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.
Accreditation
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.
There are several reasons your brace may be delayed. In many cases, we are working to obtain the documentation required by your insurance company to approve coverage. Delays may also occur while we wait for prior authorization, receive a response from your insurance provider, or if the item is on order and awaiting shipment from the manufacturer. Our team works diligently to keep the process moving and will keep you informed of any significant updates.
Generally, braces are not returnable for any reason but please contact our office to have your account reviewed. To review our return policy, click here.
Unfortunately, we cannot accept returns as the reuse of medical supplies is prohibited by Federal Law. Therefore, returns of medical supplies are only accepted in cases of manufacturer defect. To review our return policy, click here.
This is a fee for delivery and education on the proper use of a continuous passive motion machine. Depending on your insurance, it may be a covered benefit but often times is a fee paid by the patient.
No, a script is not needed if you choose to pay for the item but please note, a cash sale cannot be submitted to the insurance for reimbursement later.
When your brace or durable medical equipment (DME) is billed through your insurance, we are required to follow the reimbursement rates established by your insurance carrier based on our contracted agreement with them. These rates are determined by your insurance company and are not set by Synergy.
The products we provide are medical grade, clinically approved devices that are prescribed by your healthcare provider and are professionally fit to help ensure proper function, comfort, and effectiveness. Our team also works directly with your insurance company, manages the billing process, and provides support if questions or issues arise.
While you may find similar looking products online at a lower price, many consumer-grade products that are not professionally fitted, are not billed through insurance, and may not meet the same quality standards. In some cases, online products may be open-box or previously returned items, making it difficult to verify their condition or quality.
Although online options may appear less expensive upfront, they often do not include the clinical expertise, insurance services, product quality, and ongoing support that are part of the care you receive through Synergy.
The item you received is a covered benefit under your insurance but is subject to your plan’s specific deductible, coinsurance, or copay amount. Your doctor’s office billed for the office visit and Synergy Orthopedics is billing for the durable medical equipment your doctor ordered.
The bill you received is based on your insurance plan’s fee schedule. The retail price is different than an insurance fee schedule. When a claim is submitted to your insurance plan it is subject to their fee schedule (also named Allowed Amount or Contractual Amount) and is subject to your plan’s specific deductible, coinsurance, or copay amount.
Bills can be paid in a variety of ways:
- Through our website, synergyortho.com
- Over the phone at 610-292-8400
- Via check and mailed to 920 Germantown Pike, Suite 210 Plymouth Meeting, PA 19462
Yes, please call our office to set up a payment plan. Our customer service team is ready to assist at 610-292-8400.
There are 2 ways to get started with Synergy. If you have a prescription from your doctor and your insurance cards, you can click on the “fill script” link on our website, enter your basic demographic information and upload a photo of your script and insurance cards. Once your order has been submitted, one of our representatives will contact you within 24-48 hours.
If you don’t have a script, or are unsure, you can call our office, and our customer service representatives will walk you through the process.
Synergy Orthopedics supplies a wide range of orthopedic braces for injury recovery, post-operative care, and long-term joint support, including products for the knee, ankle, foot, wrist, elbow, shoulder, spine, and fracture care. We are vendor-neutral, meaning we work with a variety of trusted DME manufacturers. The treating provider ultimately selects the vendor and product that best meets each patient’s clinical needs, while we focus on proper fit, education, and timely delivery to support the best possible outcomes.
Many insurance plans do not cover post-operative shoes because they are often considered a temporary recovery item rather than a covered piece of Durable Medical Equipment (DME). While your provider may prescribe a post-op shoe to help protect your foot and support healing, insurance coverage is determined by your individual health plan – not by your physician or Synergy Orthopedics.
Coverage varies by insurance company and policy. Some plans may provide coverage in certain situations while others specifically exclude post-op shoes as a covered benefit. If your insurance does not cover the device, you may be responsible for the cost.
To help make treatment more affordable, Synergy Orthopedics offers a Time of Service (TOS) cash price of $25 for the post-op shoe.
If you have questions about your benefits or would like to better understand your coverage, please contact your insurance carrier.
A walker and a walker boot are two different devices that service different purposes.
A walker is a mobility aid with handles and legs or wheels that helps you maintain balance and stability while walking. It is commonly used after surgery, injury, or when you need extra support to walk safely.
A walker boot is a protective brace worn on your foot and lower leg. It is designed to immobilize and support the foot or ankle while allowing you to walk during the healing process after certain fractures, sprains, tendon injuries, or surgeries.