After you have provided all appropriate information through forms provided by our Innovative Clinic staff, our experienced office staff will verify your benefits with your insurance carrier to determine the amount of coverage available for your orthotic or prosthetic services. If needed, our staff will also obtain prior authorization from your insurance company. Our office staff will then be able to provide you with an accurate estimate of your portion of the costs prior to your orthotic and prosthetic service being provided. Payment for your personal or out-of-pocket portion is expected at the time you receive your service.
Innovative Clinic accepts several methods of payment – check, credit card or money order.
Financing is also available through CareCredit. CareCredit is a GE Money company that offers no-interest and low-interest payment plans based on your needs and budget. For more information about CareCredit visit www.carecredit.com.
As part of our commitment to service to you, we will make every attempt to verify your insurance benefits at the time your services are rendered. However, insurance verification or authorization is not a guarantee of insurance payment. This only allows our office to provide you with a preliminary estimate of any monies due by the insured on or before the time of delivery of the device. Your patient portion is subject to change based on final claim determination by your insurance carrier.
How is Insurance is Handled at Innovative
Most of the orthotic and prosthetic services provided by Innovative Clinic are covered by health insurance, including Medicare Part B. The amount of coverage available for services can vary quite a bit depending on the type of policy you hold. If you have more than one insurance plan, it is possible that the entire cost of your care could be covered.
In most cases, some percentage of “co-pay” is required to be paid out-of-pocket by the patient at the time the orthosis or prosthesis is delivered. Before your first appointment, it is a good idea to visit with your insurance company, or prospective insurance company, to understand exactly what benefits are available for O&P services.
Working closely with your healthcare team is also beneficial and can help to maximize your benefits.
Together we can assess your needs and abilities, which will assist in determining the most appropriate orthotic and prosthetic device for your lifestyle. This may also give additional leverage when working and/or negotiate with your insurance company.
How is Medicare Handled at Innovative:
Innovative Clinic has tremendous experience working with the Medicare program. Our comprehensive understanding of reimbursement, regulations, and procedures help us to answer your questions regarding eligibility, bills, deductibles, and Medicare notices.
Medicare will pay 80% of its “fee schedule” for covered orthotic and prosthetic services, after your annual deductible has been met. Generally there are no caps on types of technology covered by Medicare, as long the orthotic or prosthetic device is medically appropriate, is prescribed by a treating physician, and otherwise meets Medicare’s coverage criteria.
Again, it is very important to work closely with your healthcare team to determine which prosthetic or orthotic product is the most appropriate for your lifestyle.
What is In-Network Provider:
A health care provider on a list of providers preselected by the insurer. The insurer will offer discounted coinsurance or co-payments, or additional benefits, to a plan member to see an in-network provider. Generally, providers in network are providers who have a contract with the insurer to accept rates further discounted from the “usual and customary” charges the insurer pays to out-of-network providers.
What is Prior Authorization:
A certification or authorization that an insurer provides prior to medical service occurring and typically contingent upon eligibility, medical necessity, and benefits however not a guarantee of payment.
What is a Referral:
A recommendation to consult the (professional) person or group to whom one has been referred; “the insurance company says that you need a written referral from your physician before seeing a specialist”.
Innovative O & P offers Plans on various treatments.
Children’s Helmets are an example of our in house payment plan to help our patients and their health needs