Trying to navigate the world of insurance? Here’s some help. Below you’ll find answers to some of the most commonly asked questions about insurance from patients and parents, answered by our insurance experts. If you have a question not answered here, feel free to call customer service at 800.262.2235 or email them at firstname.lastname@example.org.
Are the products offered by Boston O&P (including scoliosis braces, plagiocephaly helmets, DMOs, orthotics) covered by insurance?
When it comes to insurance coverage, the common concern is: will my insurance cover this? In many cases, the answer is yes. Each insurance plan is different, so we recommend being familiar with your plan and Durable Medical Equipment coverage.
What insurance companies does Boston O&P work with?
Boston O&P accepts most major insurance. Please remember to bring your insurance card and a photo ID with you to every visit. If we are not in-network with your particular insurance plan, a staff member will notify you.
Does Boston O&P determine whether I am covered, or do I have to contact my insurance company directly?
The Boston O&P billing department will verify your eligibility and coverage after your initial evaluation, and will contact you with estimated out-of-pocket costs, authorization requirements or information regarding a non-covered item. We cannot guarantee payment or verify that eligibility of benefits conveyed to us or to you by your carrier will be accurate or complete. Payment of benefits are subject to all terms, conditions, and exclusions of the member’s contract at the time of service. Consult your policy for details regarding terms, conditions, coverage, and exclusions. Your eligibility for particular products and services is subject to the final determination of your insurance company.
Does Boston O&P bill my insurance company directly?
Yes. Boston O&P will submit claims for billable items to your insurance after you receive the orthotic or prosthetic item.
Is Boston O&P a preferred or in-network provider for my insurance company? How do I find out?
You can contact your insurance plan to verify Boston O&P’s participation or you can ask one of our staff members to confirm this information for you.
How often will my insurance company cover a new device if my child outgrows theirs?
Each insurance plan is different and many policies have limitations. Boston O&P will verify your coverage for each device, but we recommend that you familiarize yourself with your policy and unit limitations.
Does coverage vary by insurance company?
Yes. Coverage varies by insurance and even by different plans under the same insurance. If you change plans or insurance companies, we recommend being aware of new policy guidelines.
Do I need to get prior approval from my insurance company or primary physician before I contact Boston O&P?
In most cases, Boston O&P just needs a prescription from your referring physician in order to authorize your device. Any authorizations required by your insurance will be submitted by our billing team. In some cases, your insurance may require a referral from your PCP. One of our team members will reach out to you if we need additional documentation.
What if my insurance company denies coverage or rejects a claim for coverage for a recommended device? Do I have to pay cash for the entire cost?
That depends on why your insurance is denying a claim. In many cases, our billing team will appeal denials on your behalf. You can also appeal claim denials yourself, and our billing team can provide any documentation you need to send to the insurance company to support your appeal. If your insurance denies payment and assigns payment to patient responsibility, you will receive a bill for the cost of the device.
Do I have to pay in full for a device before it is fabricated?
Boston O&P verifies coverage prior to receipt of the device. You will be responsible for any deductible and/or coinsurance or non-covered items due according to your plan, which are due prior to receipt of the device.
When is full payment due for a device?
A member of the billing department will contact you before you receive the device to notify you of your coverage and collect any out-of-pocket cost that is due.
Does Boston O&P offer payment plans?
Boston Brace is pleased to announce that we will be offering CareCredit services to our patients. For details, visit www.carecredit.com/faqs/basics/.