What is “in network” and how does that work?
Many insurance companies have existing contracts with retailers of Durable Medical Equipment. These retailers compose the “network” of providers that your insurance company wants you to buy your medical equipment from. It is often a requirement of the policy that you purchase your prescribed DME through the network providers (“In Network”) in order to get your maximum reimbursement. Every policy is unique, but here are the most common scenarios:
- In Network required - Your reimbursement will be maximized if you purchase “In Network”. If you decide to purchase from outside of the network, your reimbursement will be less. This is very similar to the Preferred Provider policies adapted by many PPO’s.
- No “In Network” requirement – meaning you can purchase your medical equipment anywhere you choose and your reimbursement will not be affected.
My insurance company requires me to buy “In Network”. Now what?
First off, don’t worry – this is a common scenario. It might require a bit more effort on your part, but it isn’t difficult. Here’s what you do:
- Get a listing from your insurance company of the network of providers that you may purchase from. Typically these are local resellers, but they might also be national companies or even mail order. Any of these examples are fine. Typically, you will be directed to a page in the insurance company’s website that lists the network providers.
- Also find out the reimbursement policy if you try to purchase In Network but cannot. This is important – many insurance companies provide higher reimbursements if you purchase In Network, however, if your equipment (in this case, iWALKFree) is not available In Network, then the insurance company will provide the same reimbursement if you purchase the device outside of their network (since you don’t really have the option of buying it In Network). The distinction here is that you cannot comply with their In Network terms, not that you choose not to comply (i.e., you choose a non-network provider).
- At this time, find out the “Out of Network” reimbursement policy. You want this in case you voluntarily choose to buy iWALKFree from outside their network.
- Choose a provider from the list. Ideally, it will be a locally convenient provider, however, if you cannot find a local provider, don’t worry about geography. Call the provider and ask them if they have or can get the iWALKFree. If they can, then place your order through them. Some DME retailers also will process your medical insurance claim for you, so ask them if this is available. Note – if the provider asks for an insurance billing code, tell them it is E0118.
The DME retailers say they cannot get the iWALKFree. Now what?
For now, we’re not widely known, so it’s not uncommon for the DME retailer to not know about iWALKFree. That doesn’t mean that they cannot obtain one. We are fully equipped to supply your In Nework DME with the iWALKFree, in fact, we do it all the time. If your selected DME says that they cannot get the iWALKFree for you, then ask to speak to a manager and inform them that we commonly sell single units to DME’s to assist our customers in just this sort of circumstance. We have a quick, easy way for them to make a single purchase to fulfill your order. All they have to do is call us at 905 238-7630 and we can process the order. In many instances, we can also drop ship the device directly to you, their customer.
If you opt to purchase outside of network, then make sure you get a receipt for your purchase. You will need it when filing your insurance claim. Insurance companies often have specific requirements as to how the device purchased is described on the invoice, and it varies from one insurance company to another. |
|
