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Medical Insurance Information |
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H.O.P.E.
is a participating provider for:
Things You Should Know About Medical Insurance Orthotics and Prosthetics are categorized as Durable Medical Equipment (DME) Medicare generally pays 80% of the amount billed for DME. In addition, many patients have a secondary insurance with medicare which will cover the remaining 20% for covered services. Most private insurance (PPO's) like HMSA PPO, UHA PPO pay 80% of the amount billed for DME. HMAA plans pay on average 70% of amount billed for DME minus $100.00 deductible. Some HMO's and HMA, Inc., pay as little as 60% for DME. Kaiser Added Choice generally pays 0% for DME. The amount billed is regulated by the government. Prices are not set by the billing facility or practitioner. The patient is responsible for the amount not covered by their insurance. The purpose of secondary insurance is to pay the balance that the primary insurance does not pay. Most private insurances have deductibles for DME that must be met yearly before the insurance company will pay. The patient is responsible for that deductible amount. This means if your insurance has an annual deductible for DME of $300 and you are provided a device which amounts to $300 or less, you will be responsible for the total amount. Foot orthotics and shoes are generally not covered by insurance unless the patient is a diabetic or has had a partial foot amputation. |
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Page last updated: 8/08 |
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