How Insurance Billing Works in the United States.
At Spring Loaded Technology, we work with accredited US-based companies that have long-standing insurance contracts allowing them to bill most private insurance plans, Medicare, Workers Compensation (WC), and Veterans Affairs (VA). With your consent, and in collaboration with our health care provider partners, we offer this service to help bill insurance on your behalf. The process requires that we obtain certain health care information from you, in order to demonstrate medical necessity to your insurance provider.
What is required?
In order to bill your insurance provider, pertinent medical notes and a physician’s written order requesting the brace for you are required. In some cases, additional information may also be requested to ensure a successful outcome.
The following items are critical to a successful billing outcome:
- In the case of most private insurance providers, the VA and WC, medical notes that specify your knee diagnosis (including ICD code) and which document (1) knee instability testing results and/or (2) a requirement for knee extension assistance.
- In the case of a Medicare claim, medical notes must include a requirement for knee extension assistance.
- For all insurance providers, a physician’s written order (or prescription) requesting a knee extension assist brace or the Levitation Tri-Compartment Unloader by name to assist with obtaining the correct information, we can provide you and your doctor an example form including all requirements noted above.
How much is covered?
The coverage amount varies depending on the co-pay and deductible amounts specified by your insurance provider. Spring Loaded and their billing partners can complete a predetermination of benefits with your insurance provider to determine your coverage amount and out of pocket responsibility. While pre-determinations are typically accurate, please note that insurance companies do not guarantee their final payment amount until they formally process the claim. While rare, if your insurance company unexpectedly does not provide coverage after we obtain a pre-determination and bill your plan, we will ask you to remit payment in full, then issue you a payment receipt, allowing you to follow up and obtain reimbursement directly from your insurance provider.
Why your brace may cost less if purchased online
We understand that the pricing of medical products can be a confusing and frustrating experience for patients. Sometimes patients are surprised to find their insurance has been billed more for a product than the prices they see online for the same or similar products.
Spring Loaded has provided state of the art medical equipment to patients for more than 8 years. In order to supply product and bill insurance on behalf of the customers who ask us to do so, we are partnered with numerous regional and national healthcare partners and distributors who are accredited with Medicare and are contracted with hundreds of private insurance carriers across the United States. Whether billing Medicare or private insurance companies, Spring Loaded and their distribution/billing partners are held to a strict set of standards, regulations, and negotiated contracts that govern how the insurance company is billed, and how patients are billed for any unmet coinsurance or deductible amounts.
When one of Spring Loaded’s healthcare suppliers or distribution partners bills insurance on your behalf, there are significant additional services and costs incurred which are not required or incurred when a customer pays for the same product out of pocket at the point of sale.
For example, when a patient asks us to bill their insurance provider, our healthcare and distribution partners typically provide assistance with measurement, professional fitting, and ongoing customer support services. In addition, in order to bill the brace to insurance on a customer’s behalf, we must collect and carefully verify information required by the insurance plan or Medicare to submit a claim on behalf of the patient. It typically then takes months before the insurance company or Medicare reviews the claim and responds to Spring Loaded or one of our partners. In many cases, further analysis and correspondence is then required to ensure the brace is properly paid for under the terms of the patient’s plan, and in accordance with the contracts that are in place with insurance providers. Typically, this process means that Spring Loaded and/or our distribution partners do not get paid for several months, while in some cases it can take more than a year. As a result, there are significant costs associated with insurance billing services. In contrast, when buying a product at the point of sale (out of pocket), there is typically no measurement/fitting services provided, no insurance billing service, no delay in payment, no need for distribution / healthcare partners, and nothing goes toward satisfying the patient’s deductible or coinsurance amounts on their insurance plan.
In summary, items purchased online or out of pocket at the point of sale do not typically contain any of the billing, distribution, service or other costs outlined above which is why online or direct to consumer pricing can be, and typically is, much lower. Patients have every right to choose not to receive the product from a health care provider, and also have every right to attempt collection from their insurance provider directly.
We work hard to provide our customers with a positive and streamlined experience and apologize for any confusion. Often, posts on social media pages for medical supplies are negative because of the perceived pricing disparity. What is not shown are the thousands of patients satisfied by the products and insurance billing services we provide.
We are always happy to talk with patients about their specific cases. Because of patient privacy laws, we cannot discuss patient situations in an open forum like social media. However, we invite you to call our us to discuss your claim at any time, at 1.877.209.8780