
"So I bought one of your products and I was wondering if insurance will cover this." This is probably the second most common thing heard in the store (with the first being "You need a bigger sign") so I thought that if people in the store are asking this, so might our online readers.
Let me first start out by saying:
WE DO NOT BILL INSURANCE. At least for most items in our store.
And the reason why is incredibly simple: Doing so would cost us both time and money. With so many providers and plans available, it's very difficult to know what your insurance will and will not cover, which is why we leave this responsibility up to you guys. Realistically, we would have to dedicate 2 people to phone duties, alone. At this time, we feel that we can effectively serve your needs in other ways, with ways like super-speedy shipping, and info-taining blog articles.
The other part of this issue is that even if your insurance DID cover a product for you, chances are they wouldn't reimburse all of it. We would probably loose money on the deal, making it hard to keep the lights on. With that said, if you decide to bill the insurance, let me first start out by saying "good luck". Secondly, I offer you this guide to help assist your insurance-claim-journey, should you choose to accept it.
Let us use the example of an ankle sprain suffered while you were out playing ______ with _______ (I loved
Mad Libs growing up!):
1) You sustain your ankle injury. You curse, swear, and maybe even cry.
2) You go see a doctor/nurse/
PT/Athletic Trainer/Chiro/etc.
3) They listen to your story, how you injured it, take a look at the body part, poke around the skin, and maybe even move the joint around to figure asses the damage.
The health care professional has successfully diagnosed you, with a mild ankle sprain. It's at this point, do they assign a corresponding diagnosis code to your file. This is known as an
ICD-9 code. For instance, most sprained ankles are a 845.00
This is one number that you'll need to have if you decide to make a claim for insurance reimbursement.4) Like a game show, you probably received some lovely parting gifts after your visit with your health care professional. One of them was undoubtedly a bill, and the other was a course of action to make you better. This could be anything from a drug prescription for anti-inflammatories to an
ankle brace, crutches, and physical therapy (if it's bad enough).
Sometimes health care professionals might even recommend 2 ankle braces: an
Air Cast with crutches to diminish swelling, and then a
lace-up ankle brace for activities of daily living (ADLs). Unfortunately for you, these braces and crutches were not part of the package and told you to find your own.
Obviously you knew better than to go to a sporting goods store, so you turned to the internet to help you out, and you came across our site.
Like the diagnosis, the product that you need to get will also have a corresponding code, known as an
HCPCS code. For our ankle example, the corresponding HCPCS (or "hick-pick" as the industry calls them) for the
Air Cast is L4350 and for the
ASO-style ankle brace it's L1902.
This is the other code that insurance will ask you for when you submit a claim.If you have ADD/ADHD and/or don't like to read, here's a quick summary of what you'll need when going for medical reimbursement:
-ICD-9 Code
-HCPCS Code
-A copy of the prescription (not necessary but handy to have when filing)
-A copy of the receipt/invoice/packing slip, showing the item you bought with the description and how much you paid.
*DISCLAIMER* As I previously mentioned, not all insurance companies are the same. This is just a general guideline and neither myself nor B&A Sports Medicine make any promises, claims, or warranties about the accuracy/effectiveness of the previously outlined process. Again, it's a general guideline. There are people dedicated to insurance reimbursement, and even they aren't 100% successful.
If you don't have the time/desire to mess with insurance and their reimbursement programs, might I suggest try using your flexible spending card. It should work. Labels: Ankle Sprain, flexible spending, HCPCS, ICD-9, insurance, reimbursement