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<p>Insurance companies, governed by the AMA, require that we bill our services to you using a coding system known as CPT (Current Procedural Terminology). Some of the services may be found in the surgery section as the classification is assigned by AMA in the CPT book. This does not mean we are implying you had an operation. This is merely the way the CPT book is organized for ease of use by both the insurance companies and physicians.</p>
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<p>DME items are considered non-returnable once they leave the office. The only exception is if there is a material defect with the product.</p>
<p>If there is a defect, the product will be exchanged for another of the same kind.</p>
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<p>Benefits quoted prior to a procedure are an <strong>estimation only</strong> and not a guarantee of payment. Actual plan coverage and patient responsibility is determined when the claim is processed. In the event the balance owed by the patient is greater than the courtesy quote provided, the patient is responsible</p>
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<p>Yes, Payment Plan Guidelines are as Follows:</p>
<p>Minimum Payment of <strong>$25</strong> per Month.</p>
<p>Payment Plan must be Paid Off within <strong>12 Months</strong>.</p>
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<p>For Medical Records request, please call 888-100-0000.</p>
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<p>All insurance companies require that our services are billed using a coding system known as CPT (Current Procedural Terminology). The codes used to describe the services performed are found in the surgery section of the CPT code book. This does not mean you had an operation; it’s simply the category that the healthcare industry uses for fracture care billing. Your insurance explanation of benefits (EOB) may list our services as surgery. This is appropriate based on medical billing guideline standards. According to CPT guidelines, fracture care is billed as a package or global service. Meaning, at the time of initial care, a bill is generated including: treatment of fracture, first cast or splint.</p>
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<a href="">Click Here to download the User Guide</a>
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<p>The confusion for most patients comes when insurance has been filed, but the claim does not pay. There are many reasons why your insurance company may not pay a claim. Some common reasons for claim denials include the following:</p>
<p><strong>You have an Unmet Deductible</strong><br>
Even if you have paid your co-pay at the time of service, if you have not yet met your deductible, your insurance will not pay the claim.</p>
<p><strong>Service is not medically necessary</strong><br>
There is no documentation or evidence that a service or procedure was necessary for your health or well-being.</p>
<p><strong>Service is not a covered benefit</strong><br>
Your insurance does not cover this service, such as a brace, heel lifts or other DME.</p>
<p><strong>Out-of-network provider</strong><br>
You have used a provider who is not in your health plan’s network and the services may not be covered or may be subject to a coinsurance.</p>
<p><strong>Past Timely Filing</strong><br>
Most insurance companies allow 90 days from the time of service for the claim to be filed. If a claim is filed after this period, it will be rejected. That is why it is so important to provide updated insurance information at the time of service.</p>
<p><strong>No Pre-Authorization</strong><br>
Some insurance plans require pre-authorization for certain procedures. Without this authorization, insurance will not pay and the charges will be the patient’s responsibility, if you did not update you insurance with the office. If prior authorization was not obtained and it is the error of the office you will not be billed</p>
<p><strong>Authorization Timed Out</strong><br>
Authorization is usually granted for a specific duration of time. If services are performed after the authorization period, the claim will be denied.</p>
<p><strong>You were late in making your Individual Policy payments</strong><br>
If a patient is behind on their individual policy payments, the claim may be denied. This includes COBRA and month-to-month policies such as those in the HealthExchange Market.</p>
<p><strong>No Physician Referral</strong><br>
Some insurance plans require a referral from the patient’s primary care provider before services can be rendered. If service is provided before a referral is confirmed by the insurance company, the claim will be denied and the charges will be the patient’s responsibility.</p>
<p><strong>You have an Out-of-State Insurance Plan</strong><br>
Claims may be denied if you are treated in one state but your insurance plan is out-of-state and a referral is required. It is your responsibility to verify that you have out-of-network and out-of-state benefits. Many policies in the HealthExchange Market only cover the state where the policy was originally taken out.</p>
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<p>If you have more than one health insurance plan, one plan becomes your primary plan. It pays your claims first. The second plan may pay toward the remaining cost, depending on the plan. Those plans need to work together to make sure you’re getting the most out of your coverage. This process is called Coordination of Benefits or COB. </p>
