The Medical Monks Guide to Billing Insurance

Medical Monks is, of course, strictly an out-of-pocket medical product retailer. However, we do know a thing or two about insurance billing. Certain regulations and procedures are at play when insurance is involved in any kind of medical care. This is true for an emergency room visit, a hospital stay, surgery, medication, or even a simple trip to your PCP. The kind of medical supplies we provide are no different.

As difficult as it can be to juggle all the considerations involved with your medical care, being prepared will get you further more quickly when it comes to insurance. Unfortunately, most patients aren’t aware of the ins and outs of billing. Many are tripped up by obscure requirements that send them scrambling for paperwork, resulting in unacceptable delays. Add to this situation the fact that no two insurance plans have exactly the same guidelines, the result is far too many people going without supplies that are absolutely essential to their medical well-being.

Through general guidance and referrals to trusted partner companies, Medical Monks has helped many folks transition from purchasing their own supplies to billing through insurance. Below are some tips we’ve learned in the process.

Know Your Insurance

This may seem obvious, but far too many people have little idea of what is covered by their insurance, or even what insurance plan they have.

It’s probably safe to say the majority of Medical Monks’ end users are seniors, which means Medicare. But even if you’re over 65, it’s important to know which parts of Medicare you’re covered by. Nearly all the products we sell (or that you’d receive from our participating partner companies) are covered, when billable, by Medicare Part B. Remember, you are not automatically enrolled in Part B when you hit retirement age. If you’re over 65 and are a US citizen or legal permanent resident, you automatically qualify for Part B. Actually receiving coverage, however, requires you to enroll and pay a monthly premium.

Introducing private insurance complicates the picture even more. Most insurance companies offer plans for Medicare recipients, which can either supplement their coverage (secondary plans) or supplant it (Medicare Advantage/replacement plans). Both types require monthly premiums, and replacement plans are required to provide similar coverage to Medicare.

If you’re not of Medicare age, things are a bit more wild-west. Private health insurance plans, either privately purchased or obtained through your employer, vary much more widely in their coverage. Additionally, various state-level government assistance programs, Medicaid and otherwise, have different requirements depending on the state. These are the situations where it is most important to be aware of what kind of coverage you are allowed and what to expect when attempting to bill medical supplies. Contact your insurance carrier for more detailed information in those areas.

Keep Up with Doctor’s Visits

Billing most kinds of medical supplies is going to depend on prescriptions, which is why it’s important to keep up with regular doctor’s visits. This is a must for those seeking advanced wound care dressings. Medicare requires a qualified medical professional to monitor and sign off on wound supplies every month. If the healing process isn’t tracked properly the patient can be abruptly cut off from billing.

For ostomy and urology patients, too, there are yearly renewals required on the scripts for their supplies. To avoid confusion, provide your billing company with the name of a doctor that you see regularly.

Many folks with ostomies, in particular, have the mistaken belief that their surgeon must sign the script for their pouches. Often they run into problems when renewal time comes along. In many instances the surgeon won’t sign because the patient hasn’t been seen in over a year. In reality your prescription can be signed by any qualified medical professional that has examined you and is aware of your condition. The same goes for those billing catheters and other urological products.

Home Health Care or Physical Therapy May Complicate Things

Home health care is another potential roadblock for billing customers. After a hospital stay, nurses are often assigned to come into patients’ homes for a period to help with recovery. During this time, if you are billing Medicare the nursing agency is responsible for providing any and all medical supplies you may need. This means that any other billing of your medical supplies will be rejected. You will not be able to order from another source until you are discharged.

Additionally, it’s important to note that, under Medicare, your billing will be rejected if you are being seen by any home health provider for ANY reason. For example, imagine you are a catheter user who breaks her leg and needs physical therapy to regain the ability to walk. The physical therapist visiting your home would need to provide the catheters during the time you are under their care.

Similarly, rules apply when you’re billing through a supplier. Through Medicare the billing period is generally 30 days. That means you are allowed one order of a certain amount of supplies and are locked out of ordering again until 30 days after the previous order was placed. Some companies allow multi-month orders, where you’re allowed up to triple the amount of supplies for an up-to-90-day period. If you’ve made an order within that billing timeframe, you are locked out of ordering from any supplier until that period ends.

If you are under another kind of private insurance, all bets are off. Some behave like Medicare and many others allow you to order while being seen by home health or billing elsewhere. Again, it’s best to contact your insurance company to be sure of the guidelines.

Mind Your Autonomy – You Have Choices!

While navigating the complicated world of insurance billing, remember that you have choices. You have a right to choose your insurance provider, and, most relevantly, you have a right to choose the company that supplies your products.

If you’re currently with another supplier and are unhappy with their service, let us know. Our billing support team can answer any questions you may have. If you’re interested, they will access your insurance coverage and refer qualifying folks to one of our trusted partner companies.

The same goes for those who have insurance coverage but have never billed. Whatever your situation, you can trust us to refer you to a hand-picked, conscientious supplier.