A: A wide range of health insurance policies and health care plans provide reimbursement and/or coverage for durable medical equipment from Synergy Orthopedic. In order to know what is covered by your specific health insurance plan or policy, you will need to review the benefits and coverage under your specific plan.
Member Services representatives from your health plan or health insurance company are available to assist you with the review of your benefits and coverage amounts for services and durable medical equipment. Be sure to check your insurance card for the best telephone number to reach them for questions and information on coverage.
You will pay the balance due by the member (patient) after the insurance claim is processed and member (patient) applies any deductible, copayment, coinsurance, or non-covered service.
You are responsible for paying the full amount of any healthcare products or services that are not covered by your health plan.
Your deductible is the amount you owe for health care services before your health plan will start paying for your health care. Depending upon your specific insurance policy or health plan, the deductible may not apply to all services. Be sure to check your insurance card for the best telephone number to reach them for questions and information on coverage.
Co-payments are the fixed amount you pay for a covered health care service or supply. For example, $15 for a doctor visit. Be sure to check your insurance card for the best telephone number to reach them for questions and information on co-payments.
Co-insurance is your share (a percent) of the costs of a covered service. For example, if your co-insurance is 20%, and the service cost $100, you pay $20. You will need to check with your insurance company or health plan to find out if co-insurance applies to durable medical equipment from Synergy Orthopedics. Be sure to check your insurance card for the best telephone number to reach them for questions and information on co-insurance.
A non-covered service is determined by an insurance plan when the service is not considered to be medically reasonable to the patient’s condition and reported diagnosis will not be covered. Be sure to check your insurance card for the best telephone number to reach them for questions and information on co-insurance.
If your health plan does not cover all or part of Synergy Orthopedics services or products, some of these services may qualify for payment through a flexible spending account, health savings account, or health reimbursement account offered by some employers.
Product Pricing (or fees) is determined by each individual insurance plan under their contracted Fee Schedule with Synergy Ortho. Once your health insurance claim is processed, your insurance plan will review individual Health Insurance Coverage and determine the portion the insurance will pay and the portion that should be billed to the member (patient).
Synergy Ortho will send a bill to Medicare or the appropriate health insurance provider. If the patient qualifies for Medicaid, Synergy Ortho will send a bill to Medicaid. For more information on covered items, click here [LINK to resource]
The HCPCS Code stand for the “Healthcare Common Procedure Coding System” and is used to submit a claim to the insurance company for the product and/or health service a member (patient) receives during their medical visit.
For Durable Medical Equipment (DME), this code is determined by the Medicare Pricing, Data Analysis and Coding (PDAC) system a government office. PDAC works with manufacturers to review and determine the HCPCS assigned to each DME for claim submission purposes.
Synergy Orthopedics is a Medicare accredited company, as well as, independently accredited by the BOC Accreditation. At Synergy we take great pride in our Highly Rated Status as an accredited provider.