There are several reasons why you may be receiving a bill for your equipment:
- 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.
- 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.
- 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.
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.
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)
- Nasal Pillows (up to 3 per order
- Standard or Heated Tubing
- Water Tank or Reservoir
- Mask Filters (if applicable)
- CPAP machine filters (6)
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.
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.