We participate with many insurance companies and are in the network providers for most. Please feel free to contact our office regarding your specific insurance plan. In today’s health care market, coverage for prosthetics and orthotics can cary greatly with the type of insurance you have. Some require referral or authorization; a few require pre-certification. At or prior to your first visit we will contact your insurance company to ascertain your particular insurance coverage and/or requirements. We will advise you of this information and we will make every effort to comply with your insurance company’s requirements to ensure proper coverage.
The following is a list of insurance coverage we are familiar with:
Medicare HMO’s of Advantra, FreedomBlue, Gateway Medicare Assured, SecurityBlue, UnisonAdvantage, UPMC for Life
PPOBlue, DirectBlue, KeystoneBlue, PreferredBlue, EOPBlue, Blue Card Claims, Indemnity Major Medical, Signature 65 and MedigapBlue
UPMC Commercial Plans
HealthAmerica and HealthAssurance
Medicaid, including Medicaid HMO’s such as Gateway Health Plan, UnitedHeathcare of Pennsylvania (formerly Unison), UPMC for You
In general coverage for prosthetics and orthotics is as follows:
We are a participating Medicare provider. Medicare has a deductible then generally covers 80% of approved charges. The patient is responsible for the balance. If you have secondary coverage with Medicare, they will often pick up a percent of Medicare's approved charges after that. Some are billed directly by Medicare after Medicare has paid their portion while others have to be billed separately, with a copy of the Medicare explanation of benefits (EOB). Again, we do this for you.
If we are "in network" for your Health Maintenance Organization (HMO), they usually have referral or authorization requirements. They usually have a co-pay. If we are not "in network" for your HMO, but you have "out of network privileges" you can still get coverage. In this case, you may have a deductible in addition to co-insurance. Each program varies therefore we coordinate with your insurance carrier to verify your exact coverage and any requirements.
In general, PPO and POS plans have less strict pre-certification authorization and referral requirements and allow more coverage for physical therapy. They generally have a co-pay if "in network", co-insurance and deductible if "out of network". Again, each program varies therefore we coordinate with your insurance carrier to verify your exact coverage and any requirements.
Traditional insurance companies generally have no pre-certification requirements. Patients generally pay a deductible and then a percentage of charges (i.e., 20%). As always, each program varies therefore we coordinate with your insurance carrier to verify your exact coverage and any requirements.
Depending on your Worker's Compensation, authorizations are sometimes required before we are able to provide our services. We will contact your worker's compensation carrier and verify & and comply with any requirements.
Care must be exercised because benefits are often exhausted and in that case any secondary insurance requirements must be addressed prior to providing services.
Regardless of your insurance type, we submit bills to your insurance carrier for you. We ask that you pay your co-pay, deductible, and/or co-insurance at each visit unless other arrangements have been made. We accept cash, checks, MasterCard and Visa.
We make every effort to verify benefits and notify patients of their responsibility at the time of treatment. Final determination of payment is made by your insurance company upon receipt of the claim. Patients are ultimately responsible for payment of their claim and by assuming responsibility you will demand the best and that is what we expect to give.