Order form for specific verbiage, or our Pre-Filled Trilogy order form with the most commonly used settings) 
  • Patient Demographics 
  • Patient’s Height & Weight
  • Insurance info
  • History of respiratory failure 
  • An arterial blood gas (ABG) showing a CO2 level of 55 mmHg or greater 
  • Notes stating “BIPAP therapy was considered and deemed inappropriate” 

For Power Wheelchairs and Scooters : 

  • DWO listing the specific type of equipment being ordered
  • Patient Demographics 
  • Patient’s Height & Weight
  • Insurance info
  • PT or OT Evaluation  (can be done in the office but requires specific language, refer to our “Power Mobility Notes pdf for specific verbiage)
  • Home Evaluation (Performed by Mayhugh’s, this evaluation of the patient’s home is required to be sure the equipment can fit through doorways and allow patient to perform basic tasks such as getting to the restroom, getting to the kitchen, and getting to bed)

*If you plan to refer out the PT/OT eval to another healthcare provider we recommend sending your power mobility orders after the PT/OT eval is completed. The reason for this is once the order for power mobility is written there is a deadline of 30 days to fulfill the order (delivery of equipment) before the process needs to start all over again.

Category: Referrals
Referrals:  What equipment is covered?

Nearly all of our equipment is covered by insurance with a few exceptions. Some of these exceptions have to do with specific diagnosis restrictions (i.e. oxygen therapy orders with a diagnosis of pleural effusion are only covered when written from a medical office due to most insurance requirement that the patient be in a “chronic-stable state, with no underlying conditions”), other restrictions have to do with insurance company’s determination of “Medical Necessity”. 

A good thing to remember when writing an order that will be covered by your patient’s insurance is: “is there a cheaper option that has a similar therapeutic effect” if yes, that will likely be the option that is covered by the patient’s insurance. 

Here’s a short list of common items that are usually NOT COVERED by any insurance: 

  • Bathroom items including: Toilet Seat Risers, Bath or Shower Chairs, Grab Bars, Walk-in Tubs
  • TV Trays 
  • Lift Chairs (except the lift mechanism, usually about ⅓ of total cost) 
  • Knee Scooters (aka Knee Walkers) except by certain insurances
  • Certain Braces
  • CPAP Cleaners (Devices and Wipes)
  • Travel CPAP Machines

Or any equipment ordered without a qualifying diagnosis or lacking necessary paperwork.

Apart from this, coverage is always determined by benefits outlined in the patient’s plan and any deductibles or copays required by the insurer. 

Navigating the complex world of insurance coverage can be frustrating and complex. The good news is, Mayhugh’s is here to help. Send us the order and our billing experts will determine if the item is covered and if any supplementary documentation is needed.

Category: Referrals

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