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Old 03-05-2009, 04:06 PM   #21
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I just sent this to www.whitehouse.gov

Dear Mr President
I support your efforts at cutting out government waste. Did you know that Medicare routinely rents wheelchairs at $237/ month for 13 months, for a total of $3081, instead of buying them for under $200? Can you do something about this?
Thank you.

I'll let you know what I get back.
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Old 03-05-2009, 04:25 PM   #22
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Before I took over my Mother's finances she got a wheel chair (probably through Medicare) that was a POS. It is my observation that we could hardly give it away when it was evident that it couldn't meet her needs.

Hey, lets set up a "Goodwill" for medical equipment such as wheel chairs and motor chairs and incent insurers such as Medicare to use that resource. People with disabilities could repair and clean them up after they don't meet the needs of the former user.

If a patient wants only new then offer them the same amount as the "Goodwill" receives for used.

There are some patients with very special needs for whom this wouldn't be appropriate but that would be evident from the other medical services they are receiving.
Sorry, Brat but this wouldn't work. For one, it makes too much sense, Secondly, in Nevada, Florida, and North Carolina, you cannot even purchase a wheelchair (or a walker) without a doctors prescription. Care to try and figure out how those regulations came about and who benefits the most from them? It sure as heck isn't the poor b*st*rd in the wheelchair.
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Old 03-05-2009, 04:32 PM   #23
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Sorry, Brat but this wouldn't work. For one, it makes too much sense, Secondly, in Nevada, Florida, and North Carolina, you cannot even purchase a wheelchair (or a walker) without a doctors prescription. Care to try and figure out how those regulations came about and who benefits the most from them? It sure as heck isn't the poor b*st*rd in the wheelchair.
Indeed it is a business in itself guiding patients through the paper work. See below. Bolding is mine

Free Electric Wheelchair | Orbit Medical

We offer Free Insurance Filing, Free Delivery, and Free In-Home Setup for all Electric Wheelchairs!

As an authorized Medicare provider and insurance coverage specialist, we will process all of the necessary paperwork and will help you qualify for an electric wheelchair. Here is how the process works:
  • If you're interested in acquiring an electric wheelchair, contact us by phone or submit your information using the form on this page.
  • A mobility specialist will work for you to obtain the necessary paperwork.
  • Upon receiving authorization from your doctor and insurance, this same mobility specialist will help you choose the electric wheelchair that best fits your needs.
  • A trained technician will deliver your electric wheelchair to your home after insurance approval.
Pre-Qualifying for an Electric Wheelchair

All insurance plans have different guidelines to determine whether or not you'll qualify for an electric wheelchair. If you can answer any of the below questions with "Yes," you could be a good candidate to get an electric wheelchair:
  • Difficulty with mobility around your own home?
  • Can't complete your daily activities?
  • Mostly chair or bed bound?
  • Use a manual wheelchair, a cane, or a walker?
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Old 03-05-2009, 04:34 PM   #24
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And on the other end of the spectrum, while we are pi$$ing away billions on Medicare fraud, here is what a couple of enterprising folks at resourcesforhumanity.com came up with for people in countries where they can't afford $237 for a "stealchair".
Attached Images
File Type: jpg chair_new.jpg (40.7 KB, 79 views)
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Old 03-05-2009, 07:17 PM   #25
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Quote:
Originally Posted by Brat View Post
Before I took over my Mother's finances she got a wheel chair (probably through Medicare) that was a POS. It is my observation that we could hardly give it away when it was evident that it couldn't meet her needs.

Hey, lets set up a "Goodwill" for medical equipment such as wheel chairs and motor chairs and incent insurers such as Medicare to use that resource. People with disabilities could repair and clean them up after they don't meet the needs of the former user.

If a patient wants only new then offer them the same amount as the "Goodwill" receives for used.

There are some patients with very special needs for whom this wouldn't be appropriate but that would be evident from the other medical services they are receiving.
This is a good idea Brat. Along these same lines, my church has a special service group set up to collect medical equipment that is no longer needed. It is refurbished by volunteers and then lent (at no cost) to those who need it. Donors feel good because perfectly good equipment does not go to waste, and the borrowers are spared what is often a substantial financial expense. The service is one of our busiest ministries.
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Old 03-05-2009, 07:23 PM   #26
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There was an electric wheelchair in the house we bought (left behind with dumpsters worth of other stuff--that's another story). It was not a modern one, but worked and had all the accessories. Goodwill wouldn't accept it as a donation due to liability issues.

Liability laws (and their application) need reforming.
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Old 03-05-2009, 07:58 PM   #27
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Please note that fraud is not limited to Medicare fraud.

