[Silverback]

I will have had the SCS for a year on the 12th of this month. During the one year warranty period, I have had to replace the Precision Programer (the remote) and the Charger. In both instances Boston Scientific has provided outstanding service.

My question involves the Extended Warranty service now being offered by Boston Scientific. My insurer is Medicare as primary and Tricare as secondary. Boston Scientific suggests I check with the insurers to see if replacement/repair of out of warranty Remote or Charger is covered under my insurance. The code is L8681, however that is about all I have been able to find out. Trying to wade through the Medicare publications is a bit over my head.

I can't see paying for an extended warranty if Medicare/Tricare pays for replacement out of warranty, however I also do not want to pay the $300 to $3000 to replace or repair a defective out of warranty device.

Has anyone had experience in this area, or could someone offer advice on how I might proceed? I have tried talking to the Doctor's insurance person with no results.

Thanks for any help.

[Spiney95]

I have no idea about the coverage on your device but I do know that Medicare does not pay for repair or replacement parts on my durable medical equipment ie rollator or wheelchair. I could buy (and did) a new rollator for less than replacing the worn wheels. Yeh I had to buy it, well my brother did, as Medicare would not pay for the model I needed in spite of a letter from my pain doc.......a physiatrist. They have a one size fits all approach relative to mobility devices. Best wishes.

[Mark56]

Since I experienced a catastrophic failure of my remote 14 months into the game, fortunately still while my workers comp case was pending, I did inquire into the extended warranty of Boston Sci. Bought it. Cost was de minimis compared to the cost of the remote itself.

Given the pendency of the work comp case I mentioned at the time, thankfully the work comp insurance carrier paid for the replacement remote in full. My new remote is still working well over a year into the game.

I hope and pray your experience will be well and that you will find the information you desire; however, I would just spring for the insurance on the unit were I you.
Caring,
Mark56

[Rrae]

Well it's sure good to see you again!

You bring up a very good question. Since these devices are medically necessary, as the initial approval of these devices would suggest, I would think that the insurance would pay for replacements.
I mean heck, when it comes time to change our battery, I would like to assume this would be covered.

I spose this is something that we ALL should investigate with our different vendors.
I wonder how LONG the extended warranty lasts, and how much does it cost?

I do know how frustrating it is to get in touch with Medicare. Have you tried contacting the customer service so that you'd be able to talk to a human being, rather than trying to wade thru all those publications?
Hopefully you could pin down a Medicare rep specifically regarding DME's. IF in fact the SCS is actually recognized as a durable medical equipment. I'm pretty sure they are, but don't want to give out incorrect info.

Mark, (or anybody) is in fact the SCS considered a DME?

Hoping you get answers SOON, Silver!

Rae

[Mark56]

Spinal Cord Stimulation (Dorsal Column Stimulation) - 4S-146AB-R8 (L26741)

LCD - Local Coverage Determination
Medicare Policies and Guildelines

LCD Determination ID: 4S-146AB
Original Determination Effective Date: 2008-03-01
Latest Revision Effective Date: 2012-10-29

I searched spinal cord stimulation is it durable medical equipment medicare, and came up with the code references which precede this writing. I figure the remote could be excluded as "durable" since it is a battery operated whatzit.....

This is why "yours truly" bought coverage for my remote.

Uh Huh,
Mark56

[Rrae]

Thanks for this. I can see why the handheld charger wouldn't be considered DME. Im not sure what those code numbers are, but are you able to tell if the SCS unit itself is a DME?

Thanks for searching on this!

Rae

[Mark56]

Look at it this way.
If the stim unit implanted within our bodies was not Durable Medical Equipment,
Medicare would never have authorized payment for even one
such
unit.

Kinda like they authorized and paid
because of my disability classification
for the cervical fusion I experienced
in August.

Others here have reported Medicare paid for SCS.
so
it seems to reason the primary system
is classified as part of the DME universe.

So, as Jean Luc Picard would say to Number One
"Engage"

I'll have one with self programming on top please.
I think the first control is thrown in as part of the package
since without its delivery
the DME would be just so much
JUNK.

Yup,
Mark56

[Silverback]

Thanks for the responses. The consensus seems to be to pay for the extended warranty. The main reason (for me) would be to avoid the obvious red tape that would likely ensue from any claim outside of the warranty period.

On two occasions Boston Scientific has sent replacements by overnight FedEx. The service and avoiding the Medicare/Tricare bureaucracy is probably worth the $195 cost of the extended warranty.

Silverback (committed lurker)

[Mark56]

Originally Posted by Silverback

Thanks for the responses. The consensus seems to be to pay for the extended warranty. The main reason (for me) would be to avoid the obvious red tape that would likely ensue from any claim outside of the warranty period.

On two occasions Boston Scientific has sent replacements by overnight FedEx. The service and avoiding the Medicare/Tricare bureaucracy is probably worth the $195 cost of the extended warranty.

Silverback (committed lurker)

Such was the nature of my conclusion. Better to pay than sort through tape..... I have a hard enough time with tape while wrapping presents!
Yup,
Mark56

[eva5667faliure]

Originally Posted by Spiney95

I have no idea about the coverage on your device but I do know that Medicare does not pay for repair or replacement parts on my durable medical equipment ie rollator or wheelchair. I could buy (and did) a new rollator for less than replacing the worn wheels. Yeh I had to buy it, well my brother did, as Medicare would not pay for the model I needed in spite of a letter from my pain doc.......a physiatrist. They have a one size fits all approach relative to mobility devices. Best wishes.

dear Spiney

just received my medicare card
i could see i have much not to
look forward to
right now my job is held
and there for me so want to
return cannot do body broken
as it stands i am on leave status
as far as pension is concerned
my boss is fully aware of status
BCBS is primary as i still have coverage
and now medicare as secondary
all new to me must do homework
anyhow

wishing all is well
MERRY CHRISTMAS
HAPPY HOLIDAYS