<p>Updating your Coordination of Benefits helps your insurance claims process faster and maximizes your benefits, which can lower your out-of-pocket costs. It is important that you keep your information up-to-date. If you receive a request regarding your Coordination of Benefits, please respond as quickly as possible. If your insurance does not receive your response, they may reject your insurance claim.</p>
<p><strong>Accident Information Explained</strong><br />
Quite often insurance companies will request additional information from you, the member, regarding a claim that has been filed on your behalf before they will process and pay the claim to the provider. It is your responsibility to contact your insurance in this case to provide needed/required information to them. Otherwise the balance becomes yours to pay until such information is given to the insurance company by the patient and the claim is reprocessed for payment. The provider cannot provide this information to the insurance company on your behalf. </p>
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<p><strong>Co-Insurance</strong><br>
If your plan includes co-insurance, then once your deductible has been met, you will share the cost of care with your insurance company on a split basis. Example: 80/20 – means your insurance company would pay 80% and you would be responsible for 20% of the bill. Insurance will not pay 100% of the medical bill until you have met your out-of-pocket maximum.</p>
<p><strong>Co-Pay</strong><br>
A <b>Co-Pay</b> is a predetermined (flat) fee that an individual pays for health care services, in addition to what the insurance covers. The amount of the co-pay is determined by the individual’s insurance plan. For example, some HMOs require a $10 copayment for each office visit, regardless of the type or level of services provided during the visit.</p>
<p><strong>Deductible</strong><br>
This is the amount you must pay out of pocket before the health plan will start paying towards your medical bills. This amount is reset each plan year.</p>
<p><strong>Out-of-pocket</strong><br>
Once you have paid a certain amount (out-of-pocket maximum) towards your Maximum medical bills in a plan year, your insurance provider will then pay all of your covered services for the rest of the plan year.</p>
<p><strong>Plan Year</strong><br>
This is a 12-month period and may not be the same as the calendar year. To find out when your plan year begins, you can check your plan documents or ask your employer. (Note: For individual health insurance policies this 12-month period is called a “policy year”)</p>
<p><strong>Misc.</strong><br>
Depending on your Benefit Coverage Requirements, your insurance company may <br>
(1) make a full payment on your claim <br>
(2) make a partial payment on your claim <br>
(3) deny the claim (make no payment).</p>
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<p>For a comprehensive overview of Medicare Preventive Services, please go to the following link: <a href="#">Please Click Here</a></p>
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<p><strong>What is a Medicare Advantage Plan?</strong> A Medicare Advantage Plan is a Medicare policy that is administered by a private insurer (like United Healthcare, Aetna, Cigna etc) that offers the same benefits as traditional Medicare plus additional benefits that traditional Medicare may not cover. </p>
<p><strong>What is covered under a Medicare Advantage Plan?</strong> Medicare Advantage Plans are required to cover everything that is covered by traditional Medicare, plus, they often also cover dental, vision, wellness and prescriptions. </p>
<p><strong>Is there a deductible or co-insurance?</strong> Yes. In addition to the Medicare part B premium, you usually pay a monthly premium for the Medicare Advantage Plan. Each plan is different so it is important to know the costs associated with these plans before you choose one.</p>
<p><strong>I still use my traditional Medicare?</strong> No, if you opt for a Medicare Advantage Plan, your traditional Medicare is not used and will not cover any services. </p>
<p><strong>Additional Information on Medicare Advantage Plans</strong><br />
Click <a href="#">HERE</a> for more detailed information about Medicare Advantage Plans. </p>
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<p><strong>What is a supplemental Insurance?</strong> A supplemental Insurance policy is a policy you pay for to help pick-up the costs associated to you after Medicare. Supplemental Plans rarely cover the Medicare deductible, will only cover what Medicare covers (so if Medicare denies something, supplement will NOT cover it), and usually only picks up the co-insurance portion. </p>
<p><strong>What is a secondary Insurance?</strong> A secondary insurance policy is usually a policy through an employer or spouse employer that will help pick-up the costs associated to you after Medicare. Secondary plans usually will cover the Medicare deductible and co-insurance and sometimes will cover what Medicare denies as well. However, there may also be a separate deductible, co-insurance, and copay associated with a secondary plan that will apply. </p>
<p><strong>Additional Information on Medicare Advantage Plans</strong>
Click <a href="#">HERE</a> for more detailed information about Medicare Advantage Plans. </p>
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<p><strong>How does traditional Medicare work?</strong> Traditional Medicare has 2 parts – part A (hospital) and part B (medical). Part A is used for hospital services. Part B is for physicians services. </p>
