Financial Responsibilities
After you have completed all required information via our provided forms, our experienced office staff will verify your benefits with your insurance carrier to determine the amount of coverage available for your orthotic or prosthetic services. Our staff, who will obtain prior authorization if needed from your insurance company, will then be able to provide an estimate of your portion of the costs before starting your orthotic and prosthetic care. Payment for your personal or out-of-pocket portion is expected when you receive your service.
Innovative P&O accepts several payment methods, including check, credit card, or money order.
Financing is also available through CareCredit, a GE Money company that offers no-interest and low-interest payment plans based on your needs and budget. Visit www.carecredit.com for more information.
As part of our commitment to you, we will attempt to verify your insurance benefits at the time your prosthetic or orthotic care starts. 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 monies due by the insured on or before the delivery of the device or service. Your patient portion is subject to change based on final claim determination by your insurance carrier.
How is Insurance Managed at Innovative P&O
Most of the orthotic and prosthetic services provided by Innovative P&O are covered by health insurance, including Medicare Part B. The coverage amount for services can vary depending on the type of policy held. If you have more than one insurance plan, it is possible that the entire cost of your care could be covered.
In most cases, some percentage of patient “co-pay” is required upon delivery of the orthosis or prosthesis. Before your first appointment, it is a good idea to contact your insurance company, or prospective insurance company, to understand exactly what benefits are available for O&P services. Working closely with your healthcare team is also beneficial and can help to maximize your benefits.
Together we can assess your needs and abilities, which will assist in determining the most appropriate orthotic and prosthetic device for your lifestyle. This may also give additional leverage when working or negotiating with your insurance company.
Does Innovative Accept Medicare
Innovative P&O has significant experience working with the Medicare program. Our comprehensive understanding of reimbursement, regulations, and procedures helps us to answer your questions regarding eligibility, bills, deductibles, and Medicare notices.
Medicare will pay 80% of its “fee schedule” for covered orthotic and prosthetic services after your annual deductible has been met. Generally, there are no caps on the types of technology covered by Medicare, as long the orthotic or prosthetic device is medically appropriate, is prescribed by a treating physician, and otherwise meets Medicare’s coverage criteria.
Again, it is important to work closely with your healthcare team to determine which prosthetic or orthotic product is the most appropriate for your lifestyle.
To learn more about Medicare, call 1-800-MEDICARE or visit their website at www.medicare.gov or www.medicareadvocacy.org.
What is an In-Network Provider
A healthcare provider on a list of providers preselected by the insurer is an in-network provider. The insurer will offer discounted coinsurance (co-payments), or additional benefits, to a plan member to see an in-network provider. Generally, providers in the network have a contract with the insurer to accept rates further discounted from the “usual and customary” charges the insurer pays to out-of-network providers.
What is Prior Authorization
A certification or authorization that an insurer provides before medical service occurs is typically contingent upon eligibility, medical necessity, and benefits however it is not a guarantee of payment.
What is a Referral
A recommendation to consult the professional person or group to whom one has been referred; “the insurance company says you need a written referral from your physician before seeing a specialist.”
PAYMENT PLANS
Innovative P&O offers plans on various treatments. Children’s cranial helmets are an example of our in-house payment plan to help our patients succeed with their healthcare needs. Contact our office staff to see how we can work with you and your family on a plan.
