Delivering All Your Home Medical and Therapeutic Needs
Will my insurance pay for the equipment I need?
Insurance coverage and payment vary depending upon the individualís policy and medical need. Home Care Medical has experienced insurance verifiers who will verify your coverage and let you know in advance what is covered. They will also let you know what costs you are responsible for that are not covered by insurance.
Will I need a prescription from my doctor for the equipment I need?
Many items require a prescription and a prescription is always needed if we are billing your insurance.
Will you provide financing?
We do not provide financing at this time.
Do you sell used medical equipment and supplies?
No, we do not sell used medical equipment at this time.
Advanced Beneficiary Notice (ABN)
A notice that a doctor or supplier should give a Medicare beneficiary when furnishing an item or service for which Medicare is expected to deny payment. If you do not get an ABN before you get the service from your doctor or supplier, and Medicare does not pay for it, then you probably do not have to pay for it. If the doctor or supplier does give you an ABN that you sign before you get the service, and Medicare does not pay for it, then you will have to pay your doctor or supplier for it. ABN's only apply if you are in the Original Medicare Plan. They do not apply if you are in a Medicare Managed Care Plan or Private Fee-for-Service Plan.
If the provider accepts the approved amount or allowable or accepts assignment, that provider agrees to accept that amount as full payment for the product or service.
Allowable / Non-assignment (Medicare)
The Medicare allowable is the amount of money Medicare pays a provider for a covered product or service. If the allowable is less than the provider is willing to accept, the provider will inform you that they will not accept the allowable and will not bill Medicare. If you want the product or service from this provider, you will be billed and be responsible for paying the provider the retail price of the product or service. When you pay the provider, the provider will notify Medicare and Medicare in turn will either reimburse you directly or notify you that they will not reimburse you for the purchased product or service.
The fee Medicare sets as reasonable for a covered medical service. This is the amount a doctor or supplier is paid by you and Medicare for a service or supply. It may be less than the actual amount charged by a doctor or supplier. The approved amount is sometimes called the "Approved Charge." (See Assignment.)
Assignment of Benefits
An insured individual authorizes his or her health benefits plan to directly pay a health care provided for covered services. Traditional health insurance plans pay benefits directly to the insured individual.
Certificate of Medical Necessity
A form required by Medicare that allows you to use certain durable medical equipment prescribed by your doctor or one of the doctor?s office staff.
Coinsurance (Medicare Private Fee-For-Service Plan)
The percentage of the Private Fee-for-Service Plan charge for services that you may have to pay after you pay any plan deductibles. In a Private Fee-for-Service Plan, the coinsurance payment is a percentage of the cost of the service (like 20%).
Coinsurance (Outpatient Prospective Payment System)
The percentage of the Medicare payment rate or a hospital's billed charge that you have to pay after you pay the deductible for Medicare Part B services.
Coordination of Benefits
Process for determining the respective responsibilities of two or more health plans that have some financial responsibility for a medical claim. Also called cross-over.
What you pay at the time of service. Co-payments are predetermined fees for physician office visits, prescriptions or hospital services.
A health service or item that is included in your health plan, and that is paid for either partially or fully.
The money you or your family must pay from your own funds toward covered medical expenses, usually based on a calendar year. For example, if a plan has a $100 deductible, the deductible is met once the first $100 of the covered medical expenses for that year have been paid by you. After that, the plan begins to pay toward the cost of covered health care services.
The amount you must pay for health care before Medicare begins to pay, either for each benefit period for Part A or in each year for Part B. These amounts can change every year.
Explanation of Benefits (also called a Summary Notice)
A statement provided by the health benefits administrator that explains the benefits provided, the allowable reimbursement amounts, any deductibles, coinsurance or other adjustments taken and the net amount paid. You typically receive an explanation of benefits with a claim reimbursement check or as confirmation that a claim has been paid directly to the provider.
With a qualifying diagnosis and proper documentation (prescription, certificate of medical necessity) some products may be billed to Medicare, Medicaid and/or private insurance. View a partial list of the insurance companies Home Care Medical can bill.
Reminder to Home Care Medical clients:
If your insurance carrier or coverage changes, please let ReliaCare's client accounts department know immediately. Doing so will avoid unnecessary charges to you for covered items. You can reach our client accounts department at 804-458-2818 or 800-804-2818
Generally, an out-of-network benefit provides a beneficiary with the option to access plan services outside of the plan?s contracted network of providers. In some cases, a beneficiary's out-of-pocket costs may be higher for an out-of-network benefit.
Health care costs that you must pay on your own because they are not covered by Medicare or other insurance.