This is an addendum to Anne Merewood's post on getting breastpump rentals
covered with an HMO involved. In Washington state we have also switched to
having most Medicaid patients signed up with various HMOs who have contracts
with the state to provide care at a capitated cost. i.e. they pay the HMO so
many dollars per enrollee to provide care.
In Washington state if the doctor orders a breastpump and gives a dx for
which coverage is acceptable under Medicaid then the DME provider must first
apply to the HMO for coverage, then if the HMO denies the claim, the DME
provider can forward it to Medicaid and get paid. To get Medicaid
reimbursement you have to apply for a Provider number and then follow all the
billing procedures. I don't think you have to be a big DME provider to do
it. It's just that the paper work is such a pain it's not very cost effective
if you don't have a billing department to do it for you. But if you are
subsidizing the breastpump rentals anyway it might be worth it.
I learned this lesson the hard way. I hope it helps someone else.
Cindy N.