On this page you will find answers to Insurance and Billing questions. Please read below to answer most of our popular questions. If you cannot find the answer to your question here please review our other Frequently Asked Questions pages, email us at info@anodynerehab.com or call us at 952-546-5334 or Toll Free at 1-800-736-8367.
Insurance and Medicare Questions
What is Medicare?
Medicare is a Federal health insurance program for people 65 years or older, certain disabled people, and people with end stage renal disease (ESRD).
Do you accept Medicare or other forms of Insurance?
Yes. We are contracted with Medicare and most insurance companies. We will file all claims to all insurance companies on your behalf for all of our items. Here are a few of our contracted insurance companies: Minnesota Medicaid (MA), Blue Cross Blue Shield, HealthPartners, Medica, Medicare, Metropolitan Heath Plans, Preferred One, Select Care, Ucare, and many other insurance companies.
Do you assist with Medicare and Medicaid claim processing?
Yes. We will complete all of the Primary and Secondary claim filing for all Medicare and Medicaid products, as well as all other insurance plans.
What is a Medicare deductible?
A deductible is the amount you must pay each year before Medicare begins paying its portion of your medical bill. Medicare has two separate deductibles, one for the Hospital Insurance and Hospital Claims (Medicare Part A) and one for the Clinical Insurance and Clinic Claims or Doctors visits and services (Medicare Part B). Your deductible reduces the amount Medicare pays for the claim, passing that amount onto the patient to make the remaining payment. Medicare will no pa on any claims until you have met 100% of your annual deductible. If you have any questions on the status of your deductible please contact Medicare at 1-800-MEDICARE (1-800-633-4227).
Will my insurance cover a lift chair?
Insurance companies need a doctors order stating that the lifting mechanism is medically necessary. Insurance companies, including Medicare, will only consider payment on a lift chair if the proper paperwork is obtained and approved. Insurance will only pay for the mechanical part, the actual lifting mechanism, the physical chair is passed onto the patient and will be your financial responsibility. Please contact our customer service department for a quote on our lift chairs at 952-546-5334 or Toll Free at 1-800-736-8367.
Will my insurance cover a scooter?
Insurance companies need a doctors order or a prior authorization stating a scooter is medically necessary and will be used primarily in the home to perform mobility related to daily activities. Coverage can vary from insurance company to insurance company, you will want to contact your insurance company directly for benefit coverage and to assist you in obtaining a prior authorization. Use of a scooter outside the home is not considered medically necessary and would not be covered.
The process to obtain a prior authorization includes a mobility specialist bringing a scooter into your home for a home evaluation. During this evaluation we will document that your home is scooter accessible or what recommendations we have to make your home scooter accessible. We will also document that you have the ability to operate a scooter through the main areas of your home.
Is a scooter supplier supposed to waive my coinsurance or Part B deductible?
Medicare law requires that we collect all co-insurance and copay amounts from our patients and customers. We are bound by law to collect these amounts as a supplier of durable medical equipment, such a power wheelchair's, scooters, lift chairs, ect.
A deductible is the amount you must pay each year before Medicare begins paying its portion of your medical bill. Medicare has two separate deductibles, one for the Hospital Insurance and Services (Medicare Part A) and one for the clinic insurance, doctors services and visits (Medicare Part B). Your deductible reduces the amount Medicare pays for the claim, passing that amount onto the patient to make the payment. Medicare will not pay on any claims until you have met 100% of your annual deductible. If you have any questions on the status of your deductible please contact Medicare at 1-800-MEDICARE (1-800-633-4227).
What is "assignment" on the Medicare Plan and why is it important?
A doctor or supplier that agrees to accept assignment of the Medicare allowed amount as payment in full must agree to Assignment of Medicare Benefits. If is an agreement between Medicare and Anodyne stating that Anodyne will accept Medicare's allowed amount as payment in full for the supplies (like wheelchair's, scooters, walkers, braces, and ostomy supplies).
The patient is responsible for the coinsurance and deductible amounts. If you have both Medicare and Medicaid coverage, Anodyne must accept Assignment of benefits for your supplies.
Why is assignment important when choosing a power wheelchair or scooter supplier?
If you choose a supplier that does not accept Medicare assignment you may be billed up to 15% more for the wheelchair or scooter. when you choose a supplier like anodyne that accepts assignment you are only paying for you co-insurance and deductible amounts. Medicare is paying for the difference and Anodyne is accepting assignment for the remainder of the balance. This saves you money, as there is no limit to the amount a supplier can charge you if they do not accept assignment. You may have to pay the entire balance for the Wheelchair or Scooter (both your portion and Medicare's portion).
Using a Power Wheelchair or Scooter Supplier that accepts assignment is cheaper for the patient, therefore it's recommended that patient seek suppliers that accept assignment such as Anodyne Inc. Always ask a supplier if they are enrolled in Medicare and accept Assignment. Suppliers who are enrolled in Medicare must accept assignment. If they aren't enrolled in Medicare, Medicare will not pay your claim.
