American Tubs walk-in tubs are specifically designed for your safety. This is especially important for those with mobility issues who want to protect themselves from falls in the bathroom.
Will Medicare pay for a walk in tub?
With this being said, walk-in tubs are not yet approved as Durable Medical Equipment (DME) under Medicare Part B. This means that Medicare will not help pay for the cost of the tub or its installation.
If the tub is regarded as an absolute necessity with a written prescription, there might be an option for some kind of reimbursement. However, this is not until after you’ve already purchased the walk-in tub and had it installed in your home.
The prescription from your doctor is very important. Without it, you won’t have the chance to get approved for Medicare reimbursement. You should also check your finances to ensure that you can afford the purchase. While you may get reimbursement, there’s still a chance that you won’t, so it’s important to be prepared to absorb the financial burden yourself.
There are two reasons that walk-in tubs are not officially recognized DME’s:
- They can be viewed as conveniences rather than medical necessities.
- They could be used by others, besides the person with the special needs.
Although it’s not currently possible to qualify for funding in advance of purchasing your walk-in tub, you may be successful in a claim that you file after your purchase.
Walk-in bathtub buyers who have successfully received Medicare reimbursement have established a convincing claim presentation about their unique situation, mobility issues, and the medical necessity of a walk-in tub for their particular circumstances.
Any walk-in tub buyer can file a claim as long as they are enrolled in Medicare Part B (Medical Insurance). Because these tubs are not officially DMEs, the claim must be filed by you rather than by the supplier. The process is not difficult, but like most government programs, you must follow the correct procedure.
Medicare Claim Process
While a walk-in tub is not typically covered by Medicare, you may be able to get some type of reimbursement after you’ve purchased the tub and had it installed in your home. In order to get any reimbursement, you will have to file a claim with Medicare and have a written prescription from your doctor.
The claim process has proven successful for many, although not all seniors or those with mobility issues. You’ll need to prove why your unique situation qualifies for reimbursement, and even then there is no guarantee. However, we do recommend filling a claim as it can help your financial situation following the purchase of the tub.
The following suggested process will help you create a strong presentation for your Medicare claim.
- Walk-in tubs are the safest access residential tubs
- Best Cost/Value available anywhere
- Brim full of benefits to give you a lifetime of blissful bathing
- Eliminates the cause of most bathtub falls
- A prescription is mandatory for your Medicare Claim
- This is your Doctor’s letter of support
- It supports the medical necessity of the walk-in tub
- It might describe your medical condition, how it benefits your living situation, benefits of the tub, how it treats your conditions, or whatever your Doctor chooses to write
- Order, receive and install your tub
- Retain all paperwork
- Make a copy of the invoice and your proof of payment. Note that Medicare may cover the cost of the tub but they will not pay for any retrofitting required to accommodate your tub
- You must be enrolled in Medicare Part B (Medical Insurance) to file any claim
- Download Form CMS-1490S and Instructions (Document included in the booklet)
- If other questions, visit the Medicare website at www.medicare.gov
Download the product specification sheet (PDF) associated with the tub model you purchased. Choose from the following:
This is a summary of your tub model to give the Medicare Claims Examiner, including pictures, descriptions, benefits and details about the tub you purchased. Print a copy for inclusion in your claim.
Because walk-in tubs are not yet officially designated DMEs, the company cannot file the claim for you…you must file it yourself.
That being the case, Medicare will return your claim unless you include the following statement:
“The supplier did not refuse to file a claim for a Medicare-covered item or refused to enroll in Medicare. Because this claim is for a walk-in tub not currently listed as ‘Durable Medical Equipment’ and therefore the supplier cannot file the claim, I am filing the claim.”
Attach a copy of the Claim Filing Statement to your claim.
- Form CMS-1490S completed
- Doctor’s Prescription…original attached to back of Form CMS-1490S
- Doctor’s Letter of Recommendation
- American Tubs ® Model Specification Sheet
- Tub Invoice and Proof of Payment
- Claim Filing Statement
- Anything else you feel might help support your claim
- Make a copy of everything
- Retain in your files
- Staple your Claim together so nothing gets lost
- Enclose everything in a 9” X 12” envelope, keeping everything flat
- Put your Return Address on the envelope
- Address envelope to the correct Medicare address for your state
- Address Table included in this booklet
- Attach sufficient postage and mail
Medicare Response to Claims
Medicare responds to all claims. These claims are submitted directly to Medicare by your providers, and it can take about 30 days or more for Medicare to process these claims. You can check the status of your Medicare Part B (Medical Insurance) claims by visiting MyMedicare.gov and logging into your account. You will be able to see a claim within 24 hours of Medicare processing it.
It’s important to remember that there is no guarantee for the reimbursement from Medicare. Gathering all of the necessary information and documents doesn’t mean that Medicare will pay for all or even part of the walk-in tub.
Medicare will respond to your claim as either…
Know that you made a good try for reimbursement
- Enjoy a lifetime of bathing bliss in your new American Tubs® Walk in Tub
- Now you can file a Claim with your Medigap (Medicare Supplement Insurance)
- Contact your Supplement Insurance Agent immediately to find out their next steps
- They will need copies of what Medicare sent you and may handle the Claim filing for you
- Enjoy a lifetime of bathing bliss in your new Walk in Tub
It would be helpful if you shared your Medicare response with us whether it was denied or approved. We will keep your identity private, but we could use the information to improve the suggested process for others to benefit. Also, your responses could further assist in getting these tubs officially approved by Medicare as Durable Medical Equipment…much to the benefit of many more people. Please email your Medicare response information to: [email protected]
How to Fill out the
Medicare Form (CMS-1490S)
Medicare will pay you directly when you complete this form and attach an itemized bill from your doctor or supplier. Your bill does not have to be paid before you submit this claim for payment, but you MUST attach an itemized bill in order for Medicare to process this claim. It can take 30 days or more for Medicare to process your claim, and you may not get the answer you’re hoping for. However, by providing this document, you’ll be one step closer to possible Medicare reimbursement for your walk-in tub.
