- Covered by Part B only
- Pays 80% of allowed rate
- Co-Insurance covers 20% if applicable
- Medi-Medi has 100% ccoverage
Patients who have Medicare part B benefits have DME coverage. This coverage includes most medical equipment and supplies when medically necessary.
Medicare determines the fee allowable amount they will pay for each item. Of that amount they will pay 80% (called the primary claim) . The balance (20%) transfers to the patients co-insurance (called the secondary claim). If the patient does not have a co-insurer, they become responsible for payment.
Medicare has an annual deductable of $100. This amount is generally covered by the patient’s co-insurance.
Patients who have Medicare and Medi-cal (Medi-Medi) have 100% coverage for DME.
Diamond submits claims to Medicare electronically on a daily basis. Once paid, the balance is automatically forwarded to the patient’s secondary insurer. In this case the patient does nothing.
If Medicare does not have the patients secondary insurance company on file the secondary claim is not forwarded automatically. When this happens Diamond will manually bill the patient’s co-insurer.
If we do not have the co-insurance company on file, the patient will receive a bill from us. If this happens and there is a co-insurer, simply call us with the details. We can manually process the claim and the patient can disregard the billing.