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Medicare Info Request

Sherman Oaks Medical Supplies will guide you through the entire process of obtaining a Power Wheelchair or Mobility Scooter through Medicare. Based on Medicare guidelines, we are responsible for delivery, setup, and training of equipment, therefore
  1. Form
  2. 1-2-3 Steps
  3. What is Covered by Medicare?
  4. How do I obtain Medicare coverage for medical equipment I need in home?
WE CANNOT PROVIDE SERVICE FOR MEDICARE BENEFICIARIES THAT LIVE OUTSIDE OF OUR AREA.

Form


Caregiver (if applicable)
  Your Name:        Relationship to Patient:     
  Phone:         
       

Patient (*Required)
  First Name:*        Address 1:     
  Last Name:*        Address 2:     
  Contact Phone:*        City:     
  Contact E-mail:*        State:     
      Zip:     
       

1) My primary insurance is:
   

2) I am interested in the following items(s):
   Power Wheelchair    Mobility Scooter
   Manual Wheelchair  

3) Has Medicare ever provided a similar item for this beneficiary?
   Yes No
    If the answer to the above question is yes, indicate which items(s):
      Power Wheelchair       Mobility Scooter
      Manual Wheelchair       Walker
      Cane  

4) The item requested is for use:
   

5) Do you have problems completing any of the following tasks inside your home?
   Dressing    Grooming
   Eating    Toileting

6) Are you able to propel yourself in a manual wheelchair?
   Yes No

7) What time is most convenient for you to receive a call?
   
Comments:

Please enter the following code into the box provided:



       

1-2-3 Steps

The Phone Call
The process begins with your call or e-mail to request information about Power Wheelchairs or Mobility Scooters. Our Mobility Specialists will answer every question you have and gather the necessary information (address, phone number, medical problems, etc.) to create your confidential file.
The Doctor's Visit
The next step is meeting with your doctor for your mobility evaluation. Medicare requires a doctor’s prescription for Power Wheelchairs coverage. (If you plan to use Medicare for payment, it is important to schedule your doctor’s appointment right away.) This doctor's visit must be specifically for your face-to-face mobility evaluation, not a general appointment. During the mobility evaluation, your doctor will ask you a series of questions to determine if a power mobility product is medically necessary. If your doctor prescribes a power mobility device, we work with your doctor to complete the Medicare paperwork. Print Medicare Coverage Criteria and take to your doctor.
The Paperwork
We work with Medicare to complete the paperwork process. We have over 10 years experience working with Medicare and can help you get the right equipment for you at little or no cost to you.
View Medicare Eligibility Guidelines here.

The Right Chair
We fit your Power Wheelchair to your body measurements for complete comfort. We guarantee your new Power Wheelchair will fit your body proportions and will work in your home.

Delivery and Training
We deliver our Power Wheelchairs and Mobility Scooters right to your home with no delivery fees. At delivery, we teach you how to operate your new Power Wheelchair throughout your home. Based on Medicare guidelines, we are responsible for delivery, setup, and training of equipment, therefore we cannot provide service for Medicare beneficiaries that live outside of our area.

Service
We have in home as well as in store service for your convenience. Most service issues can even be solved over the phone or in your home. If your Power Wheelchair requires more extensive repairs, a temporary loaner can be provided until your Power Wheelchair is repaired.

What is Covered by Medicare?

Medicare Part B helps pay for durable medical equipment, including;
  • Manual Wheelchairs (capped rental item)
  • Power Wheelchairs (reimbursable item)
  • some positioning devices
  • Walkers, Canes, Crutches
  • Mobility Scooters
  • Seat-Lift Mechanisms for Lift Chairs, Manual Patient Lifts 
  • Mattress Overlays
  • Hospital Beds, Semi-Electric only (capped rental item)
  • Oxygen Equipment
  • Orthotics (Splints)
Durable medical equipment such as Manual Wheelchairs are covered only when meeting the correct criteria, prescribed by a doctor and when provided by a supplier approved by Medicare. You can find out what equipment is covered, and whether a supplier is approved, by calling Medicare's durable medical equipment (DMERC) regional carrier for your area.

How do I obtain Medicare coverage for medical equipment I need in home?

Your physician must write a prescription. The physician must then complete and sign a Certificate of Medical Necessity (CMN), or a form that describes the nature of your condition, this is called a Written Confirmation of Verbal Order (WCVO). We forward the Certificate of Medical Necessity (CMN) or Written Confirmation of Verbal Order (WCVO) to the physician. The physician completes these forms and returns them to us for submission.
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