.

Coverage Rules - Patients and Products

If you, or any member of your team is not 125% sure that an item will be covered, PLEASE CALL 724-537-5717. You can't give out products that won't be covered. Integrated wants to help you make sure what you dispense will be paid for, you'll get enough money, and the diagnosis is acceptable. There are strict guidelines and Integrated helps you "clear the hurdles". Look at our ALMOST ALWAYS COVERED, ALMOST NEVER COVERED list. In no time at all you will become familiar with which products are covered. You can also look at past monthly reports, view our website, or PLEASE CALL. It's much better to know it's a cash sale than have to bill the patient after the claim is denied.

.

Just because a patient gives your their red, white and blue Medicare card, THAT DOES NOT MEAN THEY ARE MEDICARE! My mother-in-law whips that card out everywhere she goes and she hasn't been Medicare in 10 years! Medicaid patients can be dropped from their coverage, but they will show you a valid card. You should say these words" Are you sure you are Medicare, not some Medicare HMO plan?" or "Has there been any change in your insurance coverage?", and "Have you ever had this item before?". Just about the only time it doesn't work and you don't get paid is because we where told to bill Medicare and the patient isn't Medicare. If the patient has had the same product before there are issues as well that have to be addressed. If the carrier is Medicare or Medicaid in your state we do not need copies of the cards. We do need to know the complete address and insurance numbers for all other carriers but usually don't need a copy of those cards either. We believe you, so please don't send us copies insurance cards.

.

Just because the patient brings you a script for a high-strength, light-weight wheelchair, DOES NOT MEAN THAT MEDICARE WILL PAY FOR IT! There are qualifications for all but the most basic products that have to be met to dispense some products, particularly the more sophisticated or expensive ones. Other items require specific diagnosis or prior procedures, like SURGICAL DRESSINGS which require open Decubitus Wounds. Even if a patient says to you "but I called Medicare and they said they pay for Surgical Stockings", you might not be able do them because there had to be surgery performed before Medicare will pay for TED Hose. Again, until you are familiar with the products and the hurdles, PLEASE CALL. We believe you, so please don't send us copies of the physician's script. If we need it or other doctor info, we will contact you.

.