Medicare services are usually supplied first, billed afterwards. When the bill doesn’t get covered it bounces back to the patient who is then on the hook for full cost plus interest. That is what this veteran is trying to avoid. Every agency involved should be shamed & forced to do the right thing for him.
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I certainly agree with the last sentence. However, it doesn’t appear that Medicare had any involvement at any stage of the prosthetic supply, so I’m still puzzled by the question of how he got the legs in the first place. If they were ordered for him then whoever did the ordering should be the ones dealing with this, especially if it was the VA hospital or nursing home.
I can illustrate one situation I see a lot in the insurance industry - there is often only 1 billing code used for a piece of medical equipment, no matter the level of design or sophistication of the equipment. There are very expensive, digital prostheses with computer chips, as well as base models with no special features. Insurance is designed to pay, based on usual an customary charges in the patient’s region, that billing code reflecting the base model. It’s often not that insurance won’t pay for a patient’s prosthetic, it’s that there’s no medical reason to pay HUGE additional costs for the model with the bells and whistles. Insurance doesn’t want to NOT pay, they just need to pay based on their contracts its members have signed with them (for the medically necessary base model). However, if the patient’s doctor can show the bells and whistles are necessary for that patient, insurance will most likely approve them. EDIT: I also want to say the medical equiment providers ALWAYS push the most expensive models, sometimes sending them home with the patient before approval has been given.
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