I'll tell you what I HAVE run into w/Medicare tho. This is in relation to durable medical equipment. Sheister DME suppliers who like to provide bottom of the line equipment and tell you Medicare won't pay for a slightly better quality product. I've found that you can NOT believe WAY TOO MANY local DME suppliers. If they don't outright lie, they are less than truthful - and if you dig out the coverage info yourself, including providing them w/the proper HCPCS code - goshes, they didn't know that! And/or they conveniently weren't aware of the allowed interval for replacement items or even that they were replaceable by Medicare.
Just as one "for instance": CPAPs (continuous positive airway pressure devices for sleep apnea). All straight CPAPs, from bare bone devices, thru compliance data only devices thru fully data capable devices are billed and reimbursed by ONE HCPCS code, Medicare has NO idea what brand and model, just that the device is an HCPCS code E0601. Of course, the fully data capable devices are somewhat more expensive than the bare bone devices so IF the DME supplier provides you w/a bare bone device their profit margin is greater. So they try to convince you, if you know enough to insist on a fully data capable device, that Medicare won't pay for it or that YOU must pay extra out of pocket for it. Both stories are just plain HORSEPUCKIES! The price they are allowed and are paid for this HCPCS code WAY MORE THAN COVERS the price of purchasing it online via a reputable internet DME supplier (who is also making a profit on the same device).
Which wouldn't be so bad IF they actually provided the education, support and service they claim as the reason for their higher prices. But way too many of them DON'T. Three of the leading interface manufacturers will replace FREE to the local DME supplier most ALL of their interfaces that a patient has tried and been unsuccessful w/IF the supplier fills out a form and returns them w/in 30 days. Yet way too few local DME suppliers have a reasonable much less lenient interface exchange policy. Once your proper pressure need has been established the interface is THE KEY to successful CPAP compliance and therapy.
All too often the blame is placed on Medicare or the insurances when it is strictly a matter of protecting and padding the local DME suppliers' profit margins.
Of course, if one hasn't yet been successful w/their CPAP therapy and is still severely sleep deprived it can be a real pleasure to vent your spleen by thwarting the DME suppliers' lies and half truths w/the facts and printed proof. *wicked grin*
Some people are like Slinkies... Not really good for anything, but they still bring a smile to your face when you push them down a flight of stairs.