Why Living Well Stores Does Not Bill Insurance

Living Well Stores does not bill Medicare, Medicaid, or private insurance. We made this choice so we can offer:

• Lower prices
• More product choices
• Faster ordering and shipping

Insurance billing for medical equipment has strict rules and lots of paperwork. Dealers who bill Medicare must follow supplier rules, documentation rules, and audits.

Medicare supplier enrollment and standards (reference): see the CMS/eCFR rules in the “CMS Reference Links” section below.

Can I Buy From You and Then Ask for Reimbursement?

For Some Items (Not Power Mobility)

For some smaller items, you can try to file a claim with your insurance plan. Whether you get paid back depends on your plan and the paperwork it requires.

We cannot promise you will get reimbursed.

Can You Give Me an Invoice?

Yes. We provide a normal invoice that shows:

• What you bought
• The price
• The purchase date
• How it was paid

But many insurance plans (and Medicare) also want special forms and medical billing codes. Those forms are usually completed only by an approved, in-network medical equipment supplier.

Because Living Well Stores is not an in-network billing supplier, we cannot:

• Fill out insurance claim forms for you
• Sign insurance paperwork
• Bill Medicare directly

Insurance Reimbursement for Power Mobility Scooters and Power Wheelchairs

You may have heard ads that say: “Medicare will pay for your scooter or power chair.” Medicare can cover some scooters and power wheelchairs, but the rules are strict. Many people do not qualify.

Medicare and private pay such as Aetna, Anthem, the Blues: Rules Are Very Strict

In general, Medicare looks for these key points:

1) Doctor Visit (In Person)

You usually must see your doctor face-to-face.

2) Need Must Be Inside Your Home

Medicare usually only considers coverage if you need the device to move around inside your home (for example, bedroom to bathroom).

Medicare does not cover a scooter or power chair just to go shopping, to events, outdoors, or around town.

3) Medical Notes and Extra Paperwork

Your doctor’s notes must show why you cannot safely use simpler equipment, like a cane, walker, or manual wheelchair.

4) You Must Use an Approved Supplier

Medicare generally requires the device to be provided by a Medicare-enrolled and accredited supplier.

That means you usually cannot buy from just any store and then ask Medicare to pay you back later.

5) Limited Choices

Medicare coverage is tied to specific codes and rules. That can limit which models are offered. Covered options may be more basic than what you can buy on the open market.

6) You May Still Owe Money

If Medicare approves the claim, Medicare commonly pays a portion of the allowed amount and the customer may still owe coinsurance (often 20%), unless they have other coverage. You can expect that the original price of the product is going to be 20 to 30 pct more than our price, btw.

Can I Buy From Living Well Stores and Then File for Reimbursement?

For most people, this is not likely to work. Many plans require the supplier, order, and documentation to be handled in specific ways before the item is provided.

• The purchase may need to be through an in-network supplier
• The plan may require approval before purchase
• The plan may cover only certain codes or models
• Missing paperwork can lead to denial

Insurance Reimbursement for Lift-Recliners

Lift recliners (also called “lift chairs”) are usually not covered by Medicare as a full chair.

But Medicare may cover only the seat lift mechanism (the lifting motor/mechanism that helps a person stand up), even when the mechanism is built into a chair.

In simple terms: the mechanism may be covered, but the rest of the chair is usually not.

When the Seat Lift Mechanism May Be Covered

Medicare’s rules for seat lift mechanisms include medical-need requirements and limitations, such as the mechanism operating smoothly and being controlled by the person using it. Certain “catapult-like” lift types are excluded.

Coverage also typically requires proper orders and documentation, and it is usually handled by a Medicare-enrolled supplier.

The Bottom Line

For many people, trying to get Medicare or private insurance to pay back a private-pay purchase is very hard— especially for scooters and power wheelchairs.

Buying private-pay can still be the better choice because it may give you:

• Faster delivery
• More choices
• Lower total out-of-pocket cost
• Less paperwork and fewer delays

If you want, our team can help you understand your options before you buy.