Global United Medical Supplies

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6818 Fort Hamilton Parkway

Brooklyn, NY 11219

718.375.1100 phone

718.745.6735 fax

EXPLANATION OF HOW MEDICARE, MEDICAID AND OTHER PRIVATE INSURANCE PAYMENTS ARE DETERMINED; COINSURANCE AND FINANCIAL HARDSHIP

Dear Patient,

Below please find a quick reference guide of how PAYMENTS ARE DETERMINED; COINSURANCE; FINANCIAL HARDSHIP.

For Medicare Patients only:

Under Medicare Part B, your deductible is $100 per year. The coinsurance amount is 20% of what Medicare determines was the allowable amount for the DME and orthotics services. For such services, Medicare will only pay 80% of what it determines was the allowable charge. The patient must pay the other 20% of the Medicare allowable amount. If DME Provider has agreed with Medicare to "accept assignment" on all Medicare charges, the provider receives the 80% payment directly from Medicare (CMS pays this via fiscal intermediaries – insurance companies). The co-insurance, the remaining 20% of the allowable charge – as allowed by Medicare – is the responsibility of the patient.

Therefore the beneficiary pays:

Medicare-approved amount for durable medical equipment. Exclusions applies to those patients who has Medicaid; other Supplemental Plans or experience certain financial hardship.

Additionally, In making your decision to rent or purchase the equipment, you should know that for purchased equipment, you are responsible for 20 percent of the service charge each time your equipment is actually serviced and, for unassigned claims, the balance between the Medicare allowed amount and the supplier’s charge. However, for equipment that is rented for 15 months, your responsibility for such service is limited to 20 percent coinsurance on a maintenance and servicing fee payable twice per year whether or not the equipment is actually serviced.

For Medicare and Medicaid Patients or Patients who has other Private Plans or Coinsurance:

For the recipients who have both Medicare and Medicaid or other Private Plans, 20% coinsurance is paid by Medicaid or other private insurance plan. The patient in this case has 100% coverage.

For Private Insurance Patients only:

For Private Patients Insurance contract specifies the amount of coinsurance. Depending on the percentage of the coverage, the rest is the responsibility of the patient.

For Patients who experience Financial Hardship:

There are a few programs that provide varying levels of help with Medicare coinsurance. The most helpful of these programs is the “Qualified Medicare Beneficiary” program (QMB), which pays for all Medicare premiums, deductibles, and coinsurances. To be eligible for QMB, countable income cannot exceed 100% of the Federal Poverty Income Limit. The other least generous programs include QI-2 and pay just small amount of Medicare’s premium.

Patients, who do not have any coinsurance or receive any of the programs listed above, the letter of financial hardship should be given to the provider explaining why 20% cannot be paid.

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