Anti-Fraud Resource Center
The National Health Care Anti-Fraud Association (NHCAA) estimates conservatively that 3% of all health care spending—or $68 billion—is lost to health care fraud. That’s more than the gross domestic product of 120 different countries, including Iceland, Ecuador, and Kenya.[1]
Other estimates by government and law enforcement agencies[2] place the loss due to health care fraud as high as 10 percent of our nation’s annual health care expenditure—or a staggering $226 billion—each year. And the cost of health care will only continue to rise[3], which means the price tag associated with health care fraud will rise too unless we can work together to combat it.



Here is an interesting fraud problem: medical identity theft:

But are you as familiar with the risks posed by medical identity theft? You should be, considering that 250,000 to 500,000 individuals have been victims of this escalating crime[4]. When a person’s name or other identifying information is used without that person’s knowledge or consent to obtain medical services or goods, or to submit false insurance claims for payment, that’s medical identity theft. Medical identity theft frequently results in erroneous information being added to a person’s medical record, or even the creation of an entirely fictitious medical record in the victim’s name.
Victims of medical identity theft may receive the wrong medical treatment, find that their health insurance benefits have been exhausted, and could become uninsurable for both life and health insurance coverage.



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Old 03-05-2009, 08:24 PM   #28
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Please note that fraud is not limited to Medicare fraud.
Well, I certainly don't expect any system to be free of fraud, cheats will try their hand wherever they see a chance. So if that is the requirement, we might as well just stop with any changes now. Although, I'm not sure that was your point?

My point is that a voucher system would seem to provide a motivation to reduce waste in the system. Consumers would be motivated to shop for the best deals. Suppliers would be motivated to attract customers with better services and prices. Or at least more so than today. I think it would be an improvement (if properly structured).

In a "the govt is going to pay for it" system - where is the motivation to reduce waste? Clearly, in these wheelchair stories, there is none. If you look at some of those ads, it's all "come to the trough and get yours - it's freee!!!"

-ERD50
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Old 03-05-2009, 09:18 PM   #29
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Just to be precise, I don't think there's anything fraudulent about the wheelchair renting situation in Medicare as it has been described. It is clearly wasteful and it might be an abuse of the system.

I am sure that waste is a much bigger problem in the Medicare system than is fraud. And, the best way to combat waste is to give the patient a vested interest in reducing costs (e.g through a cost-sharing co-pay system) and to assure the insuring entity (public or private) has a motive to reduce wasteful internal practices and external expenditures. With private insurers, this motive is the profit motive. With government insurers, the motivation to reduce costs is . .. I'll have to get back to you on that one.
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Old 03-06-2009, 06:06 AM   #30
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Just to be precise, I don't think there's anything fraudulent about the wheelchair renting situation in Medicare as it has been described. It is clearly wasteful and it might be an abuse of the system.
Exactly. That's why I called this a self-fraud case. Because if you or I billed Medicare thousands for services or equipment worth $250 at most we'd be charged with fraud. But they're happy doing it to themselves, which is why I accused the lady on the line of self-fraud.

Technically, this is a case of waste. But it's such an outrageus case, that I'm inclined to put it in the category of fraud. At the beginning, someone somewhere defrauded Medicare by allowing such a practice, and it's been perpetuated ever since.
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Old 03-06-2009, 10:37 AM   #31
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Medicare clerk you spoke to had no authority to change the regulations. She gave you the information you need to change them. I think the time is ripe to do that.
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Translation Please:
Old 03-06-2009, 10:56 AM   #32
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Translation Please:

Medicare FAQ | Medicare Wheelchair | Medicare Lift Chair | Medicare Hospital Bed | Medicare Walker | Medicare Rollator | File Medicare Claim

Quote:
Q What does capped rental mean?

A For the majority of products covered by Medicare, 80% of the rental is covered for 13 continuous months of use. Most secondary insurers pick up the remaining 20%. Products covered as capped rental of 13 months:
  • Hospital Beds.
  • Manual Wheelchairs.
  • Patient Lifts.
  • Some Support Surfaces such as Low-Air-Loss and Alternating Pressure mattress.
After Medicare has paid for 13 months of continuous use, the supplier may transfer the title to the beneficiary.
So does this mean that someone w/o supplementary insurance would be paying 20% of that $237 each month? 13 months times $237 * 20% = $616 (out-of-pocket) for a $90~$140 wheelchair?

