General
Chapter 1
Addendum B
Figures
Revision:
Figure 1.B-1 Suggested Wording To The Beneficiary
Concerning Rental vs. Purchase Of Durable Medical Equipment (DME)
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“We
have determined under the Regulation that the total TRICARE benefit
allowable, subject to usual deductible and cost-sharing requirements,
is $________. This amount is equal to (the allowable purchase price
of the equipment) (____ months of estimated medically necessary
rental, at $______ allowable rental per month).
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“You
may obtain this equipment under any arrangement you wish. However,
it would be advantageous for you to obtain the equipment by (rental)
(purchase or lease/purchase). Any expenses you incur in excess of
the TRICARE-allowable amount will be your own responsibility.
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“If
you are not satisfied with the action taken on your case, you have
the right to a review. Your written request for a review must state
the specific matter with which you do not agree and must be received
in this office within 90 days of this notice.
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“Accordingly,
TRICARE payments for this equipment will end with whichever of the
following occurs first:
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1.
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When $_______
has been reimbursed, subject to usual deductible and cost-share
amounts.
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2.
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When you no longer
require the equipment medically.
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3.
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When your TRICARE
eligibility ends.”
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- END -