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Funding Your EasyPivot Patient Lift
Contact us to learn more about funding the purchase of
your EasyPivot.
We can provide you with information about such issues as the following:
 | Private Insurance - If you are insured by a
private insurance company, you should contact them prior to purchasing your EasyPivot.
Many private insurers have contracts with specific Durable Medical Equipment
suppliers. These are called "preferred providers". Many policies,
especially PPO policies and HMOs, require that your purchase through their preferred
provider in order to receive the stipulated reimbursement. In other words, if your
policy is an 80/20 policy, you might receive 80% of the insurers allowable from your
insurance if you purchase through your preferred provider. If you purchase "out
of network" (through a non-contracted provider) you might receive less... for example
only 60%.
A key word above is allowable. Many insurers have now
adopted what they consider the customary and ordinary for a patient lift in your
area. That usually means "what they will pay for a sling lift".
Slings are generally less expensive than the EasyPivot.
Be certain to ask your insurer: "What is the allowable for patient
lifts? Must I buy from a preferred provider? Who is the preferred provider in our
area?"
You are not required to purchase from the preferred provider, and
indeed, many don't. Also, if there is no preferred provider who has the EasyPivot
available in your area, many policies provide a clause which allows the insurer to name an
"out of network" provider, in that particular case.
Rand-Scot can help you with this process but we need your signed
statement that we have your permission to contact your insurer. Additionally, we'll
need your insurers name, address, phone contact, and your policy number and ID number. ( Release of Medical Information Form - Insurance Information Form )
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| Medicare Insurance - Medicare, through
congressional mandate, provides covered individuals with reimbursement to purchase the
lowest cost equipment to meet a particular need. In other words, Medicare has
published allowable limits as to what they will pay for a patient lift. These
allowable limits vary by state. Complicating this issue, is the fact that Medicare
classifies certain items as rentals and publishes a capped rental amount (the maximum
amount it will pay for a monthly rental).
In order to be approved by Medicare and receive an EasyPivot or
reimbursement for one, you must have Medicare A and B, have met your yearly deductible,
have a valid doctors prescription, and meet the guidelines for medical necessity.
The EasyPivot has been granted the HCPCS code E0630 (click
here to view the Medicare assignment letter). This is the
standard code for patient lifts and includes the standard hydraulic (Hoyer) lift.
This code is a rental code... If your doctor prescribes an EasyPivot, your
dealer can provide it in two ways.
1.) Assigned Sale: here your dealer agrees to accept Medicare's
allowable each month. The dealer will bill you the proscribed amount that Medicare
allows. This is 20% of the allowable for the first three months and 15% of the
allowable for the remaining ten months of the rental period. In the tenth month the
dealer will send you a letter asking if you wish to purchase the item. If you agree
to purchase it they will bill you for three more months after which, the product is yours
and maintenance is your responsibility. If you elect to continue renting the item,
they will bill you for five more months after which the item remains property of the
dealer and they agree to service it for four additional years. You pay no further
rent, accept you do pay a co-payment every six months for service from the dealer
(regardless of whether service is need or not).
2.) Unassigned Sale: here the dealer and you negotiate a price for the
EasyPivot of choice. You pay the dealer based on the agreed price. The dealer
then bills Medicare each month on your behalf. The prepaid amount is considered
prepayment of rent for the first ten months. You will receive (assuming Medicare
accepts the claim) the reimbursement of 80% of the allowable amount for the first three
months and 60% of the allowable for the next ten months. In the tenth month you make
the choice to purchase or to continue to rent the machine.
Of good news to Medicare recipients is the PATIENTS CHOICE or commonly
called Upgrade Amendment, recently passed by congress and published by Medicare (now
called CMM).
Remember that Medicare based it's allowable's on the lowest cost item
to meet a particular need. This essentially froze-out many innovative new (and more
expensive) items. In fact, previous to the PATIENTS CHOICE, it was illegal to
purchase certain options and "comfort items" through Medicare. Now, your
dealer can inform you as to what is paid and what isn't, and you can select to pay
additionally for those items not coded for payment by Medicare. It's a simple form
called the ABN (Advance Beneficiary Notice). Ask your dealer about this option.
Helpful Forms: Release of Medical Information Form - Insurance Information Form - ABN Form - Medicare Reimbursements Chart - Supplier
Standards - Medicare Assignment Letter -
Medicare Authorization Page
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| State Medicaid Insurance - To purchase any
Durable Medical Equipment through Medicaid, the Medicaid covered individual must first see
a state-approved Medicaid dealer. The dealer will submit a PAR (Prior Authorization
Request). Medicaid will not pay unless a device is pre-authorized. You must
have a prescription to start a PAR. Also, any letters of recommendation, even
photographs of you being lifted (to show the difficulty) can be submitted. If
approved, Medicaid pays the dealer. The dealer, in most states, cannot bill you
anything.
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| Workers' Compensation Insurance -
Almost universally, workers' compensation companies recognize the ability of the EasyPivot
to keep their future bills low. Therefore, work comp insurers routinely purchase
EasyPivot machines. You should review the statement on private insurers above.
Many work comp companies have preferred providers. If you have a case
manager, contact them early and get them working with you. The EasyPivot can save
tens of thousands of dollars and your case manager will recognize that. Make them an
ally. Of course, we can help with suggestions or by contacting your insurer on your
behalf. In order to do this, we will need your signed statement that we have your
permission to contact your insurer. Additionally, we'll need your insurers name,
address, phone contact, and your policy number and ID number. ( Release of Medical Information Form - Insurance Information Form)
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| Veterans Administration (VA) - The
VAMC (Veteran Administration Medical Center) has purchased many EasyPivot machines for
qualified veterans. They have granted contract number V797P-3497k, which is the
number of Rand-Scot's contract with the VA.
Typically, the prosthetics division at your VA handles purchases of equipment such as the
EasyPivot. If you need one, have your therapist contact prosthetics on your behalf.
Follow up, because they are busy people! We provide the VA a large discount
on EasyPivot machines, to try to make them more affordable to our nations veterans.
All of our various models are discounted. We provide the freight to you.
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| Vocational Rehabilitation (VR) -
This is an excellent source of funding for many. If you work with DVR, ask your VR
counselor what they think about the EasyPivot. Their job is to help you become an active
member of the work force. The EasyPivot can (hundreds have told us) be an important
part of that process. It helps you be on time to your job, with clothing straight
and proper. If you need justification letters, please contact us.
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| Other Funding Sources - Don't feel that there
is no help available if you don't qualify for any of the larger organizations above.
With 30,000+ EasyPivots sold, we've learned through our customers' resourcefulness
of many ways to get help. Some look to their church groups. Others contact
local service agencies such as Shriners, Rotary, Friends of Man, Masons, Elks, VFW, etc.
Don't forget the local chapters of MS, MDA, ALS, and other support groups... even
if they don't fund items, they may know who, in your area, does. We've even
had people buy EasyPivots via bake sale and other fundraising efforts. If you've
exhausted all available means, write us a letter as to your need. Maybe we can help. |
Need assistance in selecting, purchasing, fitting,
customizing, or using your EasyPivot Patient Lift or Travel Lifter?
Rand-Scot is here to help you let our products make a positive
impact in your life. Use our Contact Us forms
or telephone us at (800) 467-7967 (8:00 a.m. to 5:00 p.m. MST) to learn more.
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