Navigating the Insurance Reimbursement Process
You can either complete the claim yourself or choose to have a billing person complete the claim for you. We have outlined the steps you would complete to get your reflux positioning products paid by your insurance company, or we have sourced a billing person who can do the work for you if the process turns out to be too time consuming, confusing, or frustrating. Her information is at the end of this article.
Completing Your Insurance Claim Yourself
Because each insurance company and each insurance plan is different you need to start the process by calling the 800# on the back of your insurance card. Be aware that depending on the person you get and their knowledge you may get a different response. If you don't necessarily get the response you want the first time call back in a few hours and talk to a different representative. Some of them will be more helpful and creative than others. Don't give up until they all give you the same answer. Before you call have your insurance card with the plan number and the diagnostic codes for the products you are interested in purchasing in front of you.
Call the customer service number on the back of your insurance card. Tell them that your baby has been diagnosed with reflux and you are inquiring to find out if they cover some infant positioning products that your physician or therapist has recommended. Give them the url (http://www.pollywogbaby.com/cat--Infant-Positioning-Products--Positioners.html) and the particular products you are interested in.
Diagnostic and equipment codes (HCPS codes) by product:
The first number, 530.81 is the diagnostic code, meaning reflux. The second number is the equipment code. If your insurance company tells you that E1399 is too general a code ask them if they cover the equipment under the codes E0190 for wedges and E0621 for slings. If needed I can reflect those codes and split out the cost on your bill to work with your insurance company.
They may also require a procedure code which you will get from your physician or therapist. Most insurance companies will have you purchase the items and then download a claim form from their website to submit a claim for reimbursement. Ask them to walk you through the process so you have no surprises or delays in receiving reimbursement. Our tax ID number is 20-0666520.
Some insurance companies will require you purchase your items from an "in network" provider but if you can prove to them there is not one in your area they frequently will cover the items from an "out of network provider" (typically someone not in your city or state) as well. You may need to submit a letter from the manufacturer that they do not have an authorized manufacturer in your area. If this is the case please email me and I will do my best to get a letter for your item(s). If they don't make an exception for when there is no one in network, ask them for a list of approved DMEs (durable medical equipment companies) and start phoning them to have one of them purchase from us.
Some insurance companies will also require you submit a letter of medical necessity from your doctor. You can download a sample letter of medical necessity here. This letter is drafted for the RESQ wedge but you can customize it to suit your needs. You will need it to be signed by your baby's doctor.
If your insurance company does not cover these items they may be covered under your pre-tax cafeteria plan (IRS Section 125).
If your process turns out to be different I would love to hear from you so I can update this article and help more parents!
Feel free to email firstname.lastname@example.org or phone 866-332-0958 (only between 8 a.m. and 5 p.m. Pacific Time please!) with any additional questions and I'll try my best to help you.
Have Your Claim Completed For You
If the insurance reimbursement process is turning out to be too time-consuming for you our resident billing specialist, Barbara Fernandez Bussa can do it for you. Barbara has been a medical billing specialist for six years and can be reached by email or phone (305-494-6449). Minor billing charges apply only if you receive reimbursement. All billing charges and payments for them go directly to Barbara, I recommend her services purely as a benefit to you and make no money from so doing.
Wishing you hugs,
Does your baby cry every time you try to put him down?
Visit our online store for a complete line of feeding and sleeping wedges as well as other products handpicked for babies with infant acid reflux. Our wedges are covered by most insurance.