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Oct 22, 2022

Medicare denying coverage for both extender strips and barrier rings? Need advice!

This topic is about a Medicare beneficiary who has encountered an issue with their supplier regarding the coverage of ostomy supplies. Specifically, they have been told that Medicare will no longer cover both barrier rings and extender strips in the same month, which has left them short on necessary supplies. They suspect the issue might be with the supplier rather than Medicare itself and are seeking advice on how to resolve this situation. Here are some helpful suggestions:

1. Verify coverage directly with Medicare:
- Contact Medicare to confirm whether the specific codes for barrier rings and extender strips can be billed together.
- If Medicare confirms coverage, ask for written confirmation or note the rule to present to your supplier.

2. Escalate or file a grievance with the supplier:
- Request to speak with a supervisor if you receive incorrect information or poor service.
- If the problem continues, consider filing a grievance with Medicare.

3. Consider switching suppliers if necessary:
- Some users recommend suppliers like Edgepark Medical Supplies, which reportedly provide both items monthly under Medicare.
- Look for a supplier that is knowledgeable and accommodating to your needs.

4. Involve your healthcare team:
- Ask your healthcare provider to write a new prescription that specifies both items.
- If you need more than the standard limit, request a Letter of Medical Necessity to ensure coverage.

5. Try different ordering strategies:
- Place separate orders if items are incorrectly flagged as having the same function.
- Adjust your reported usage frequency to ensure your prescription covers the maximum allowed.
- Order the maximum quantity allowed to build a reserve for future needs.

6. General tips:
- If a customer service representative seems uninformed, try calling back to speak with someone else.
- Keep past invoices as proof of previous coverage.
- Remember that Medicare rules are federal and do not vary by state, though supplier interpretations might differ.
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