<p><strong>Is there a deductible or co-insurance?</strong> Yes, The current Medicare part B deductible for 2017 & 2018 is $183.00 per year, and is subject to change each year. The deductible must be met before Medicare starts making payment on claims. Once the deductible is met and claims are being paid, you are also responsible for a 20% co-insurance. </p>
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<p>Yearly "Wellness" visits: If you've had Part B for longer than 12 months, you can get this visit to develop or update a personalized prevention help plan. This plan is designed to help prevent disease and disability based on your current health and risk factors. Your provider will ask you to fill out a questionnaire, called a “Health Risk Assessment,” as part of this visit. Answering these questions can help you and your provider develop a personalized prevention plan to help you stay healthy and get the most out of your visit. It can also include:</p>
<ul>
<li>A review of your medical and family history</li>
<li>Developing or updating a list of current providers and prescriptions</li>
<li>Height, weight, blood pressure, and other routine measurements</li>
<li>Detection of any cognitive impairment</li>
<li>Personalized health advice</li>
<li>A list of risk factors and treatment options for you A screening schedule (like a checklist) for appropriate preventive services.</li>
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<p>A "Welcome to Medicare" preventive visit: You can get this introductory visit only within the first 12 months you have Part B. This visit includes a review of your medical and social history related to your health and education and counseling about preventive services, including these:</p>
<ul>
<li>Certain screenings, shots, and referrals for other care, if needed
<li>Height, weight, and blood pressure measurements
<li>A calculation of your body mass index
<li>A simple vision test
<li>A review of your potential risk for depression and your level of safety
<li>An offer to talk with you about creating advance directives.
<li>A written plan letting you know which screenings, shots, and other preventive services you need. This visit is covered one time. You don’t need to have this visit to be covered for yearly "Wellness" visits.</li>
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<p>All people with Part B are covered. </p>
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<li>You pay nothing for the “Welcome to Medicare” preventive visit or the yearly “Wellness” visit if your doctor or other qualified health care provider accepts assignment. The Part B deductible doesn’t apply. However, you may have to pay coinsurance, and the Part B deductible may apply if:</li>
<li>Your doctor or other health care provider performs additional tests or services during the same visit.</li>
<li>These additional tests or services aren't covered under the preventive benefits.</li>
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<p><strong>Note:</strong> Your doctor or other health care provider may recommend you get services more often than Medicare covers. Or, they may recommend services that Medicare does not cover. If this happens, you may have to pay some or all of the costs. It is important to ask questions so you understand why your doctor is recommending certain services and whether Medicare will pay for them.</p>
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<p><strong>Step (1) - Visit to the Doctor</strong><br />
If you have health insurance, you will provide your updated insurance information to the front desk on the day of your visit.</p>
<p><strong>Step (2) - Claim is submitted by Doctor's Office to your Insurance Company</strong><br />
Claim is submitted by Doctor’s Office to your Insurance Company. A Claim is the form filled out and sent by your doctor to the insurance company asking for payment from your insurance provider for the medical services that were rendered. The insurance industry has established that services rendered be described using a medical coding system known as CPT Codes (Current Procedural Terminology). These codes are organized for ease of use by both the insurance companies and physicians. Many times, the short description language accompanied by the code on the patient statement, is referring to the section of the coding book and does not adequately reflect the services performed. A list of CPT codes with their full description can be found on the American Medical Association website.</p>
<p><strong>Step (3) - The Insurance Company Adjudicates the Claim</strong><br />
Adjudication is the term used in the insurance industry to refer to the process of paying claims submitted or denying them after comparing claims to the benefit coverage requirements.</p>
<p><strong>Step (4) - An Explanation of Benefits (EOB) is sent to you from your Insurance Provider</strong><br />
An Explanation of Benefits (EOB) is sent to you from your Insurance Provider. An Explanation of Benefits (EOB) is a summary sent to you by your insurance company showing what services you received, what portion of the cost your health plan paid to your doctor, and showing if you owe the doctor any additional balance for those services rendered. An EOB is Not a Bill.</p>
<p><strong>Step (5) - After the claim has adjudicated, a Patient Statement is sent to you from your Doctor's office</strong><br />
After the claim has adjudicated, a Patient Statement is sent to you from your doctor’s office. A Patient Statement is a bill sent to you from your doctor’s office if there is a patient responsibility remaining. The statement will show how much money you owe for the services that were rendered after insurance has been billed and the claim has been adjudicated.</p>
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