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There appear to be two reasons regular walk in tubs and Hybrid Tubs are not already officially recognized DMEs. 1. They can be viewed as Conveniences rather than Medical Necessities 2. They could be used by others, not only by the person with the special needs Those tub buyers who have been successful getting Medicare reimbursement probably have overcome these two problems with a convincing claim presentation about their unique situation, mobility issues and medical necessity that is, needed for the treatment of their medical conditions. The only way to find out if you can get reimbursement for your tub purchase is to go through the Medicare claim process and see what happens. Your Medicare claim can only be filed after you first satisfy several requirements and then buy the tub. Because much of the claim filing process is after you buy your tub, you must be sure you can afford the tub on your own and have no expectation of getting any Medicare reimbursement. Any tub buyer can file a claim as long as they are enrolled in Medicare Part B (Medical Insurance). Because these tubs are not officially DMEs, the claim must be filed by you rather than by the supplier. The process is not difficult, but like most government programs, you must follow the correct procedure. The following suggested process will help you create a strong presentation for your Medicare Claim. It might increase your chances of partial Medicare reimbursement for your Rane Hybrid Tub. However, even with a good presentation, you would be well served to have an attitude of total joy with your new Hybrid Tub and no expectations of Medicare reimbursement. Then, if you do get your claim approvedCelebrate the unexpected.
A Prescription is mandatory for your Medicare Claim 3. Ask for a Letter of Recommendation from your Doctor (Optional, but very helpful) This is your Doctors letter of support It supports the medical necessity of the tub It might describe your medical condition, how it benefits your living situation, benefits of the tub, how it treats your conditions, or whatever your Doctor chooses to write 4. Buy the Rane Hybrid Tub of your choice Order, receive and install your tub Retain all paperwork Make a copy of the Invoice and your proof of paymenttub only, as Medicare will not reimburse construction costs, etc. 5. Enjoy the many Benefits of your new Rane Hybrid Tub Note especially how good it makes you feelphysically, mentally, spiritually Note changes and improvements in your medical condition, quality of life, etc. Note specifics like pain relief, safe access, reduced fear of falling, etc. 6. Compose a Personal Letter This is basically an appreciation letter for the new tub in your life Express your thoughts and feelings now that you have experienced your new tub Include what you noted abovethings like your improved medical condition, not having to be bathed by someone else, relieved from the debilitating fear of falling, improved stay-at-home independence and quality of life, etc. Sign your letter 7. Complete Medicare Form CMS-1490S You must be enrolled in Medicare Part B (Medical Insurance) to file any claim Download Form CMS-1490S and Instructions ( If other questions, visit the Medicare website at www.medicare.gov 8. Download Your Rane Hybrid Tub Summary This is a summary of your tub model to give the Medicare Claims Examiner pictures, descriptions, benefits and details about the tub you purchased RM3 RH Z, Z
Print a copy for inclusion in your Claim 9. Claim Filing Statement Because regular walk in tubs and Hybrid Tubs are not yet officially designated DMEs, the company cannot file the claim for youyou must file it yourself That being the case, Medicare will return your claim unless you include the following statement The supplier did not refuse to file a claim for a Medicare-covered item or refused to enroll in Medicare. Because this claim is for a Hybrid Tub, not currently listed as Durable Medical Equipment and therefore the supplier cannot file the claim, I am filing the claim a copy of the Claim Filing Statement to your ^
10. Compile your original Claim, consisting of: Form CMS-1490S completed per Instructions (#7) Doctors Prescriptionoriginal attached to back of Form CMS-1490S (#2) Doctors Letter of Recommendationif Doctor provided (#3) Your Personal Letter (#6) Rane Hybrid Tub Model Summary (#8) Tub Invoice and Proof of Payment Claim Filing Statement (#9) Anything else you feel might help support your claim 11. Copy your Claim Make a copy of everything (#10) Retain in your files 12. Mail your original Claim Staple your Claim together so nothing gets lost Enclose everything in a 9 X 12 envelope, keeping everything flat Put your Return Address on the envelope Address envelope to the correct Medicare address for your state Address Table Attach sufficient postage and mail Now sit back and enjoy your tub!
