Insurance companies have made it more difficult than ever for Medical Equipment Companies and their patients. They determine how much we can bill and if they will allow benefits.

Listed below are the steps we must take before we can submit your claim.

1. Verify your insurance eligibility - we will determine if you have coverage and how long it will last. If your item is a rental we must be able to verify your coverage for the duration of the rental.
2. Verify that you have Durable Medical Equipment Coverage - not all insurance offer DME coverage
3. Discuss your benefits including any deductibles, out of pocket expenses and co-insurances - Most insurance have a yearly deductible that must be met before they will pay for the item. Most insurance will only cover up to a certain percent, leaving the patient with a co-insurance. If your policy includes an out of pocket expense, your insurance usually will cover 100 percent once that is met.
4. Request all medical documentation from your ordering physician - Each piece of equipment requires that certain criteria be met. You must meet the qualifications for the specific item you need as required by your insurance. This includes office notes from your physician that document why they ordered the item, specific diagnosis, and if the item is a rental, how long you will need it.
5. Obtain any prior approvals if required - This will include obtaining medical documentation and submitting to your insurance. Prior approvals may be granted the same day or could take up to 30 days.
6. Claim submission - Once we receive all the required documentation, we can now submit your claim for payment. If the item is a purchase, we will submit the claim promptly. If the item is a monthly rental, the claim cannot be submitted until the end of the monthly rental period. For example, if you receive the item on January 1st, the monthly rental period will be from January 1st to January 31st. We cannot submit the claim until February 1st. Therefore, actual payment from your insurance may be 60 days from the initial delivery date.
7. Your bill - We cannot send you a bill until we receive payment from the insurance company. So your bill may become very confusing if payment from them is not received promptly or at the same time each month. For example, you may not get a bill from us until March for an item received in January.

Deductibles - If you have a yearly deductible, this must be satisfied before a benefit payment can be made. Our bills for services may be applied to your deductible.

Coinsurance - Once your deductible has been satisfied, your insurance will reimburse us the percentage of your coverage. .