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What Documentation Does Medicare Need So That My Prosthetic Is Covered?

If you recently began coverage with Medicare, you may believe that all the problems you had with private health insurance companies will go away since you have Medicare.

However, that’s not true. Medicare has had issues with prosthetic claims, and will most likely closely scrutinize what is submitted before payment, which can leave amputees wondering whether their prosthetic will be covered or not.

Medicare has concluded that a doctor’s medical records, not the records of the prosthetist, are the key records in determining if a patient can receive a lower-limb prosthetic. Therefore, if the doctor fails to appropriately indicate in your medical records that you have a need for a prosthetic, the prosthetist may not be paid.

Many prosthetists, therefore, are concerned about making prosthetics for Medicare beneficiaries, for fear the doctor will not have adequately documented the need for the prosthetic, which could result in non-payment. Some prosthetists may demand to see the doctor’s records before delivering the prosthetic.

As an amputee, if you are on Medicare it’s important that you be proactive. Inform your doctor about the documentation Medicare needs in order to pay for your prosthetic.

The Amputee Coalition has a letter which can be downloaded here which outlines specifically what Medicare wants to see in your records in order to pay for the prosthetic.

If you are having legal issues with the non-payment of your medical bills by a California insurance company or Medicare, call me, Conal Doyle, Amputation Lawyer at 310-385-0567.

Besides being an attorney, I am also an amputee, and I enjoy helping other amputees with their legal issues. Call me today to learn more about your rights.

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