Medicare will respond to your Claim (keep everything they send you) as either 1. Denied Know that you made a good try for reimbursement Enjoy a lifetime of bathing bliss in your new Rane Hybrid Tub 2. Approved CONGRATULATIONS ! Now you can file a Claim with your Medigap (Medicare Supplement Insurance) Contact your Supplement Insurance Agent immediately to find out their next steps They will need copies of what Medicare sent you and may handle the Claim filing for you Enjoy a lifetime of bathing bliss in your new Rane Hybrid Tub
Use the following address table to ensure the correct address will be provided on the claim.
If you live in: Connecticut, Delaware, District of Columbia, Maine, Maryland, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, Vermont Illinois, Indiana, Kentucky, Michigan, Minnesota, Ohio, Wisconsin Return your form to: NHIC, Corp. P.O. Box 9165 Hingham, MA 02043-9165
Alabama, Arkansas, Colorado, Florida, Georgia, Louisiana, Mississippi, New Mexico, North Carolina, Oklahoma, Puerto Rico, South Carolina, Tennessee, Texas, U.S. Virgin Islands, Virginia, West Virginia Alaska, American Samoa, Arizona, California, Guam, Hawaii, Idaho, Iowa, Kansas, Missouri, Montana, Nebraska, Nevada, North Dakota, Northern Mariana Islands, Oregon, South Dakota, Utah, Washington, Wyoming
National Government Services, Inc. DMEPOS Operations Medicare DMEPOS Claims P.O. Box 7027 Indianapolis, IN 46207-7027 CIGNA Government Services P.O. Box 20010 Nashville, TN 37202-0010
DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES
Patients Sex
2
Patients Mailing Address (City, State, Zip Code) Check here if this is a new address
I Male
I Female I
Telephone Number
(Include Area Code)
(
3
(Street or P.O. Box Include Apartment Number)
) _
3b
(City)
(State)
(Zip)
4b 4
I Yes
I No
B. Accident I Auto
I Other I No I No I No
4c
a. Are you employed and covered under an employee health plan? b. Is your spouse employed and are you covered under your spouses employee health plan?
c. If you have any medical coverage other than Medicare, such as private insurance, employment related insurance, State Agency (Medicaid), or the VA, complete:
Name and Address of other insurance, State Agency (Medicaid), or VA office Policy or Medical Assistance No. Policyholders Name: Note: If you DO NOT want payment information on this claim released, put an (X) here
I AUTHORIZE ANY HOLDER OF MEDICAL OR OTHER INFORMATION ABOUT ME TO RELEASE TO THE SOCIAL SECURITY ADMINISTRATION AND CENTERS FOR MEDICARE & MEDICAID SERVICES OR ITS INTERMEDIARIES OR CARRIERS ANY INFORMATION NEEDED FOR THIS OR A RELATED MEDICARE CLAIM. I PERMIT A COPY OF THIS AUTHORIZATION TO BE USED IN PLACE OF THE ORIGINAL, AND REQUEST PAYMENT OF MEDICAL INSURANCE BENEFITS TO ME.
Date signed
6b
IMPORTANT ATTACH ITEMIZED BILLS FROM YOUR DOCTOR(S) OR SUPPLIER(S) TO THE BACK OF THIS FORM
Description of each surgical or medical service or supply furnished. Charge for EACH service. Doctors or suppliers name and address. Many times a bill will show the names of several doctors or suppliers. IT IS VERY IMPORTANT THE ONE WHO TREATED
YOU BE IDENTIFIED. Simply circle his/her name on the bill.
It is helpful if the diagnosis is also shown on the physicians bill. If not, be sure you have completed Block 4 of this form. Mark out any services on the bill(s) you are attaching for which you have already filed a Medicare claim. If the patient is deceased, please contact your Social Security office for instructions on how to file a claim. Attach an Explanation of Medicare Benefits notice from the other insurer if you are also requesting Medicare payment.
The supplier did not refuse to file a claim for a Medicare-covered item or refused to enroll in Medicare. Because this claim is for a Hybrid Tub, not currently listed as Durable Medical Equipment and therefore the supplier cannot file the claim, I am filing the claim.