Luna Medical, Inc. will verify each patient’s insurance coverage before any products are considered for home management of his/her lymphedema. Any financial obligations will be clearly explained to the patient.
A “Notice of Privacy Practices” (HIPAA) form will be signed by the patient or guardian prior to verification of insurance benefits.
Many patients have insurance plans that will only pay a certain dollar amount per year for all medical products, known as a cap per year. It is relevant to work with a company such as Luna Medical that practices cost containment.
An “out-of-network” provider of lymphedema products is one which has not contracted with the insurance company for reimbursement at a negotiated rate. Some health plans, like HMOs, do not reimburse out-of-network providers at all, which means the patient will be responsible for the full amount charged by the provider. Other health plans offer coverage for “out-of-network” providers, but the patient responsibility would be much higher than it would be if you were seeing an “in-network” provider.
An “In-network” provider of lymphedema products is one which has contracted with the insurance company for reimbursement at a negotiated rate. This expedites the authorization process and provides members the insurance coverage that they are entitled to:
We are “in-network” with Anthem, Blue Cross Blue Shield, Cigna, Humana, Multiplan and Tricare. We are also “in-network” with many other insurance companies and insurance networks as well, feel free to contact us for an updated list.
Medicare: Unfortunately, Medicare does not pay for our products so patients must pay for their medical products by credit card or check prior to order placement and distribution.
- Secondary Insurance: If a patient has a secondary plan to Medicare, we can assist them in getting possible reimbursement for their medical products. All payments will be subject to any deductibles and/or coinsurances due in accordance to the plan provisions. Plans such as Tricare, BCBS Federal, etc. usually have these types of benefits. These secondary plans are offered to patients from former employers. The secondary insurance will consider picking up as the primary payer with proof of a denial from Medicare. We will file a claim electronically to Medicare for a denial and subsequently to the secondary insurance with proof of the Medicare denial. Any possible reimbursement will be mailed directly to the patient.
- Supplemental Insurance: If Medicare denies a claim, the supplemental insurance will also deny the claim.
Medicare Replacement Policies: These plans are administered by a health plan and act as an HMO. Since these plans will follow Medicare guidelines, they will not pay for lymphedema medical products.
Private Pay: We offer discounts to patients paying “out-of-pocket” for lymphedema medical products.
In some events we will need to submit an authorization requests to an insurance company we are in-network with. We handle everything for this and depending on the insurance it can take anywhere from 5-30 business days for them to approve the authorizations. Which in the meantime means we cannot place any requested order. Insurance companies do not always take that long but we want everyone to understand that in extreme cases they can take up to 30 days to be approved. If for some reason we are out-of-network with the insurance company, we will ask the patient to pay out of pocket first then we will go through the steps mentioned and if approved and billed the insurance company will reimburse the patient or we will once we receive the payment.