Health Insurance Information
Insurance Coverage and Financial Responsibility
Each person’s insurance policy defines the terms of coverage for Durable Medical Equipment (DME) (Durable Medical Equipment includes devices such as prosthetics, orthotics, and medically prescribed shoes.) We recommend that you become familiar with your individual policy terms and limitations.
Your policy defines the deductibles, coinsurance, out of pocket costs, fee schedule, medical necessity, and/or if authorization is required. Based on a contracted fee schedule the cost for the items you are receiving have been predetermined by your insurance company. All DME items are identified by a medical coding system which are typically “L” codes or “A” codes. The codes describe the type of device you are receiving to the insurance company when we submit our bill. If you have a secondary insurance we will determine the coverage for that insurance plan as well.
At Independence we work for you to determine your insurance benefits and we will provide you with important information to help you understand your coverage and responsibility. We will provide an insurance verification form which outlines your coverage and limitations. A service estimate will also be provided to show the actual cost of your device being billed to your insurance company.
Reasons you may have a financial responsibility:
YOU HAVE NO INSURANCE: You will be responsible for the cost of our product and services
NON-COVERED ITEMS: There are some items that are a not covered by insurance (i.e. elastic items and shoe modifications). In these instances, we will require payment in full. At your request, we can still process billing through your insurance company and will reimburse you any difference if your insurance company pays.
** If you are a Medicare beneficiary receiving a non-covered item, you will be required to sign an Advanced Beneficiary Notice which states that you were advised that Medicare may not pay for your DME item.
YOU HAVE A COPAY: If you have not met your deductible and/or you have a coinsurance and/or out of pocket costs. You are responsible for these expenses and our staff will advise you of your financial responsibility.
INSURANCE DENIALS: If the insurance denies coverage as “not medically necessary” or “experimental” Insurance companies may deny an item if you have had an item of the “same or similar” item within the past 3-5 years
If a denial does occur, you will be notified. Our billing staff will work to appeal any insurance denials on your behalf. This may require requesting medical information from your physicians and/or therapists.
Our policy is to secure full payment at the time of the delivery if you have a financial responsibility. For custom items, half of the financial responsibility is required before production of your item will begin.
We offer payment agreements and hardship options for patients who qualify. If you require a payment agreement or think you may qualify for hardship options, please advise our front office administration and they will assist you.
At Independence we recognize the complexity of understanding healthcare insurance. We will educate and advise you of your coverage options. As a healthcare business our goal is to provide care for those with medical needs. To accomplish our goal, our business must be fiscally responsible to collect payment for our products and services rendered in a timely manner.
John Horne, President
Independence Prosthetics-Orthotics, Inc.
**The payment agreement required 50% deposit with up to 3 months of automatically charged payments via debit card or credit card.
**To qualify for the hardship option, you must complete the hardship application. If a hardship is determined, extended payment agreements and/or product discount may be offered.
Please contact us to verify acceptance if your insurance is not listed below.
- Most workers compensation and auto policies upon approval
- Most major insurances and 3rd party payers
- Bankers Life and Casualty
- CIGNA Healthsprings
- Delaware Medical Insurance
- Health Options Plan
- Highmark Health Options
- Independence Blue Cross
- Keystone First
- Keystone HMO
- Pennsylvania Medicaid
- TriCare for Life
- United Healthcare
- United Healthcare Community Plan