“Will my insurance cover the rental cost?”
This question can best be answered by the patient’s insurance company, but our experience has shown that rental fees can possibly be covered by private insurance companies, at least partially, provided that a pre-certification or prior authorization is approved by the insurance company.
OWL is an out-of-network provider of durable medical equipment; therefore, the rental is patient’s responsibility upfront including any and all additional rental time.
OWL Leasing has been informed by Medicare that the post-operative Vitrectomy support equipment, which we provide is “Not Reasonable and Necessary” and will not be covered. Medicare will deny all payments for this equipment.
Most insurance companies follow the same guidelines as Medicare (even if they are their own private company) and with Medicare denying payments for this equipment, there is a higher chance that other insurance companies will deny payment or reimbursement as well.
If you choose to contact your insurance company about reimbursement, please notify them to check your out-of-network level benefits. If you don’t mention this, they will automatically check your in-network level benefits and those can be different than out-of-network. Also, the code for this equipment is E1399. This is a generic code for Durable Medical Equipment (DME) and it is strictly the only code that is allowed to be used for this equipment. The code can also be called the following:
- CPT Code
- Procedure Code
- HcPcs (Pronounced HicksPicks)
“Will OWL Leasing bill my insurance company?”
Our staff is currently unable to assist with obtaining a preauthorization or filing a claim if requested by the patient. We will automatically provide you with the paid invoice at the beginning/end of the rental, which contains the necessary code for this equipment that is needed for insurance filing. If you choose to file a claim to your insurance yourself, we recommend obtaining the following items:
- Letter of medical necessity from the ordering physician (a copy of this form is located below, and should be completed by your surgeon’s office)
- Clinical/Office notes of your visits (not every insurance company requires these, but they can sometimes be beneficial to obtain anyways).
Again, confirming with your own insurance company on what is required to file a claim, would be the most accurate information you can obtain as each insurance company can require different items or information. Your insurance company would also have the claim form to fill out, if the form is necessary (again each insurance company is different).
Insurance Form(s)
Sample Letter of Medical Necessity (to be Completed by Surgeon's Office)
DISCLAIMER
The Content is not intended to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your physician or other qualified health care professional with any questions you many have regarding a medical condition. Never disregard professional medical advice or delays in seeking it because of something you have read on the OWL Leasing website.