Gave me papers to submit to Medicare, told me to get dr's signature to qualify for partial reimbursement for a medical lift chair. Medicare rejected.
Purchased 2/28/14; Style UC5432M medical lift chair; $939.99.
The owners gave me papers to submit to Medicare for partial reimbursement. They told me to get dr's signature and then submit. I did that. Medicare rejected claim because The Comfortable Chair store does not have a Medicare ID #, and so sales from them do not qualify for reimbursement from Medicare. They misled me so they could make a sale
Want them to get a Medicare ID so I can be reimbursed. Or, tell me how to go about getting reimbursement. I can't be the first person who has had this problem.
We have never represented our business as being a Medicare provider or intentionally misled any customer with respect to the Medicare reimbursement process in order to make a sale, as is alleged by this customer. As the public record will verify, this is our very first customer issue with the BBB in the 22 years we have been in business. My wife and I would have been happy to work with this customer--or his wife, who made the actual purchase--had we been contacted prior to the filing of a grievance with the BBB.
When customers inquire about Medicare reimbursement on our lift chairs (which we have sold for approximately 10 years), we routinely suggest that they contact Medicare directly since we are a furniture store and as such, do not accept Medicare assignment. When asked by customers for our understanding of the process, we have said that we believe a person seeking partial reimbursement for the purchase of a lift chair can file their own claim by submitting the following qualifying documentation to the regional Medicare administrator:
1. A doctor's prescription (which should be completed prior to purchase).
2. A Certificate of Medical Necessity, form #CMS-849 (this is an attestation of diagnosis and treatment that necessitates a lift mechanism by the attending physician that should be completed prior to purchase).
3. A receipt for the purchase of the lift chair.
4. A letter from the manufacturer stating the value of the lift mechanism.
5. A request for reimbursement from Medicare (form #CMS-1490S), noting that we are not a Medicare provider.
Upon receiving this notification today, we immediately contacted CGS in Nashville, which is the Medicare durable medical equipment administrator for the state of Georgia, at **************. We spoke with a representative, who confirmed that our understanding is correct and also that a furniture store does not have to be a designated Medicare provider for a qualified Medicare recipient to receive a partial reimbursement for a lift chair. (We will gladly provide the BBB with the representative's name and I.D. number upon request, but do not wish to post it on the Internet.)
Therefore, this customer may wish to contact the number stated above, or to write to ******************************************* or to visit http://www.cgsmedicare.com*********************** to find out why his claim was denied and to find out if it can be resubmitted. Perhaps there is another simple reason for the denial, such as the documentation was incomplete or that the physician's attestations did not qualify him for reimbursement under current Medicare guidelines.
My wife and I are available to speak with the customer or with a BBB representative during our regular business hours, which are 10am-6pm Tuesday through Saturday, and noon-6pm on Sunday.
I am writing on behalf of my father-in-law, **** ******, regarding the above mentioned complaint. I cannot access the online complaint system referred to in your correspondence of May, 16, 2014. I get a 404 error code on the online system, and it will not allow me to proceed any further. Because today is the deadline for us to respond to your letter, I am writing this email to all of you.
The case concerns whether or not Medicare will give partial reimbursement to my father-in-law for a lift chair he purchased from The Comfortable Chair Store. He felt he was mislead in that they told him that he would be able eligible for partial reimbursement, if he provided 5 pieces of information to Medicare. While the store owners were very helpful in providing him with all the forms and address he would need to file a claim, they did indicated that they would not file the paperwork for him.
My father-in-law provided all the necessary documentation to Medicare (Dr's letter/prescription, certificate of medical necessity, receipt of purchase for the lift chair, letter from the manufacturer stating the value of the chair, request for reimbursement form).
He received a rejection from Medicare on the grounds that the supplier (Comfortable Chair) did not have a Medicare supplier ID number.
To be clear, as was suggested in their complaint rebuttal on 5/14/14, Medicare did not indicate that:
"documentation was incomplete" or that the physician's attestation did not qualify him for reimbursement".
Upon receipt of the rejection, my mother-in-law,****** ******, called the store and spoke with Mr. Daniels, the owner, and asked him for the Medicare ID number. He indicated that they didn't have one, and offered no insight on how to proceed further. ****** felt betrayed.
We are in a situation now, where Comfortable Chair says their contact at ***** Government Services (CGS), says that the furniture store does not have to be a designated Medicare provider for a qualified Medicare recipient (of which **** ****** has been for 30+ years). Their contact at CGS will not speak to **** or******, as they only speak to suppliers. ****** spoke with 3 contacts at the designated CGS number for patients, and all 3 contacts say that this purchase does not qualify because the provider is not a designated provider. Had **** and****** known, they would have purchased the chair from a "designated, qualified provider" instead of The Comfortable Chair Store.
We believe Comfortable Chair, when they say that they have sold many chairs to clients on Medicare and that the clients may not have encountered problems with reimbursement from Medicare. We believe them when they say this is their first complaint ever.
The bottom line -- **** did not get reimbursement as he was told he would, despite the fact he did everything he was supposed to do. When brought to the attention of the The Comfortable Chair Store, he/she did not get the assistance he would have expected under the circumstances, and he/she did not know what else to do.
I have spoken with the owners of the store. I suggested we get everyone together on the same calls to their CGS contact as well as ****'s CGS contact to try to break the code on this claim. I plan to file a Denied Claim Appeal with Medicare on ****'s behalf, following the Medicare guidelines.
This is where we are at. I will continue to be involved until **** receives the reimbursement we feel is due him.
Thank you for your attention on this matter.
**** and******'s daughter-in-law
Final Business Response
We would like to point out that this is our very first complaint with the BBB, as is documented by the public record, and that if, as has been suggested, we were not completely aboveboard in our business practices with seniors, who make up a large part of our 22-year-old business, this would simply not be the case.
As we have previously stated, at no time did we, as furniture store owners, tell Mr ****** or his wife that he would definitely receive partial reimbursement from Medicare for the purchase of a lift chair. For the sole purpose of trying to be helpful to our customers, when asked, we did tell them on their first visit to the store what we understood about the filing and eligibility process, but we did not predict the outcome of Mr ******'s Medicare claim since we do not have, and have never claimed to have, an affiliation with Medicare that would qualify us to do so. Since Mr ****** did not purchase his lift chair on his first visit to our store, he or a family member could have contacted Medicare directly for more information, as we suggest, prior to his purchase.
In another effort to be helpful, we located and forwarded the URL for claims and appeals on the Medicare website, and were glad to read that an appeal is being filed by the family and hope it is successful in obtaining the partial reimbursement, if eligible, or the reason for a denial. If another denial is received that specifically indicates that the ONLY reason is because our business is not enrolled with Medicare, please contact us immediately and provide us with that information in its original form and we will, as you have suggested, call CGS, the Medicare administrator for Georgia, from our store and get a representative on the line for Mr ****** to speak with when both my wife and I are present to help get this issue resolved as quickly as possible.
Please understand that as a retail furniture store, neither my wife nor I have ever assisted anyone outside of our own family with a medical claim. Unfortunately, we do not, as was suggested, have a specific contact with CGS; we have simply spoken to any representative available and in fact, just recently re-confirmed the accuracy of our understanding of the filing process with two separate GCS representatives. As a furniture store, our role does not normally include communicating with Medicare or CGS or any other insurance entity.
The Medicare.gov website provides instructions for filing The Patient's Request for Reim