How to Check Your Insurance Coverage, Step-by-Step Guide
Below is a step-by-step guide on how to call and ask your insurance company about your coverage benefits for a bracing product as well as if the product requires an pre-authorization. Note that in some cases, SOS will perform this if the brace is known to be needed for surgery or routine treatment after a surgery.
- Locate the insurance company phone number and call that number. In most cases, the contact number is located on your insurance card, along with your plan information.
- Ask for benefits regarding a DME or Bracing product. They will ask for a billing code, which SOS will provide for you. You can also contact SOS for that billing code prior to contacting your insurance company.
- Items that you will need to ask your insurance company about: Is the item covered by your particular plan? What is the percentage that your particular plan is covered? What is your financial responsibility? Does your particular plan have a deductible? If so, how much has been met and how much is remaining? Does your particular plan require a pre-authorization for this product? If yes, please contact SOS and let us know that it does and we will obtain a pre-authorization.
- Prior to ending the phone call, please be sure to document all the information as well as the individual that you spoke to and a reference number for the phone call.
Does My Insurance Cover a Brace?
SOS understands that insurance coverage is a complicated situation for many people as there are a lot of details behind the answer. In many situations, SOS will attempt to pre-authorize the brace and check the benefit details if the brace is known to be needed ahead of time, such as for a surgery or a high cost item. SOS will communicate that information to you and your financial responsibility prior to fitting you for the product.
Can I Try the Brace First, Then Decide if I Want it?
Per federal regulations, any bracing product that SOS may dispense for you is considered a one-time medical use item. That means that once the product has left the office, we cannot return it if you do not like it or do not wear it (Please see the Warranty and Return Policy section for more details). SOS will never force you to take a bracing product if you do not initially want it and SOS can provide a prescription for you to receive at an outside location. If you are unsure, please make sure that you discuss your options with your physician prior to accepting the product. SOS has bracing specialists that are well-versed in explaining a product to you and assisting you in making an informed decision, so if you are unsure please ask your SOS physician to set up a fitting appointment to explain the product in detail.
How do I Know that My Insurance Covers a Brace?
SOS will attempt to pre-authorize and check the benefit details of products that are known to be needed ahead of time, such as for a surgery or high cost items. You can call your insurance company prior to receiving the product to check the benefit details and if a pre-authorization is needed for your particular plan so you are comfortable in knowing that your product is covered and what your financial responsibility is for the product. A step-by-step guide is above on how to contact your insurance company and receive this information. However, the benefit details are not a guarantee of coverage per insurance policy as they will define medical necessity and final coverage determination for that product.
What Happens if My Insurance Does Not Cover a Brace?
SOS realizes that not every insurance plan will provide coverage for bracing products. In some cases, you can appeal that decision to your insurance company. However, if you do not have coverage for bracing products through your insurance company, SOS can provide a prescription for you to receive the brace at an outside location so you have the freedom to choose where you receive the product, if at all. If you would like to receive the product through SOS and it is determined that there is no insurance coverage for the product, SOS will attempt to provide the brace at a discounted rate and will ask for payment at the time of fitting.
Additional questions about insurance coverage? Contact the DME/Bracing department at (315) 703-3479.