TIA -ERD50
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Old 03-06-2009, 11:12 AM   #33
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Medicare FAQ | Medicare Wheelchair | Medicare Lift Chair | Medicare Hospital Bed | Medicare Walker | Medicare Rollator | File Medicare Claim

So does this mean that someone w/o supplementary insurance would be paying 20% of that $237 each month? 13 months times $237 * 20% = $616 (out-of-pocket) for a $90~$140 wheelchair?

TIA -ERD50
Good find. I went back to the medicare receipts and, sure enough, medicare "only" covered 80%. The other 20% was payed by Tricare. So Medicare pays $2464.80 and Tricare pays $616.12 for a $250 list price wheelchair.

If someone has no secondary carrier, they could pay the $616, or just buy the darned thing for maybe $90. Of course, if they buy it they give up the chance for that $10,000 motorized wheelchair in the future.
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Old 03-06-2009, 11:34 AM   #34
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If someone has no secondary carrier, they could pay the $616, or just buy the darned thing for maybe $90.
And most likely, the very people who do not have secondary insurance are the ones who need to control costs the most. Further, those same people are probably less likely to be doing comparison shopping on the internet and so forth. They probably just "trust" that the 20%/month payment is a good deal ("I'm only paying 20%, Good Old Uncle Sam is picking up the rest!").

So, how many needy people have paid $616 out of pocket for a $90-$140 wheelchair? What a shame. Yet, it is the Capitalists that are so often criticized for not having a heart. I don't get it. Who's the good guy here, and who's the bad guy

No wonder that sarcastic line "I'm from the Government, and I'm here to help you! ", has endured.

Yep, we need more of this kind of help

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Old 03-06-2009, 06:56 PM   #35
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No wonder that sarcastic line "I'm from the Government, and I'm here to help you! ", has endured.
I guess you couldn't find the smiley pointing a gun at you.
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Old 03-06-2009, 07:45 PM   #36
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I guess you couldn't find the smiley pointing a gun at you.
heh, heh, heh - that one will work too!

and here comes a man, with paper and a pen,

telling us our hard times are about to end.... The Band

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Old 03-06-2009, 07:59 PM   #37
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This would make an interesting case study-- I wonder how much Medicare pays, on average, to rent wheelchairs for patients who have no supplemental coverage compared to those people with the coverage. I'll bet that if Granny is writing a check for $47 every month, that it only takes a few months for her to spot the scam and put a stop to it.
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Old 03-07-2009, 01:48 AM   #38
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Hospitals routinely charge $7 for a single tylenol tablet (more than a bottle of 100 anywhere else), and private healthcare providers routinely pay it. The cost of administering the tablet is extra. Single payer isn't the problem.

I favor some sort of universal HSA type catastrophic health insurance for everyone in the US, where the first few thousand per year comes from the insured. That will keep this waste from getting out of control; people will just bring a bottle of tylenol from home and mail order their wheelchairs.
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Old 03-07-2009, 08:58 AM   #39
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Hospitals routinely charge $7 for a single tylenol tablet (more than a bottle of 100 anywhere else), and private healthcare providers routinely pay it. The cost of administering the tablet is extra. Single payer isn't the problem.
There is a flaw in your logic. Just because there is a problem with X, that does not mean Y is better or worse or the same. Gotta dig a little deeper.

But you raise a good point. Why is it that private ins cos seem to routinely pay what appear to be outrageous charges?

Dental is simpler for me to think about, it's generally more routine and more limited in scope and common. Offhand, none of the charges from my dentist seem too out of line. It takes skill and time to fit a crown and there are liabilities if you do something wrong; him and his staff needs to charge a fair price. And when DD went in for wisdom tooth extraction, the office offered the whole set of meds to me for $20 (pain killers, prednisone, antibiotics) - that was worth it to avoid a trip and waiting at the pharmacy, and I may have paid more there, I don't know.

Medical, tougher call. My other DD had some tests recently that were very expensive ($ thousands each for ~15 minute run on several different instruments), and the equipment looked like it probably earned it's cost back in 1992. Obviously, the specialist who interprets the data can earn good money for his skill, but those are separate charges. BTW, the tests confirmed no real problem just a suspicious symptom that needed to be checked, so that story ended well, just drained my pocket book a bit more than I think it should have.

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Old 03-07-2009, 11:25 AM   #40
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My Mother was in a nursing home for years. They forbid a resident consuming meds obtained from anyone but their institutional pharmacy, even over the counter ones. When she was dying she needed pain med on a Sunday which could be obtained at the pharmacy a few blocks away (which we could give her) but we were required to wait for the institutional pharmacy to deliver 6 hours later. They said it was state law.
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