Page 22 THE EVERETT ADVOCATE – WEDNESDAY, NOVEMBER 24, 2021 S y Senior Does Medicare Cover Mobility Sa e a Dear Savvy Senior, I have arthritis in my hips and knees and have a difficult time getting around anymore. What do I need to do to get a Medicare-covered electric-powered scooter or wheelchair? Need a Ride Dear Need, If you’re enrolled in original Medicare, getting an electric-powered mobility scooter or wheelchair that’s covered by Medicare starts with a visit to your doctor’s offi ce. If eligible, Medicare will pay 80 percent of the cost, after you’ve met your Part B deductible ($203 in 2021). You will be responsible for the remaining 20 percent unless you have supplemental insurance. Here’s a breakdown of how it works. Schedule an Appointment Your fi rst step is to call your doctor or primary care provider and schedule a Medicare required, face-to-face mobility evaluation to determine your need for a power scooter or wheelchair. For you to be eligible, you’ll need to meet all of the following conditions: Your health condition makes moving around your home very difficult, even with the help of a cane, crutch, walker or manual wheelchair. You have signifi cant problems performing activities of daily living like bathing, dressing, getting in or out of a bed or chair, or using the bathroom. You are able to safely operate, and get on and off the scooter or wheelchair, or have someone with you who is always available to help you safely use the device. If eligible, your doctor will determine what kind of mobility equipment you’ll need based on your condition, usability in your home, and ability to operate it. It’s also important to know that Medicare coverage is dependent on your needing a scooter or wheelchair in your home. If your claim is based on needing it outside your home, it will be denied as not medically necessary, because the wheelchair BY JIM MILLER Senio Mbili Scooters or Wheelchairs? M di nior C nir ior or scooter will be considered a leisure item. Where to Buy If your doctor determines you need a power scooter or wheelchair, he or she will fi ll out a written order or prescription. Once you receive it, you’ll need to take it to a Medicare approved supplier within 45 days. To fi nd Medicare approved suppliers in your area, visit Medicare.gov/ medical-equipment-suppliers or call 800-633-4227. There are, however, circumstances where you may need “prior authorization” for certain types of power wheelchairs. In this case, you’ll need permission from Medicare before you can get one. Financial Aid If you have a Medicare supplemental (Medigap) policy, it may pick up some, or all of the 20 percent cost of the scooter or wheelchair that’s not covered by Medicare. If, however, you don’t have supplemental insurance, and can’t aff ord the 20 percent, you may be able to get help through Medicare Savings Programs. Call your local Medicaid offi ce for eligibility information. Or, if you fi nd that you’re not eligible for a Medicare covered scooter or wheelchair, and you can’t aff ord to purchase one, renting can be a much cheaper short-term solution. Talk to a supplier about this option. For more information about power mobility devices call Medicare at 800-6334227 or visit Medicare.gov/ coverage/wheelchairs-scooters. Medicare Advantage If you happen to have a Medicare Advantage plan (like an HMO or PPO), you’ll need to call your plan to fi nd out the specific steps you need to take to get a power-wheelchair or scooter. Many Advantage plans have specifi c suppliers within the plan’s network they’ll require you to use. Send your senior questions to: Savvy Senior, P.O. Box 5443, Norman, OK 73070, or visit SavvySenior.org. Jim Miller is a contributor to the NBC Today show and author of “The Savvy Senior” book. providing services without physician authorization A s part of an ongoing effort in Massachusetts to address fraud, waste and abuse in the home health care industry, Attorney General Maura Healey announced a lawsuit against a home health care agency for allegedly falsely billing the state’s Medicaid program, MassHealth, for services that were not authorized by a physician and/ or not medically necessary. The lawsuit – fi led in Suff olk Superior Court against Prestige Health Care Services, Inc., its owner/CEO Isdory Lyamuya, and Chief Operating Offi cer Augustus Kormah – alleges that the defendants were aware that many Prestige patients lacked a physician authorization certifying that the services Prestige purported to provide were medically necessary, yet they continued to bill MassHealth for services anyway. “Home health care services assist low-income individuals with activities of daily living, and our offi ce AG Healey sues home health care agency for is committed to rooting out fraud within this industry,” said Healey. “We allege this agency repeatedly and knowingly billed MassHealth for unauthorized services and are seeking to hold them accountable to ensure our health care dollars are spent appropriately.” MassHealth pays for three kinds of home health care services for eligible members: nursing, home health aide and therapy (physical, occupational and speech/language). To bill MassHealth for any of these services, the member’s physician must review and sign a Plan of Care (POC) certifying that home health care services are medically necessary. According to the Attorney General’s complaint, Prestige began providing services to patients who did not require services, and it continued to service patients after they no longer required skilled nursing services. In some instances, physicians OBITUARIES AG HEALEY | SEE PAGE 24 Martin L. Gartland did not authorize the services listed in the POC, some returning the POC with notations like “services not needed.” If Prestige received such a rejection, the Attorney General alleges, Prestige often shredded the Of Everett, formerly of East Boston, November 15, 2021. Beloved son of the late Gertrude (Sulkey) and Joseph L. Gartland. Brother of Maureen Dell’Orfano and her late husband John, Mary Gartland, Michael Gartland and his wife Lisa, Lori Recupero, Kathleen Gartland, and the late Evelyn Martinelli, Barbara Ann, Joseph, Judith and William Gartland. Also survived by his aunt, Mary Canavan and three generations of nieces and nephews. Martin proudly served his country in both the U.S. Army and the U.S. Air Force.
23 Publizr Home