Funding - Face-To-Face Questions
Q: What is the Face-to-Face requirement?
A: As a condition of payment, insurance requires a physician document a Face-to-Face examination with a beneficiary prior to prescribing Durable Medical Equipment (DME). Speech generating devices are considered DME, and therefore, a recent physician’s visit must be on file within 6 months of the speech device prescription date.
Q: I recently had a doctor’s visit for the flu. This should satisfy the requirement, correct?
A: Possibly. The requirement would be met only if the physician also examined and/or discussed treatment for the diagnosis resulting in the need for the speech device. For example, if your physician only treated your flu symptoms and did not discuss the need for a speech device, you will need to arrange a separate office visit.
Q: I usually see a Nurse Practitioner within the practice. Do I need to switch to a physician?
A: No. Insurance allows the Face-to-Face exam to be conducted by a Nurse Practitioner, Physician Assistant or Clinical Nurse Specialist.
Q: I have never heard of this requirement before. I receive other medical equipment, and no other company has mentioned this. Is this a speech generating device policy only?
A: No, the Face-to-Face requirement applies to other DME items including hospital beds, oxygen, nebulizers and wheelchairs.
Q: I just saw my specialist. Do I really need to go back to my general doctor?
A: There is no need to see your general doctor if your specialist examines you, makes notes in their records about the communication impairment, and writes the prescription. But if your specialist did not treat or examine you for the communication disorder, another visit will be needed.
Q: I have an HMO through a private insurance company. Does this requirement apply to me?
A: Maybe. Most Commercial Insurers have their own medical necessity criteria. Tobii Dynavox has a team of funding associates who review each file to ensure the medical records meet the criteria of your insurance company. At the current time, most insurers are not requiring Face-to-Face exams. For the most up-to-date information on your insurance plan’s criteria, please contact your insurance company.
Q: How will you know the physician recorded my last visit? Will you call my physician, or do I need to ask my doctor’s office for documentation?
A: The Tobii Dynavox prescription form contains a section for the physician to note the date of your last visit. In most cases, the Funding team at Tobii Dynavox will also contact your physician upon receipt of your funding request to confirm the Face-to-Face requirement was met.