Chapter 5: Health and Mental Health

Section 1: Medicare

Centers for Medicare and Medicaid Services

Medicare is the health benefit available to persons receiving Social Security Disability Insurance (SSDI) or Social Security retirement and to some other connected individuals.

Medicare generally covers Durable Medical Equipment (DME) that:

  • Can stand repeated use;
  • Is primarily and customarily used to serve a medical purpose;
  • Is generally not useful to a person in absence of illness or injury; and
  • Is appropriate for use in the home.

Medicare typically pays 80% of the Medicare allowable charge for an item or service. The patient may have to pay a deductible and co-payment. A doctor's prescription and in some cases a Certificate of Medical Necessity are required for Medicare payment for medical equipment.

Palmetto Government Benefits Administration handles Durable Medical Equipment (DME) claims for Medicare in this region. Questions on Medicare DME coverage can be directed to 800-213-5452.

Select a state supplier list at this site. The suppliers listed are those who have agreed to accept what Medicare pays and to charge the patient no more than the Medicare allowable charge. The beneficiary still must pay the normal Medicare co-payment for medical equipment, but "participating" suppliers will not charge more than that.

Note: Medicare beneficiaries can also use "non-participating" Durable Medical Equipment (DME) suppliers who have Medicare supplier numbers. These suppliers have not agreed to charge no more than the Medicare allowable charge. For a list of both "participating" and "non-participating" DME suppliers go to the following link: https://www.medicare.gov/what-medicare-covers/part-b/competitive-bidding....

Medicare and You, the Medicare Handbook

Medicare Fraud

To report Medicare fraud, call 1-800-MEDICARE or follow this link to the Medicare Fraud webpage, https://www.medicare.gov/forms-help-and-resources/report-fraud-and-abuse....

Durable Medical Equipment (DME) Center

Palmetto Government Benefits Administration handles Durable Medical Equipment (DME) claims for Medicare in this region. Questions on Medicare DME coverage can be directed to 800-213-5452. For more information on Durable Medical Equipment follow this link, https://www.medicare.gov/what-medicare-covers/part-b/durable-medical-equ....

https://www.cms.gov/About-CMS/Agency-Information/RegionalOffices/Downloa...
The Dallas Regional Office (Region 6) should be your initial point of contact on any Medicare, Medicaid, or State Child Health Insurance Program (SCHIP). For general inquiries, use the telephone number listed below. For more specific issues, review the Contact List under the Downloads section at the bottom of this page.

CMS - Region 6
1301 Young St., Ste. 714
Dallas, TX 75202
214-767-6423 Voice
ROATLORA@cms.hhs.gov

Medicare Contact Center Operations PO Box 1270
Lawrence , KS 66044

TTY: 

877-486-2048

Toll Free: 

800-633-4227

End Stage Renal Disease Network

Email:

malbin@nw14.esrd.net

For questions about where to submit a complaint about quality of care received from a kidney dialysis facility.

4200 Perimeter Center Dr., Ste. 102
Oklahoma City , OK 73112-2314

Voice: 

405-948-2244

Toll Free: 

800-472-8664 For Patients Use Only

Fax: 

405-942-6884

Medigap Plans Available in Oklahoma

For people with disabilities under the age of 65:

Blue Cross Blue Shield of Oklahoma
1400 S Boston
Tulsa, OK 74119
800-942-5837 Toll Free
www.bcbsok.com

Christian Fidelity Life Insurance Co
2721 N. Central Ave.
Phoenix, AZ 85004
888-863-6674 Toll Free
www.cflic.com

Combined Insurance Company of America
8750 Bryn Mawr Ave.
Chicago, IL 60631
800-225-4500 Toll Free
https://www.combinedinsurance.com/us-en/
Medigap A only

National States Insurance Company
2210 Missouri Boulevard
Jefferson City, MO 65109
573-634-8455
https://mo-iga.org/

