Thursday, August 28, 2008
Whats the reimbursement process? -
im going to buy this medical machine for home use. i want it to get it reimbursed. can someone help me and tell me the process of getting it reimbursed by my insurance company? thanks. First, call your insurance company to see if they WILL reimburse you for it, and under what conditions. Then, you have to meet those conditions - usually a letter of medical necessity from your doctor. And you get reimbursed the contract amount, not how much you pay for it. It's easier to just work through the insurance company in the first place. If someone is trying to sell you something now, with a promise that your insurance company will cover it - well, they're SELLING, and you're buying. There's no guarantee that the insurance company will cover it. It's a common fraud perpetrated on people who are too fast to blame the insurance company instead of the salesman. For Durable Medical products...you normally need a prescription from your doc and then authorization from your insurance carrier. Some carriers require that you use a specific DM facility. That DM will file the necessary paperwork for reimbursement. If they allow you to use any DM facility or pharmacy, and they are participating with your plan, they will submit the claim to get you reimbursed. If not they will give you the form to file yourself. You will need all receipts of payment. You'd better find out if its covered and get the reimbursement approved before you buy it. Otherwise, they may deny it. Call the number on your insurance card and ask them what their process is and if the item you are buying is reimbursable. Usually they'll send you a form that you or your doctor's office fill out, then you send that with your receipt of purchase to the insurance company. If it's approved, they'll send you a check (minus any copays or deductible). If you're buying the item through a home health care pharmacy, many times the pharmacy will do the billing for you and you'll just have to pay the copay.
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