FAQs

Fox Medical An Independent Company for Independent Living

Common Questions & Answers

Q. How do I qualify for Home Medical Equipment if I have Medicare?
A. You may qualify if your physician orders equipment or supplies with a prescription and you have Part B on your Medicare Card. For any item to be covered by Medicare, it must 1)be eligible for a defined Medicare benefit category, 2)be reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member, and 3)meet all other applicable Medicare statutory and regulatory requireemnts.

Q. Does Medicare, Medicaid or my Insurance company pay for all medical equipment and supplies?
A. No! There are strict guidelines concerning the qualification of equipment.

Q. Do I have to have a prescription to purchase equipment or supplies?
A. No! A prescription is always required for oxygen but not equipment or supplies unless Medicare, Medicaid or an insurance company will pay. They will require a prescription. Oxygen is controlled by the Federal Food and Drug Administration and is considered a drug.

Q. How do I select a Quality Home Medical Equipment (HME) Company?
A. You should visit the Home Medical Equipment Company, if possible, and talk to the Customer Service Representatives about the services they offer. The company should have a showroom that will allow you to examine equipment and determine if it is appropriate for your medical needs. You should inquire if the company is accredited by a nationally recognized company or has a state license. Fox Medical has been accredited for over ten years.

Q. How much will I have to pay for my equipment or supplies?
A. You may have to pay only your yearly deductible and co-insurance if you have Medicare or health care insurance. Health care coverage can be very complex and you should consult with a billing specialist concerning your coverage to fully understand your requirements. Medicare and insurance companies usually require patients to share in their medical expenses. Medicare has a yearly deductible of one hundred dollars and you determine what your deductible will be when you obtain your .insurance policy. Medicare pays eighty percent (80%) of allowed charges and requires that you pay the other twenty percent (20%). You may have a policy that covers the deductible from Medicare and the twenty percent (20%).

All insurance policies are different and each must be read and understood.

Q. What is an allowable charge?
A. Medicare and insurance companies have designated what they will pay for certain equipment and supplies. This is their allowed charge and they will not pay more than the allowed charge.

Q. Why does my "allowed charge" on my Explanation of Medical Benefits change?
A. Medicare has an allowed charge for rental equipment that decreases by twenty-five percent (25%) in the fourth month.

Q. I have limited income and may not be able to pay my co-payment. Will I have to forfeit my equipment?
A. Medicare and insurance companies require you to pay your share. This policy helps eliminate frivolous the renting and purchasing of equipment. You may request a "Waiver" from the HME company if you can not pay your share. This usually requires a brief financial statement. However, you will be expected to pay your yearly deductible.

Q. What does billing Medicare unassigned mean?
A. It becomes necessary to bill the patient a higher amount for equipment or supplies when Medicare fails to compensate a supplier sufficiently to cover cost, such as, ostomy supplies. The patient receives all the money from Medicare after the patient has paid the HME company the correct amount and the supplier has billed Medicare, unassigned,

Q. What is an ABN?
A. An "Advance Beneficiary Notice" is a document that explains that Medicare may not recognize or pay for a certain piece of equipment. The patient signs this document, after carefully reading and understanding, and keeps a copy for their record. The patient will have to pay the Home Medical Equipment supplier if Medicare does not agree to pay. This document should never be signed unless it is fully understood. You should always keep a copy signed by both parties.

Q. How long do I have to pay my co-insurance?
A. Medicare has policies that dictate when equipment is leased/rented or purchased. A letter will be sent after the tenth month requesting the patient to make a decision if they wish to continue to lease/rent or to purchase equipment. Medicare requires a total of thirteen (13) months for purchased equipment and fifteen (15) months for leased/rented equipment.

Q. Who will repair my equipment if I decide to purchase my equipment.
A. Medicare covers repairs on equipment and you will pay the twenty percent co-payment. However, the HME company is not required to repair your equipment.

Q. How do I prove that I own the equipment?
A. You will be issued a "Title" to your equipment when all payments have been made.

Q. What happens when I decide to keep leasing or renting my equipment?
A. The equipment will be on maintenance after fifteen (15) months and the supplier will be required to maintain the equipment until it is no longer needed or replaced. The HME company will receive a reimbursement equal to one month rent every six (6) months and you will be required to pay the twenty percent co-payment.

Q. Will Medicare purchase a whirlpool for my bath tub?
A. No! Medicare, and most insurance companies, will not purchase or rent equipment for bathrooms.

Q. Will Medicare purchase an air-conditioner for my apartment?
A. No. An air-conditioner is considered a convenience item

Q. May I call you if I have a question?
A. You may contact Fox Medical at their E-Mail address: customerservice@foxmed-equip.com

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