Consumers are often so confused by the plethora of definitions, policies, generics, and often just plain old misinformation they are furnished that they give up and pay for covered services out of pocket. This seems to be common place with Medicare patients who are often inundated with paperwork and endless long "hold" periods on the phone.
Here is an example of how the frustration often pays off for the insurance company and explains why the process continues.
A tens unit, or interferential unit, is a pain relieving device that can be worn by any chronic pain patient for pain relief. The pain machines require the use of what are called tens electrodes or reusable electrodes in order for the pain machine to work properly. The process, with Medicare in particular, requires the patient to go not once, but twice to the physician to get the unit and also to get the approval to purchase the unit for the Medicare patient. This not only takes time but also more out of pocket costs so many patients choose to purchase the units over the internet. Technically the FDA requires the unit to be "dispensed only by the order of a licensed physician" in the U.S. however the FDA fails to enforce the rules.
The patient often decides it's easier and cheaper to buy on the internet, rather than deal with the cumbersome requirements of many insurance companies, Medicare being one. The patient purchases on the internet, rather than using their insurance to buy one for them even though it's a "covered service". What the patient is missing though is with tens especially, not as much so with interferential as one gets "carryover pain relief" with interferential, but the true cost is long term buying of the supplies. A tens unit may require 2 pair of electrodes per day in humid climates costing the patient as much as $32.00 per day just for electrodes.
The initial cost of the tens or interferential unit may be minimal but over the lifetime of the use of the unit the costs can be staggering. Save a oenny, spend a dollar is not best for the consumer in this specific.
Often overlooked is the need for rechargeable batteries, skin care products etc. for the continuing use of the tens unit. When the unit is purchased out of pocket then the costs for these products are borne by the patient for one simple reason - there is no record in the patient's health record of the purchase of the interferential or tens unit therefore the accessories are "non covered".
The patient over their lifetime may spend countless hundreds or thousands of dollars out of pocket for a service that was covered by the insurance the patient paid for or was paying for.
It's very important for all companies, insurance companies included, to advise and educate the customer on their rights under insurance policies. As the professionalism of the insurance industry and medical industries increases the patient will be better served and protected.
Bob Johnson is owner/founder of MedFaxx, Inc. and has been a continuous advocate for over 30 years for proper education and information for the paying public. Often MedFaxx will recommend if the patient has insurance to go through the processes in order to save money over the long term.