Bioworks is eager to help you save time and money and make optimal use of your health insurance. However, with the complexity of health insurance policies today, and the constant changes made by insurers and employers, keeping up-to-date on every policy is difficult for us. When possible, we do let you know what we know about certain carriers or policies, even when a certain product or services is not covered.
So we are encouraging you to understand the limits and requirements of your health insurance. This is critically important when you are or a family member is referred to a durable medical equipment (DME) supplier.
How Health Insurance Deals with DME
Many DME referrals require prior authorization by your insurance company, which means that your insurance company may reject the cost of the merchandise provided to you, unless they have been notified and provide approval in advance. Many carriers no longer allow you to obtain the DME before notifying them and get authorization later. Many insurances are denying these “retroactive” authorizations.
Not only do virtually all insurance companies differ in their requirements and coverage, but their policies and procedures are constantly changing. We strive to contact all insurance companies prior to you receiving your item, that way we can have your claim processed properly and the best way for you. While we try our best to keep current with developments in health insurance, you are the only person who can know everything about your particular policy at any given time and with particular treatments are equipment.
How You can Avoid Health Insurance Issues
Please review your policy and become familiar with all its requirements. Call your insurance carrier whenever you are going to the doctor or you are anticipating needing to make a DME claim. Our insurance and billing staff will be available to you as you need services and DME from Bioworks.
Some Things to Remember about the Billing Process
- Prior Authorization does not guarantee payment.
- If insurance tells you an item is a covered benefit, that still does not guarantee payment; insurance companies must first determine medical necessity before paying the claim.
- Claims are not submitted until item is received (that is your bill date).
- We must have a prescription prior to billing insurance but that does not prove medical necessity; insurance companies have their own stipulations.
- If you claim does get denied we can offer you percentage off of your bill.
- We will also work with you and the insurance company for any appeals that need to be done for denied claims.
- If your claim is applied towards your deductible or co-insurance, we can not take any additional amount off of your bill.
If you have any questions, call us at 513-793-7335. Thank you!
The BIoworks Staff
photo credit: www.freeimages.com, photographer Marcelo Moura