My doctor already sent you a prescription, why have you not sent out my product yet?
Your doctor took an important first step. For some insurances and product lines, this alone will allow us to provide you with the items and services requested. But many insurances require additional documentation, such as patient chart notes, testing results etc., to demonstrate that the request meets their guidelines for coverage. Our customer service team works closely with your doctor’s office and other health care providers, on your behalf, to obtain those documents. We realize that delays do not make anyone happy, and we do our best to establish coverage as fast as possible to make sure your insurance will ultimately pay the bill, so you don’t have to.
You are contracted with my insurance, why can’t I get this product from you?
Medicare along with some other insurances contract with different providers for different product lines so we cannot always provide our full spectrum of services under that health plan. If these cases we will make you aware up front and you have an option to either pay out of pocket for the product or your insurance can refer you to a different provider. In some cases, the insurance contract only covers the least expensive item that meets the medical guidelines in any product group. In these cases we may not be able to accept your insurance on the product you desire but will offer a similar substitute. In some cases your insurance will allow that you pay an upcharge for premium equipment.
Why are you asking for money although I have insurance?
You may end up with an out-of-pocket responsibility even though we bill your insurance. Many health plans have annual deductibles, which have to be met before they pay for the benefit. For durable medical equipment many plans also have coinsurance percentages built into their policies. In those cases they will only pay a portion of the claim and the remaining amount falls to the beneficiary’s responsibility. In some cases, they will exclude an item for coverage altogether under their guidelines, so you would have to pay out of pocket for the entire cost. We realize how confusing this can get, and our staff will make their best effort to give you a good estimate of possible out of pocket costs before delivery of your equipment. Unfortunately we cannot give any guarantees for accuracy, as the decision ultimately lies with your insurance. We strongly recommend that you contact your health plan and ask how your individual policy covers certain product groups before you receive any healthcare services.
I do not want to rent this product, can I purchase it outright?
There are certain items that are “rental only”. Common examples include oxygen concentrators and ventilators. Most items have a rental a rental cap where we bill on a monthly basis up to a certain threshold. If a member is requesting a different time frame for the rental cap or purchase outright, the Health Plans typically dictate if that is an option. CHME will submit an auth with this request but Health Plan makes final decision. . Many electric wheelchairs fall into that category. If you rent any item from our company and your insurance changes, it is imperative that you notify us immediately so we can update your health plan benefits. If you do not notify us, the member does run the risk of becoming financially responsible for the monthly payments.
Can I get the product without a prescription, and can you still bill my insurance?
Generally you need a prescription for most items covered by your insurance. There are some cases where we can provide certain items that do not require a prescription under state and federal law and have you sign a waiver form to seek reimbursement from your insurance without a doctor’s order. You would need to pay for the item up front in these cases. We will disclose to your insurance that you have no prescription for these services and they will make an individual coverage decision. Some items such as oxygen, CPAP and the associated supplies require a doctor’s order under state and federal laws and we cannot dispense them to you at all if you do not have a current prescription for them.