Q: My Doctor gave me a prescription for (____________). Why won’t my Insurance pay for it?
A: A Doctors order all by itself is not enough to get an item covered by your insurance. Most Insurance companies follow Medicare guidelines (rules) in order to determine whether what your Doctor ordered will be covered. For that to happen, the item MUST be considered “medically necessary” you will need ALL the following items:
1. A visit to the Doctor’s office. You must have a documented face to face visit with your Physician and discuss the specific reason why you need the Equipment or Supplies. We will need a copy of the Office Notes from that visit, along with the Prescription that your Doctor wrote for the item(s) that you need.
2. A Qualifying Diagnosis. Your Insurance will only cover items that match a Specific Diagnosis. For example: If you have surgery for a Knee replacement due to a specific Diagnosis that significantly impairs His or Her ability to participate in one or more mobility-related activities of daily living (MRADLS) in their home environment such as; toileting, feeding, dressing, grooming, and bathing, your Insurance will probably cover a cane or a walker. Other types of equipment or supplies will require their own Specific Diagnosis, along with written documentation justifying the need for the equipment.
Q: My Doctor gave me a prescription for a Shower Chair. Why won’t my insurance pay for it?
A: Insurance companies have never paid for items used in bathrooms. This includes Shower Chairs, Transfer Benches, Elevated toilet seats, or Grab Bars.
Q: If your company is a “Participating Provider” with my Insurance, and I have all of the documents that you need to submit a claim, why can’t you guarantee me that my item will be paid for by my insurance?
A: Our contract with your Insurance does not give us the authority to guarantee payment. As a matter of fact, they specifically require that we DO NOT guarantee any kind of payment. We can only follow what the Insurance company tells us that they need in order to submit a “Clean Claim” and assure you that we have followed all their directions to get your items paid for. We do suggest that you contact your insurance company if you are concerned about a claim and ask them specific questions. Be sure to get the NAME and CONTACT information of the individual that you spoke to in case you have to contact them again later. You may even ask them to assign you a REFERENCE NUMBER for your call.
Q: Why is your company collecting a Deductible and Co-Payment from me? My Doctor told me that my item would be completely covered 100%, and that it would not cost me anything.
A: Anything that we collect from you comes directed from your Insurance. All of them are different (according to your specific plan) in how much an individual deductible or co-payment may be. Our contract with your Insurance is VERY specific about deductibles and co-payments. We are REQUIRED to collect them in order to keep our status as a contracted network provider. As much as your Physician may mean well, our contracts are not the same. They may have more flexibility to waive certain payments that we do not.
Q: Your company claims to offer “Emergency 24-hour Service”. I needed a pair of crutches after a fall over the weekend and your Answering Service told me that I would have to wait until the office re- opened Monday to get them. Why didn’t you help me?
A: Our Service Technicians are on call for the Life-Sustaining (Oxygen) Equipment that we have provided to our customers. If that equipment breaks down when we are not open during regular business hours, we will dispatch and correct the situation. The “Emergency 24-hour Service” promise assures them that we will always be there for them when they need equipment repair services. It does not cover every item that we offer.
Q: Why doesn’t your company accept my insurance?
A: We want to accept all insurances. Why wouldn’t we? Submitting claims and getting paid is what keeps our doors open! The truth is that all insurances do not want every Provider in their network. It is a strategy that they believe makes it easier for them to do business. We try to contract with EVERY insurance that we know to be active in our area so that people can easily get what they need. That’s how we want it to be because when you need something, we KNOW that you don’t want to have to wait for a company that doesn’t even have an office here to get you what you need. The most difficult thing that we must do is tell someone that we CAN’T accept their insurance. Just know that it’s not that we haven’t tried to contract with them. The best thing that you can do to help us fix the situation is to call your company and complain. Better yet, if your insurance came from an Employer or a Salesman in the area, tell them what is happening and let them know that you need a LOCAL company to get your items from.