dme.html

Durable Medical Equipment (DME)

Which Items are Durable Medical Equipment?	Which Items are Not Paid for by Medicare
I have a question, who can I call?	Which Items Require Prior Authorization?
Who are the local distributors?	Is there a local lending closet?

Medicare covers some home medical equipment. Claims for these items fall into categories such as Durable Medical Equipment, Prosthetics, Orthotics and Supplies. They are separated from Medicare Part B claims and processed through one of the four carriers known as the Durable Medical Equipment Regional Carrier. Our carrier is AdminaStar Federal, Inc. located in Indianapolis, Indiana.

In order for Medicare to pay for Durable Medical Equipment, it must:

Withstand repeated use,

Be used to serve a medical purpose,

Be appropriate for use in the home and

Be ordered by a physician.

A list of SOME (but not all) of the items covered:

Canes	Crutches	Walkers
Commode Chairs	Blood Glucose Monitors & Supplies	Wheelchairs
Hospital Bed	Oxygen Equipment	Ventilators
Aspirators	Suction Pumps	Prosthetics
Orthotics

A list of SOME (but not all) of the Durable Medical Equipment that is NOT COVERED by Medicare.

Exercise Equipment	Stair Lifts	Home Ramps
Vehicle Ramps	Surgical Stockings	Adult Diapers
Wigs	Bath Aids	Hearing Aids
Air Conditioners

If I have a question, who can I call?

If you are unsure if an item is covered by Medicare, you can call the Benefit Specialist at (920) 683-4180. You can call Medicare directly to find out if a specific item or service is covered, however, No items or services can be approved over the phone. (800) 270-2313

General Information:
    Medicare pays 80% of the Medicare allowed amount
    You are responsible for the 20% coinsurance amount.
    Ask your supplier if they accept Medicare assignment; it could save you money.
    If you get a denied claim: it means that your doctor has not given Medicare enough proof of why you need the equipment. You can always appeal a denied claim. Call the Benefit Specialist for help at (920) 683-4180
    If you receive a denial because the item was non-covered, you will have to pay for the item or service, you cannot appeal a non-covered service.

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Prior Authorization

If you are a Medicare Beneficiary enrolled in Medicare B, and your doctor has prescribed a Power Operated Vehicle, Seat Lift Mechanism, or Transcutaneous Electrical Nerve Stimulation (TENS) Unit, you may want to consider Durable Medical Equipment (DME) Prior Authorization.
Prior Authorization gives you the opportunity to find out if Medicare will approve your claim before you make a financial commitment to purchase the item.

How does prior authorization work?

You or your supplier must submit a written request for Prior Authorization to Medicare.

The written request must include a Certificate of Medical Necessity (CMN) signed by your Doctor (a form available from your supplier, a written prescription from your Doctor is not acceptable).

The request must be prior to delivery of the equipment.

You may request a Certificate of Medical Necessity directly from Medicare by calling: (800) 270-2313.
Durable Medical Equipment Local Providers

Aurora Home Medical Service...(920)793-8550
toll free.....(888)850-8020

Great Lakes Home Medical ...(920)683-9911
toll free ......(800)850-8020

Green Bay Home Medical Equipment...(920-465-3000)

Home Care Resources, LLC...(920-458-5791)

Manitowoc Pharmacy ...(920)683-5259

North End Drug Home Medical/HFMMC ...(920)686-2400

Wolfe Snyder Drug Home Medical/HFMMC...(920)793-2226

Durable Medical Equipment Lending Closets

The Two Rivers Fire Department has some durable medical equipment available through their lending closet. A minimum deposit is required.. Items that are routinely available include: shower chairs, walkers, commodes, wheel chairs, canes and crutches. Call for availability:

Two Rivers Fire Department Lending Closet...(920)793-5521

Aging Resource Center/Lions Club Lending Closet
Durable medical equipment available includes wheel chairs, shower chairs, walkers, commodes, canes and crutches. A minimum deposit is required.
Call for availability:

Aging Resource Center ......(920) 683-4180
or Toll free .... 877 416-7083

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