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Medicare Reimbursement
LIFT CHAIRS:
If you have Medicare coverage and qualify, Medicare will reimburse you for the cost of the lift mechanism inside the chair.
The seat lift mechanism is the only part of a lift chair that is covered by Medicare.
Medicare pays approximately $250 - $350. Approximately 80% of our customers file for reimbursement.
Only the seat lift mechanism on a lift chair could be considered medically necessary if all of the following coverage criteria are met:
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The patient must have severe arthritis of the hip or knee or have a severe neuromuscular disease.
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The seat lift mechanism must be a part of the physician's course of treatment and be prescribed to effect improvement, or arrest or retard deterioration in the
patient's condition.
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The patient must be completely incapable of standing up from a regular armchair or any chair in their home. (The fact that a patient has difficulty or is even incapable of getting up from a chair, particularly a low chair, is not sufficient justification for a seat lift mechanism. Almost all patients who are capable of ambulating can get out of an ordinary chair if the seat height is appropriate and the chair has arms.)
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Once standing, the patient must have the ability to ambulate (walk).
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Coverage of seat lift mechanisms is limited to those types which operate smoothly, can be controlled by the patient, and effectively assist a patient in standing up and sitting down without other assistance. Excluded from coverage is the type of lift which operates by spring release mechanism with a sudden, catapult-like motion and jolts the patient from a seated to a standing position. Coverage is limited to the seat lift mechanism, even if it is incorporated into a chair.
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You will need the following three documents:
- A doctor's prescription
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The bill of sale
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And a Certificate of Medical Necessity (CMN)
We will provide you with the bill of sale. You obtain the CMN form
by clicking here. You then take or mail the CMN to your specialist for their completion. Once completed by your doctor, mail the CMN, bill of sale, and the doctor's prescription to your Medicare regional claims office. If approved, you will receive a check back for reimbursement.
BATH LIFTS:
Most bathroom equipment is not covered under this type of insurance except the standard Commode! Medicare considers a bath lift as a non-covered item and will decline your claim in most cases. As silly as it sounds, they feel bath lifts are a "luxury item" and are not deemed a necessity. However, like all medical equipment, bath lifts can be reviewed on a case by case bases if requested. We have found that claims for items such as bath lifts, stair lifts, lift chairs and vertical platform lifts can be submitted and will initially be denied but can be resubmitted with additional documentation that will help in the appeal process. An item that is denied as non-covered is different than an item that is denied as not medically necessary.
If your claim for a certain Durable Medical Equipment item is denied, that could mean that the item does not meet the coverage criteria in a medical policy or that there is not enough information to prove why you need the item. You can always appeal a medical necessity denial. You cannot appeal a non-covered item. Non-covered items could include hearing aids, syringes, exercise equipment, wigs, etc.
Medicare does pay for many kinds of Durable Medical Equipment (DME), Prosthetics, Orthotics, and Supplies. These items help you move around in your home or help you when you are sick or injured.
Sometimes your doctor may prescribe or you may want an item that Medicare will not pay for. This is called a non-covered service. See the following list of non-covered services:
- Insulin
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Syringes
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Wigs (cranial prosthesis)
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Stair lifts
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Grabbers
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Ramps
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Adult diapers (i.e. Depends)
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Hearing aids
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Surgical stockings or hose
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Special TV for close caption
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Computer keyboards for communicating
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Air conditioners
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Whirlpool tubs
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Most prescription drugs
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Home modifications
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Bath aids
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Wheelchair lifts
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Exercise equipment
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Reading machines
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White cane for the blind
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Light therapy
Medicare will never pay for these items. If you want one, or your doctor prescribes one, you or your other insurance will have to pick up the cost. Even with a prescription from your doctor, Medicare cannot pay for non-covered items.
If you are unsure if an item is covered by Medicare, call 1-800-270-2313 to find out. Medicare can only let you know if a general service or item is covered. No items or services can be approved over the phone.
Remember: A non-covered service is different than a denied claim. If you claim for a piece of DME is denied, that means your doctor has not given Medicare enough proof of why you need the DME. You can always appeal a denied claim. You cannot appeal a non-covered service.
All Other Items:
Pleas refer to Medicare regarding reimbursements, if any,
provided for the product you are interested in purchasing. For the
most specific instructions for you and your state, please refer to
the Medicare Home Coverage section of www.medicare.gov.
We can help you filing your Medicare paperwork, but we cannot
guarantee a reimbursement. We will give you all the help we can, to
ensure you have the best chance of getting your reimbursement.
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