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What is the UAW-Ford National DME and P&O SUPPORTSM Program?
This Program provides
convenient access to quality products and skilled professional care through a
national network for persons whose physical condition requires using in-home
durable medical equipment (DME) and/or prosthetic & orthotic (P&O) appliances.
Who
is Covered by the Program?
The Program
applies to you and your eligible dependents if you are enrolled for coverage
under a Traditional Health Care Plan with BCBS or UniCare. This includes:
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Active employee and eligible dependents |
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Retiree, surviving spouse and eligible dependents |
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COBRA/Cash Pay participant and eligible dependents |
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Who
is Not Covered by the Program?
Persons enrolled
in a Health Maintenance Organization (HMO) or certain Preferred Provider
Organizations (PPO! are not included in the Program.
What Does the Program Cover?
The Program covers
a wide range of non-hospital DME and P&O services including those approved by
Medicare effective October 1, 1 999 and thereafter as approved by the
UAW-Ford joint Committee. Examples of covered DME and P&O services are as
follows:
Durable Medical Equipment (DME)
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Medical Equipment
Walkers,
canes, wheelchairs, crutches, hospital beds, monitoring devices, commodes,
IV stands, etc. |
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Respiratory Therapy
Oxygen and respiratory equipment, including the related services of trained
professional respiratory therapists or registered nurses. |
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Medical Supplies
Items
essential for use with covered equipment, ostomy supplies, diabetic
monitoring supplies and certain surgical supplies, etc. |
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Enteral Feedings
Limited to long-term. |
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Prosthetics and
Orthotics (P&O): |
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Prosthetics
Includes upper and lower extremity prosthetics (artificial limbs) and
mastectomy products. |
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Orthotics
Includes upper and lower extremity orthoses (braces), which provide
protective support or correction. |
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The above examples
are not all-inclusive. The booklet titled "Your Employee Benefits" or "Your
Retiree Benefits" contains a more complete description of covered DME and P&O
benefits and exclusions. |
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Please note:
DME/P&O services received in a hospital or nursing home setting will
be billed
through your Traditional health care plan with BCBS or Unicare. For
services that are not provided in a hospital or nursing home setting,
the SUPPORT
Program will generally cover all medically necessary DME/P&O covered
services, when they are arranged for by the SUPPORT Program. |
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How
are Program Services Obtained?
You or your
medical provider should simply call the SUPPORT Program at 1-800-831-0999 to
obtain services. One call coordinates all of your Program care. Services are
provided 24 hours a day, 7 days a week. You are required to have a prescription
from your physician to obtain services or equipment.
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What About Out-of-Network Services?
If covered
services are ordered from a provider outside of the network, the Program or
Medicare will pay 80% of the maximum payment amount (this is the approved amount
for covered services). You will be responsible for the remaining 20% of the
maximum payment up to an annual $500 out-of-pocket maximum. After you have met
your annual out-of-pocket maximum, the Program will reimburse you up to 100% of
the maximum fee payment allowed for covered services. Also, you may be
responsible for paying the difference between the actual amount billed by the
out-of-network provider and the maximum payment amount. This difference may be
substantial.
In order to avoid
or limit out-of-pocket costs, you or the out-of-network provider should call the
SUPPORT Program to determine:
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If the service(s) is covered |
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The SUPPORT
Program's approved amount for that service |
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The difference
between the out-of-network provider's charge and the SUPPORT Program's
approved amount |
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Using approved
network providers will help to avoid unnecessary expenses. |
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How
do I Submit a Claim for In-Network Services?
When services are
received through the SUPPORT Program, no claim forms are necessary, nor will you
receive a bill.
How
do I Submit a Claim for Out-of-Network Services?
You should ask the
out-of-network provider to submit a claim form on your behalf. The provider
should mail the claim form, a copy of the prescription and a copy of your
receipt for payment to the SUPPORT Program (see address below).
If you submit the
out-of-network claim, you should ask the provider for an itemized bill that
includes the following information:
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Your name and
Social Security number |
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Patient's name
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A precise
description of the equipment |
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Charge for the
equipment |
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How long you
expect to need the equipment |
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Date of service |
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Diagnosis |
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Provider's name,
address, phone number and tax ID number |
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A copy of the
prescription |
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Explanation of
Medicare benefits (Medicare recipients only) |
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Send the itemized
bill together with a copy of the physician's prescription and your receipt to:
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SUPPORT
Program
P.O. Box 82060
Rochester, MI
48308-2060
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Is
there a Program Appeals Process?
Decisions
regarding medical necessity may be appealed to the Director of Benefit Services
at the SUPPORT Program by calling
1-800-831-0999
(toll-free). If you do not agree with this decision,
you may request an
independent decision as well as information concerning the steps in the process
for resolving complaints and grievances. Put this request in writing and mail it
to:
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SUPPORT
Program
P.O. Box 82060
Rochester,
M148308-2060
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What if I Require Emergency Assistance or Would
Like More Information?
The SUPPORT
Program is available to help you 24 hours a day. If you need services
immediately or more information, you should call the SUPPORT Program at
1-800-831-0999.
You can call this
telephone number from any where in the United States 24 hours a day. The
SUPPORT Program staff will be happy to assist you in an emergency or answer
questions you may have about the Program.
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This page
contains a brief explanation of the
DME and P&O
benefits based
on
documents, policies and negotiated
Agreements by
which these benefits are provided. If there
is any
difference between the Plan texts and this brochure, the plan tests and
negotiated always will govern.
The
Company
reserves the right to end, suspend and amend plans, subject to the
applicable Collective Bargaining Agreement. Amendments also will be made to
comply with applicable statutes and regulations. If changes are made, you
will be notified. |
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