New Era Life Insurance Companies
11720 Katy Freeway, Suite 1700
Houston, TX 77079
www.neweralife.com

Old Surety Life Insurance Co
5201 North Lincoln Boulevard
Oklahoma City, OK 73105-1804
800-272-5466 Toll Free
http://oldsurety.com/

Physicians Life Insurance Company
P.O. Box 3313.
Omaha, NE 68103-0313
800-228-9100 Toll Free
www.physiciansmutual.com/cs/home/home.html

Oklahoma Department of Human Services

Help Paying Medicare Out-of-Pocket Expenses
These programs can help low income Medicare beneficiaries:

  • Qualified Medicare Beneficiary (QMB): Medicare recipients with very limited income and resources may qualify to have Medicaid pay their Medicare deductibles, premiums and copayments. Presently the income limit for an individual is $851 monthly, but this figure could change. Apply at your local DHS office.
  • Specified Low Income Medicare Beneficiary (SLMB): Medicare recipients with income up to $1,021 a month (current) can qualify to have Medicaid pay their Medicare Part B premiums. Apply at local DHS offices.
  • Qualifying Individual (QI-1): Pays Medicare Part B premiums for individuals with incomes up to $1,149 monthly (current), and couples to $1,265 monthly (current). Apply at local DHS offices.
  • Qualified Disabled and Working Individuals (QDWI) : QDWI pays recipients with incomes up to $1,702 monthly Medicare premiums and your Social Security benefit must have been stopped only because of your earned income.

To qualify for these programs you must also have very limited resources (the things you own and money you have available). Some things are not counted as resources, such as a person's home, car, furniture, some life insurance and burial plots.

Hotlines:

Adult Abuse 800-522-3511
Child Abuse 800-522-3511
Child Support Customer Assistance 800-522-2922

Developmental Disabilities:
North and West Oklahoma 800-522-1064
North and East Oklahoma 800-522-1075
Central and South Oklahoma 800-522-1086

Website link to other hotline numbers:
http://www.okdhs.org/contactus/pages/DHSHotlines.aspx

Sequoyah Memorial Office Building
2400 N. Lincoln Blvd.
Oklahoma City , OK 73105

Voice: 

405-521-3646

Oklahoma Foundation for Medical Quality

Oklahoma Foundation for Medical Quality (OFMQ) is a healthcare consulting services company. They are committed to advancing the quality of healthcare and improving lives. As an independent nonprofit organization, their service lines include quality improvement, health information technology, data analytics and health care review.

515 Central Park Drive, Suite 101
Oklahoma City , OK 73105

Voice: 

405-840-2891

Fax: 

405-840-1343

Oklahoma Hospice and Palliative Care Association

Email:

support@okhospice.org

The Oklahoma Hospice & Palliative Care Association (OHPCA) is the largest and most established organization in Oklahoma focusing solely on hospice and palliative care. They are leading the efforts to unify Oklahoma hospices with resources and information that will promote each hospice to provide quality compassionate hospice care to the terminally ill and their families.

PO Box 1466
Ardmore , OK 73402

Voice: 

405-985-9197

Pinnacle Medicare Services

Medicare Part B Carrier for Oklahoma: Information on Medicare Part B coverage, doctor services, outpatient care or other medical services; information on how to recognize Medicare fraud and abuse.

Toll Free: 

800-633-4227

Senior Health Insurance Counseling Program (SHIP)

The Senior Health Insurance Counseling Program (SHIP) is a non-profit organization helping to inform the public about Medicare and other senior health insurance issues. This division provides accurate and objective counseling, assistance, and advocacy relating to Medicare, Medicaid, Medicare supplements, Medicare Advantage, long-term care, and other related health coverage plans for Medicare beneficiaries, their representatives, or persons soon to be eligible for Medicare. Call their Senior Help Line at 1-800-763-2828 for assistance.

Oklahoma Insurance Department
400 NE 50th Street
Oklahoma City , OK 73105

Toll Free: 

800-763-2828