My patient is currently under wound care with a Nurse provided by a Home Health Care Agency paid by Medicare. The nurse has indicated that once the patient is discharged the patient should continue to have Mepilex Border dressings to “prevent” the wounds from reoccurring. The PCP indicated he will provide a writ or prescription. How do I get it fulfilled and paid by Medicare. Is this considered DME?
And, you may have found someone in the same position. But as you see u received different answers. Some people receive the wrong information even from those who should know. Always go to the source which would be Medicare, Moms supplimental or Medicare Advantage.
What you need to do is get a script for the bandages. Take it to your pharmacy and ask if Medicare will cover them. If not, maybe take Mom to a wound care center. Maybe as long as she has someone caring for the wound, the bandages will be covered.
Your other choice is to call Medicare directly. Maybe a company will not bill Medicare but Medicare will allow you to put in a claim and be reimbursed.
Sorry if u feel we aren't helping. We are Caregivers and exCaregivers from all over the US. We can only point you in the right direction but we can't be expected to know everything concerning Medicare.
"Medicare will cover all surgical dressings that are deemed medically necessary for your treatment. You will only be responsible for the copayment amount for these dressings (each of which is set for the type of dressing). Dressings are covered under Medicare Part B, and so the standard deductible applies.Jan 14, 2014"
What Stacy was saying was Medicare only pays 80% of the cost. Also, if you have not used your deductible for the year, it will not be covered until the deductible is met. Like any prescription you can take it to a pharmacy. But don't expect them to have it in stock. May take it a day or two to get from supplier.
However, when she had her PICC line put in, that doctor wrote a script for supplies and I got a boxful of bandages, saline, gloves, something called "lab in a box", a sharps container; the whole nine yards. If the doctor is writing the script, why don't you call him/her to verify how you will be getting the supplies, whether you will have to pick them up or if they will be shipped? I am sure they can tell you exactly how to go about getting the supplies, if they are indeed going to be covered by Medicare.
A list of suppliers will come up that handle surgical dressing was the closest item I saw to select. You may be able to call one of the providers listed in your area to see if you can find your product. It’s a Medicare site
https://www.medicare.gov/medical-equipment-suppliers/
I saw that many hits came up just googling Mepilex Border Dressing. Amazon, wound care sites, etc.
I wouldn’t think Medicare would cover but some things you wouldn’t expect to be covered are. the other day my husband picked up his regular meds and his new doc had ordered baby aspirin. I thought how bizarre. His employer insurance covered it and it was like less than a dollar. It wouldn’t have occurred to me to ask for a prescription for aspirin.
Years ago my mom had a script for lidocaine patches from her rehab doctor. They were working great for her. Her insurance plan for drugs wouldn’t pay unless they were for shingles. She had a back fracture. $200 with prescription and no insurance coverage. It didn’t occur to me to check Part B Medicare which is what covers DME.
Aunt had to take Polyethylene Glycol 3350 daily. Less than $2.00 for a huge bottle with part d insurance. Then they stopped covering it. She had to pay much more for Miralax. Now she is on hospice. They provide the glycol and it’s covered by hospice.
Let us know if you get it covered. Might help someone else.
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So how it works here, the wound clinic is part of the hospital and the hospital also has a visiting nurse assn. The dr. gives the script to those nurses, they take care of everything because sometimes drs. overlook things. Then it is delivered to the house or you go pick it up.