Doctors Orders and Prescriptions
Do I need a prescription to get a supply?
Certain covered items can be reimbursed by Insurance only if the doctor has furnished Anodyne Inc with a written prescription for the item, before delivery. There are multiple items that require a prior authorization or prescription. Please contact us Toll Free at 1-800-736-8367 or Locally 952-546-5334 if you have any questions on orders and prescriptions you need for specific products.
Important Note: If the item is prescribed after the purchase date, the claim will be denied.
Do you accept verbal orders from physicians?
Anodyne Inc can only accept verbal orders on some items in certain instances. we are required to follow-up and obtain a detailed prescription from the physician to have on file for documentation. If the verbal order is for disposable supplies, which are to be supplied monthly on an ongoing basis, we will only dispense the first month on a verbal order. we are required to obtain the written script for all orders after the first month. anodyne Inc will work with you and your physician to get all of the necessary documentation before the next reorder date.
What is a detailed prescription?
A detailed prescription supports the need for a specific product or service. It is a document provided by your physician. The document must include the patients name, Date of Birth, description of the item or service, length of need (if applicable), and must include the physicians signature and date.
My doctor wrote a detailed prescription for my item, is it covered by insurance?
Even thought your provider completed the detailed prescription it does not mean that it will be covered by insurance. every insurance carrier has different coverage criteria for every item. Many items which are covered y one insurance, are not a covered benefit under a different insurance. Anodyne Inc. will be happy to verify your benefit and coverage criteria before any service is rendered. some insurances also require specific doctor orders or Prior authorization.
What is a certificate of Medical Necessity?
A Certificate of Medical Necessity (CMN) is a form required by Medicare authorizing the use of certain durable medical items and equipment prescribed by a physician. This form is to be completed by your doctor or the doctors employee. Anodyne Inc will coordinate with your doctor to see that all the necessary information is submitted to Medicare. a change in prescription and/ or a change in your condition requires that an updated certificate be completed and submitted.
What supplies require a certificate of medical necessity (CMN)?
The following items require a CMN:
- Air Fluidized beds
- Continuous Positive Airway Pressure (CPAP) devices
- Hospital Beds
- External Infusion Pumps
- Lymphedema pumps/ pneumatic compression devices
- Osteogenesis Stimulators
- Parenteral and Enteral Nutrition
- Oxygen
- Power Operated Vehicles (POV's) or Scooters
- Seat Lift Mechanisms (for Lift Chairs)
- Transcutaneous Electronic Nerve Stimulators (TENS units)
- Wheelchair's.
Payment Options
What form of payment do you take?
There are various payment options available to pay your copay, deductible, or spend down. We will submit claims first to your insurance company for processing and payment. Once we receive the Explanation of Benefits or a Payment we will bill you for any remaining responsibility. Anodyne Inc will take Visa, MasterCard, or Checks as a form of payment. If you have further questions about our payment options please call us at 952-546-5334 or Toll Free at 1-800-736-8367.
Will you provide financing?
Anodyne Inc does not provide financing at this time. If you need to set up payment arrangements please call our business office at 952-546-5334 or Toll Free at 1-800-736-8367.
Billing Questions
What do I owe when I pick up my order?
All insurance polices are different and each insurance company has specific coverage which may include a deductible or co-insurance. When you place your order, if there is an amount due at the time of delivery, our Customer Service representative will advise you of this amount.
Anodyne Inc will submit claims to your insurance company for processing and payment. Once we have received and Explanation of Benefits or a Payment from your insurance company we will bill you for any remaining responsibility. If you made a payment at the time of delivery, you will only pay the difference in your responsibility and what you have already paid. We will take Visa, MasterCard, or a check as payment. If you have further questions about our payment options please call us Toll Free at 1-800-736-8367 or Locally at 952-546-5334. We do not guarantee coverage by insurance companies until the claim is processed.
We do our best to ask all the pertinent questions so we can educate you to make the best decision for yourself before we advise you of the service or product that best fits your needs. For specific insurance coverage questions, please contact your insurance company directly.
I was told this was a covered benefit and my doctor prescribed it for me, why do I have to pay for it?
Your doctor may prescribe an item or supply for you, but that does not guarantee that the item is covered by your insurance company. Each insurance company determines if it is a covered benefit or not. The insurance company will not guarantee payment until a claim is received and reviewed by their staff.
Why do I owe this bill, I already paid my co-pay to my doctor?
Anodyne Inc supplies home medical equipment that falls under your durable medical equipment benefit of your insurance policy. This benefit pays a percentage of the charged amount so you will owe a deductible or percentage (co-insurance), instead of a copay. You may also have to meet a deductible before your insurance policy will pay any amount. Anodyne Inc will collect the remaining balance after your insurance company has paid their responsibility.