Speeding your way to a P.O.V.
Medicare reimburses 80 percent of the purchase price so long as the item is "medically necessary" and the price falls within their guidelines (your supplier or Medicare will be able to give you the exact amount). Medicare now allows you to see whether your purchase will be deemed medically necessary before you buy. While you can still submit a claim after buying, a prior authorization lets you know where you stand.
The forms are processed in four regional centers; check below to see which center serves your state. Suppliers in your area may have the forms that you will need to make your application. Be aware that you will need to deal with a Medicare-approved supplier who has a Medicare number.
What Medicare looks for You need to send Medicare a C.M.N. (Certificate of Medical Necessity) filled out by your doctor. If your purchase is a P.O.V., Medicare prefers that doctor to be a specialist in physical medicine or neurology. (An exception is made if your condition precludes a visit to a specialist or there is none within a one day's round-trip ride.) The doctor must certify that: you would be confined to a bed or chair without the use of a wheelchair; you are unable to operate a manual wheelchair; and you require the vehicle for movement inside the home. Medicare does not cover scooters for outside use only. You may want to make sure that your doctor is aware of these requirements before he or she fills out the forms.
Your vehicle must be delivered within 60 days from your notice of prior authorization (if not, you will have to reapply with an updated C.M.N.). After purchasing, you will still have to submit a claim for reimbursement. And, Medicare will still make sure that you have the appropriate coverage, that you are dealing with an approved supplier, and that you have not sent in a duplicate claim. Finally, because prior authorization only evaluates medical necessity, it is not, strictly speaking, a legal promise to pay.
Medicare regional centers Region A: 1-800-842-2052 for CT, RI, ME, NH, VT, NJ, DE, PA, NY, and MA
Region B: 1-800-270-2313 for IN, MN, DC, OH, WV, IL, WI, MD, MI, and VA
Region C: 1-800-213-5452 for AL, AR, CO, FL, GA, KY, LA, MS, NM, NC, OK, SC, TN, TX, Puerto Rico, and Virgin Islands
Region D: 1-800-899-7095 for MT, ID, WA, UT, MO, NE, KS, ND, SD, IA, WY, AK, OR, CA, NV, HI, AZ, Guam, Samoa, and the Marianas
Katherine Spurlock volunteered at the NMSS as a publications intern in 1994.
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|Title Annotation:||power operated vehicle|
|Date:||Jan 1, 1995|
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