Medicare Enrollees Should Be Skeptical of Ads for Back and Knee Braces

DENVER, Colorado, March 4 -- The Colorado Department of Regulatory Agencies' Division of Insurance issued the following news release:

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- Medicare may not pay for them if ordered by phone.

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Recognizing this week as National Consumer Protection Week, the Colorado Senior Medical Patrol (Colorado SMP), housed within the Colorado Division of Insurance at the Department of Regulatory Agencies, is cautioning Medicare enrollees to be wary of advertising for back and knee braces.

Companies that sell the braces and other types of durable medical equipment (also called DME), are doing aggressive advertising in Colorado and across the country - on television, in newspapers, through direct mail, and even calling Medicare beneficiaries at home.

The advertising implies that Medicare will cover the cost of these braces, with no costs for the beneficiaries. The ads encourage people to call a number to start the process, often with "Medicare coverage specialists standing by."

"These ads are designed to get people on the phone," said Kimberly Latta, Director of Colorado SMP. "From there, they want someone's Medicare number, so they can bill for these braces or other equipment."

If the braces are sent in response to a telephone order, unless they are off-the-shelf products, they cannot be covered by Medicare. In those cases, the Medicare beneficiary could end up with the bill instead. Off-the-shelf braces and similar products may not be the best for a beneficiary's particular health needs. And these companies can be difficult to contact about returning equipment.

"Medicare is like other health insurance," added Latta. "It bases its coverage of DME on medical necessity as determined by a licensed healthcare provider, ideally through an in-person exam. Medical necessity is not easily established over the phone, especially in attempting to address particular needs. And necessity is certainly not established by the company selling the equipment."

In extreme cases, once companies get ahold of an enrollee's Medicare number, they may bill Medicare for other equipment without the enrollee's knowledge, equipment that may or may not even be delivered.

"This practice drains Medicare funding for items that are not medically necessary and that may not even get to consumers," said Colorado Insurance Commissioner Michael Conway. "When we're trying to squeeze as much value out of our healthcare dollars as we can, both here in Colorado and across the country, these practices not only hurt individuals, but the entire healthcare system."

If you think you need medical equipment, talk to your doctor who can assess your condition properly, write you a prescription and refer you to a reputable DME company that bills Medicare legitimately.

Everyone, including Medicare enrollees, should beware of any medical product or service that is mass marketed and claiming that Medicare or other insurance will automatically pay for it. Because some of these companies are calling Medicare enrollees in their homes, the Colorado SMP reminds people to be extremely cautious in giving out personal information over the phone, especially Medicare numbers.

To report suspected Medicare fraud or abuse, or something that just doesn't seem right, call the Colorado Senior Medical Patrol at 800-503-5190.