Mail your completed claim form to the Medicare Carrier responsible for processing your claim. If you do not know the address of your carrier, call 1-800-MEDICARE (1-800-633-4227).
FOLLOW THESE INSTRUCTIONS CAREFULLY:
Block 1. Print your name shown on your Medicare Card (Last Name, First Name, Middle Name)
Block 2. Print your Health Insurance Claim Number including the letter at the end exactly as it is shown on your Medicare card.
Check the appropriate box for the patient’s sex.
Block 3. Furnish your mailing address and include your telephone number in Block 3b.
Use the following address table to ensure the correct address will be provided on the claim.
|If you live in:||Return your form to:|
|Connecticut, Delaware, District of Columbia, Maine, Maryland,Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania,Rhode Island, Vermont||NHIC, Corp.P.O. Box 9165 Hingham, MA 02043-9165|
|Illinois, Indiana, Kentucky, Michigan,Minnesota, Ohio, Wisconsin||National Government Services, Inc. DMEPOS Operations Medicare DMEPOS Claims P.O. Box 7027 Indianapolis, IN 46207-7027|
|Alabama, Arkansas, Colorado, Florida,Georgia, Louisiana, Mississippi, New Mexico, North Carolina, Oklahoma,Puerto Rico, South Carolina,Tennessee, Texas, U.S. Virgin Islands,Virginia, West Virginia||CIGNA Government Services P.O. Box 20010 Nashville, TN 37202-0010|
|Alaska, American Samoa, Arizona,California, Guam, Hawaii, Idaho, Iowa,Kansas, Missouri, Montana, Nebraska,Nevada, North Dakota, Northern Mariana Islands, Oregon, South Dakota, Utah, Washington, Wyoming||Noridian Administrative Services P.O. Box 6727 Fargo, ND 58108-6727|
Block 4. Describe the illness or injury for which you received treatment. Check the appropriate box in Blocks 4b and 4c.
Block 5a. Complete this Block if you are age 65 or older and enrolled in a health insurance plan where you are currently working.
Block 5b. Complete this Block if you are age 65 or older and enrolled in a health insurance plan where your spouse is currently working.
Block 5c. Complete this Block if you have any medical coverage other than Medicare. Be sure to provide the Policy or Medical Assistance Number. You may check the box provided if you do not wish payment information from this claim released to your other insurer.
Block 6. Be sure to sign your name. If you cannot write your name, make an (X) mark. Then have a witness sign his or her name and address in Block 6 too.
If you are completing this form for another Medicare patient you should write (By) and sign your name and address in Block 6. You also should show your relationship to the patient and briefly explain why the patient cannot sign.
Block 6b. Print the date you completed this form.
- Date of each service
- Place of each service
- Doctor’s Office Independent Laboratory Outpatient Hospital
- Nursing Home Patient’s Home Inpatient Hospital
- Description of each surgical or medical service or supply furnished.
- Charge for EACH service.
- Doctor’s or supplier’s name and address. Many times a bill will show the names of several doctors or suppliers. IT IS VERY IMPORTANT THE ONE WHO TREATED YOU BE IDENTIFIED. Simply circle his/her name on the bill.
- It is helpful if the diagnosis is also shown on the physician’s bill. If not, be sure you have completed Block 4 of this form.
- It is helpful if the diagnosis is also shown on the physician’s bill. If not, be sure you have completed Block 4 of this form.
- Mark out any services on the bill(s) you are attaching for which you have already filed a Medicare claim.
- If the patient is deceased, please contact your Social Security office for instructions on how to file a claim.
- Attach an Explanation of Medicare Benefits notice from the other insurer if you are also requesting Medicare payment.
COLLECTION AND USE OF MEDICARE INFORMATION
We are authorized by the Centers for Medicare & Medicaid Services to ask you for information needed in the administration of the Medicare program. Authority to collect information is in section 205(a), 1872 and 1875 of the Social Security Act, as amended.
The information we obtain to complete your Medicare claim is used to identify you and to determine your eligibility. It is also used to decide if the services and supplies you received are covered by Medicare and to ensure that proper payment is made.
The information may also be given to other providers of services, carriers, intermediaries, medical review boards, and other organizations as necessary to administer the Medicare program. For example, it may be necessary to disclose information to a hospital or doctor about the Medicare benefits you have used.
With one exception, which is discussed below, there are no penalties under Social Security law for refusing to supply information. However, failure to furnish information regarding the medical services rendered or the amount charged would prevent payment of the claim.
Failure to furnish any other information, such as name or claim number, would delay payment of the claim.
It is mandatory that you tell us if you are being treated for a work related injury so we can determine whether worker’s compensation will pay for the treatment. Section 1877(a)(3) of the Social Security Act provides criminal penalties for withholding this information.
According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0938-0008.
The time required to complete this information collection is estimated to average 16 minutes per response, including the time to review instructions, searching existing data resources, gather the data needed and complete and review the information collection. If you have any comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: CMS, Attn: PRA Reports Clearance Officer, 7500 Security Boulevard, Baltimore, Maryland 21244-1850.
Whether or not you are successful in your Medicare Claim, you can rest assured that your safety and quality of life will increase significantly by investing in a walk -in tub.
Call today for a free in-home consultation and get on the road to redefining your bathing experience.