How to bill a patient's medical insurance for a custom made oral appliance for sleep apnea that was never delivered to the patient after being madeYou know what we’re talking about. That custom made oral appliance that has been sitting on your shelf for months, and your patient refuses to show up for delivery. Now you have a lab bill from the manufacturer, and no delivery appointment to bill to medical insurance.
Good news! Many carriers (including Medicare) will reimburse you for undelivered DME. A narrative explaining the situation will always be required for this. From the Medicare supplier manual, the process is explained as:
1) Submit a claim with the FULL billing amount you usually bill.
a. Date of Service should be Date of Refusal or Date of Death
2) Include in the narrative section a brief explanation of the situation. Mention that the item ‘has no salvage value and is a complete loss’.
3) After receipt of claim, they may ask for more information such as a receipt of the purchase of the item, explanation of your other related costs such as staff time, your own time, etc. It is their discretion depending on many factors such as how often you have claims such as this, the total amount involved, and other DME history of patient and provider.
4) Based on all this, the carrier will pay whatever they feel is appropriate, even up to the full amount billed or… .nothing at all!
5) This decision can be appealed up to the various levels following usual procedures