Most services Alliance provides, whether it be for orthotics or prosthetics, are covered by health insurance, including Medicare part B. The amount of coverage your insurance provides will vary by your specific insurance and your personal policy. It will depend on your insurance and the codes we bill to determine the amount we are billing your insurance per their fee schedule. Insurance plans may have benefit maximums, and only cover up to a certain amount for a specific service. Once we have seen you for an appointment, we can go over in more detail how much your device will cost and our estimate of your responsibility.
Here at Alliance, we strive to make sure we provide quality service and devices in a timely manner. We verify your insurance before going over financials with you. This is always just an estimate of what we think insurance will cover based on what we are able to see from your policy. If there is a patient responsibility, you will need to pay 50% of your portion before we move forward with ordering your device. We will endeavor to collect the remaining financials at delivery or set up a 3-month payment plan if needed.
If you are NOT using insurance and moving forward as self-pay, either due to a non-covered item or you are out-of-network with us, we use the GA fee schedule in most instances except for a few set price items such as custom Inserts, refurbishing one of our custom inserts, custom orthopedic shoes, an offloading shoe, and carbon footplates. We would need to collect payment in full for self-pay items before we would be able to order them for you and move forward.
We can set up payment plans in either case, insurance or not, but we would still need to collect the above-mentioned total before ordering.
We cannot return any custom-made devices once ordered or off-the-shelf items that you take home with you. We do not give refunds for these items. We will work with you to adjust and repair your device in the first 90 days of you receiving it to have it work properly. Your satisfaction is super important to us, but once these custom items are ordered, we cannot return them to the manufacturer, you are then responsible for the item(s). Likewise with off-the-shelf items such as back braces, once you put them on and leave the office, we cannot use the item or give it to anyone else, therefore it is your responsibility.
If insurance covers more than we thought it would, we will always refund you that amount back. Ex. $1000 device - You paid $100, and we thought insurance would cover the remaining $900, but they ended up paying us $950. We would contact you to refund that $50. Likewise, if insurance covers less than we thought, ex. Paying only $800 in the example above, we would be reaching out to collect an additional $100 from you to cover that difference.
Questions About Insurance:
There are a handful of things we really need to know from your insurance, and we can’t always see or have access to those things. We use an online service portal for verification and authorization and cannot always see and know everything you have access to. We encourage you to call your insurance to find out this information as much as possible once you have received the billing codes from us so we can more accurately communicate to you how much insurance will cover; every personal policy is different. The total we give you is always an estimate, but we try to make that estimate as accurate as possible. Once we bill insurance, whatever they don’t cover you will be financially responsible for. Your patient portion is subject to change based on the final claim determination by your insurance carrier.
To help understand your insurance, you can also use this Glossary of Healthcare Terms to explain common terminology.
(Website link - https://www.healthcare.gov/SBC-GLOSSARY/)
*This information does not cover all situations and should not be construed to be an all-inclusive listing of all possible situations. As part of our commitment of service to you, we will make every attempt to verify your insurance benefits at the time your services are rendered. However, insurance verification or authorization is not a guarantee of insurance payment. This only allows our office to provide you with a preliminary estimate of any money due by the insured on or before the time of delivery of the device. Your patient portion is subject to change based on the final claim determination by your insurance carrier.
If your claim is denied by your insurance company, we are happy to assist in filing an appeal. If after the appeal process, they still are denying your claim, we will be reaching out to you to collect any further payment if needed.
If there is a factor involved that makes us unsure if your insurance will pay, or we think will cause them to initially deny your claim, we will ask you to fill out an ABN form, especially if you have Medicare. It is a form that Medicare requires us to have, and states that if insurance denies your claim, then you are financially responsible for the device(s).
Same Day Deliveries:
We will need a written order to be able to deliver any device. If you come into our office for an Off-the-Shelf item and want to take it home with you that day, we will try to make sure that your insurance is verified, and we give you an estimated cost of the device before you leave. (If for any reason we cannot get a hold of your insurance to get your benefits, you are welcome to wait until we get it resolved before leaving with the brace or we will ask you to pay in full and we will reimburse you anything your insurance covers once we have billed.) We will collect any patient responsibility financials before you leave with the brace. We will not have had time to authorize your insurance by the time you leave your appointment. We will have to gather the required paperwork from your doctor before starting the authorization process and then go through the insurance. Your insurance has up to 30 days to give us a response on auth approval. If you leave our office with your brace the same day, please be aware we are delivering before approval has been gathered. If your insurance denies the claim, we will try to appeal, but they may stick with their decision to deny your brace. If that is the case, we will need to collect any remaining financials from you to cover the difference and make sure the brace is paid in full.
Process When Going Through Insurance:
Once we have seen you and put codes in the system, we will work with you to collect any financials from you that are needed in order to move forward as discussed above. We will also go ahead and move forward with getting a detailed written order from your doctor. This is a form that has the codes we are billing your insurance for your doctor to sign off on. We may also need to collect office notes from your doctor as well. Once we have collected that paperwork from your doctor, we will always check to see if authorization is required. If so, we will go through the process of getting your codes authorized. Your insurance has up to 30 days to give us a response on the authorization. Once we get the go-ahead that auth is either approved or not required, and if the appropriate amount of financials has been collected, we will then order your device. Once we know the estimated time of arrival; we will reach out to you to schedule a delivery appointment.
Process When Moving Forward as Self-Pay:
If we have a prescription from your doctor and you are not going through the insurance, we would be good to start with your device(s) immediately, without having to wait on additional paperwork from your doctor or authorization. Once we have seen you for your initial eval and put codes in, we will go over financials, collect in full, and then order your brace. As soon as we have an ETA on when the brace should be in our office, we would reach out to you to schedule a delivery appointment.
Paperwork at Initial Eval and Delivery:
A general fill-in-the-blank demo sheet: Blank Patient Demos
A HIPAA consent form: HIPAA Consent form
There will also be a digital signature we will get from you that goes along with the HIPAA form.
If you are going through insurance: Insurance Coverage Form
If you are going through insurance to receive diabetic inserts and/or shoes: Diabetic Shoes - Insurance Coverage Form
If you are going to end up being a same-day delivery: Same-Day Delivery Form
If you are going to end up being a same-day delivery, we would also have you sign a form stating you received care instructions from us at this appointment and a delivery receipt that you received your device.
We will also have you sign a digital signature at some point in the process stating we went over financials with you, and you understand that if insurance does not cover, you are financially responsible.
We will have you sign a form stating you received care instructions from us for your device(s).
We will have you sign a delivery receipt that has all the codes we are billing your insurance and that states you are taking your device(s) home with you.
When filling out this paperwork, if you have any questions, our front desk staff would be happy to assist you.