Posts From October, 2009


What is durable medical equipment? 

Thursday, October 15, 2009 12:35:51 PM
  Durable medical equipment is sometimes referred to simply as DME.  This type of equipment:   Can be used repeatedly Is medically necessary   DME can include prosthetic limbs, walkers, canes,... read more

Trends in workers' compensation funding for prosthetics 

Thursday, October 15, 2009 12:20:04 PM
  Like all other funding sources in this economy, workers’ compensation carriers have begun to focus more on cost containment. Unlike an amputation due to vascular disease, cancer, or congenitaldefect, injured workers who... read more

Prosthetic Parity Act 5615 

Thursday, October 15, 2009 12:17:43 PM
  The Prosthetic Parity Act (HR 5615) aims to guarantee amputees reasonable coverage forprosthetics under employer-funded and group health plans. The bill must travel through several levels of approval before being considered in the... read more

Does Medicare Cover Prosthetics? 

Thursday, October 15, 2009 12:15:33 PM
  For the most part, Medicare provides excellent coverage for prosthetic services.  Of course, that 20% coinsurance can really drain a beneficiary's saving's account.  Many people assume, because they are on Medicare, the... read more

Insurance FAQs By O&P Business Solutions 

Thursday, October 15, 2009 12:12:24 PM
  “Specializing in Business, Compliance, Claims & Billing & Administrative Practices in Orthotics &Prosthetics”                 ... read more

Life Care Plans 

Thursday, October 15, 2009 12:09:45 PM
  An orthotic/prosthetic Life Care Plan, sometimes referred to as a Lifetime Care Cost Projection, refers to the estimated cost of care for an individual for a lifetime of orthotic and/or prosthetic services.  This is an... read more

Primary Care Physician 

Thursday, October 15, 2009 12:08:34 PM
  A primary care physician, or PCP, is a physician who provides both the first contact for a person with an undiagnosed health concern as well as continuing care of varied medical conditions, not limited by cause, organ system,... read more

How often can I get a new orthosis (brace)? 

Thursday, October 15, 2009 12:07:28 PM
  Replacement orthosis are determined by the individual insurance policy.  There are some policies that will not allow you to get a new orthosis during the first five years, stating five years is the reasonable useful lifetime for the... read more

Are shoes and inserts covered durable medical equipment? 

Thursday, October 15, 2009 12:05:23 PM
  Insurance companies process shoes and inserts under 2 different categories:  orthopedic and therapeutic.   Orthopedic Shoes are considered shoes that are Oxford, high top, depth inlay, or custom non-diabetic shoes. ... read more

Do insurance companies cover foot orthotics? 

Thursday, October 15, 2009 12:03:48 PM
  Inserts and other shoe modifications are usually covered if they are on a shoe that is an integral part of a brace and if they are medically necessary for the proper functioning of the brace.  Some insurance companies... read more

Do you need a referral to obtain orthotic and prosthetic... 

Thursday, October 15, 2009 12:01:25 PM
  With most HMO plans a referral is required for services rendered.  Some plans determine if a referral is required based on the cost of the item, while others require referral for all items prescribed. read more

Is a prescription required for orthotic or prosthetic... 

Thursday, October 15, 2009 11:54:52 AM
  Insurance companies require a prescription or dispensing order is required from the treating physician before a device can be dispensed to the patient. read more

What is a coinsurance? 

Thursday, October 15, 2009 11:34:58 AM
  Co-Insurance   A co-insurance is often referred to as a share-of-cost.  The co-insurance is a percentage of the insurance company’s allowable charge for a service.  For example, if an insurance company’s... read more

What is a deductible? 

Thursday, October 15, 2009 11:33:05 AM
  The amount of a loss that an insurance policy holder has to pay out-of-pocket before reimbursement begins in accordance with the coinsurance rate. read more

What is a PPO? 

Thursday, October 15, 2009 11:29:06 AM
  A PPO is a Preferred Provider Organization. A health care organization composed of physicians, hospitals, or other providers, which provides health care services at a reduced fee. PPOs may offer more flexibility by allowing for visits to... read more

What is a co-pay? 

Thursday, October 15, 2009 11:27:09 AM
  A co-pay is a portion of patient financial responsibility set by the patient’s insurance company. Different benefit types may have different co-pay amounts. For example, an insurance plan may impose a $20 co-pay for a primary... read more

What is an HMO? 

Thursday, October 15, 2009 11:25:35 AM
  An HMO is a Health Maintenance Organization. This is a type of managed care organization that provides health insurance coverage that is fulfilled through hospitals, doctors, and other providers with which the HMO has contracted. Only visits ... read more

Are cranial remolding helmets covered? 

Thursday, October 15, 2009 11:16:59 AM
  Each insurance company has there own determination as to whether or not cranial helmets are covered.  Each insurance company has different criteria that need to be met in order for the helmet to be considered medically... read more

Florida VOC Rehab IMPORTANT Update 

Thursday, October 15, 2009 11:11:33 AM
  The Division of Vocational Rehabilitation (VR) is one of the best kept secrets in the orthotic and prosthetic industry.  VR agencies vary from state to state and can be included in various larger divisions, such as the... read more

Prosthetic Coding Playing Detective 

Thursday, October 15, 2009 10:49:06 AM
  Confused about the explanation of benefits for a single prosthesis, where there may be fifteen different charges? Each component of a prosthesis is listed separately on the bill to the insurance company… everything... read more
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