‘Same or similar’ — the denial nobody sees coming

The rule

Medicare will not pay twice for equipment that serves the same purpose within its useful lifetime. If a claim has already been paid for an item in the same category, a second one is rejected as ‘same or similar’ — regardless of what happened to the first.

The equipment does not have to be identical. A walker and a rollator are similar. A manual wheelchair and a transport chair are similar. Two different support surfaces are similar.

Why it catches people

• The original item came from a different supplier, years ago, and nobody remembers.
• It was supplied while the patient was somewhere else — another state, another facility.
• It broke, was thrown out, or was left behind at a hospital.
• It was ordered for a family member at the same address and got attributed oddly.
• The patient's needs genuinely changed and the new item looks similar on paper.

What can be done

• Check first. We check before ordering, which is why we sometimes ask questions about equipment you had years ago that seem irrelevant.
• Replacement for loss or damage has a route, with documentation of what happened.
• A change in medical condition that makes the previous item unsuitable has a route, with documentation from your clinician explaining the change.
• Expiry of the useful lifetime means the clock has run and a replacement can be considered.

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