Medicare

Spectrum Medical Inc. will file your primary claim to Medicare. After Medicare pays we will file a claim to your secondary or supplemental claims for payment of the balance. We will bill you the balance after all of your insurances have paid.

Claims may be submitted either assigned or non-assigned.  Assigned claims are paid directly to Spectrum Medical Inc.; non-assigned claims are paid directly to the patient.  It is the patient’s responsibility to reimburse Spectrum Medical Inc. in full. 

Medicare has utilization limits and medical necessity criteria for certain items and services. Utilization limits restrict how often and/or how many Medicare will pay for certain items and services. These limits are not always disclosed to Spectrum Medical Inc.  Medical necessity criteria determine which items and services may or may not be covered by Medicare.

Medicare does not pay for bath benches, raised toilet seats, hand-held showers, E-Z reachers, and/or sock aids. Only one ambulatory aid will be covered by Medicare. If a patient requires a walker and a wheelchair, one can be billed to Medicare and the second item will be patient pay.

Before these items or services are provided, Medicare patients will be asked to read and sign an Advance Beneficiary Notice (ABN) that explains Medicare payment restrictions. By signing the ABN, you assume financial responsibility in the event Medicare denies payment.