Funding - Private Insurance Questions
Q: I was informed by my funding coordinator that the approval my insurance company gave us does not meet our guidelines. What does this mean?
A: Imagine receiving a bill in the mail for $2,000.00 because we had to estimate what your insurer was going to pay! Getting the right documentation up front helps to ensure that the claim is paid correctly. If Tobii Dynavox is not a participating provider with your insurer, a written approval from your insurer that provides the following is required: the dates of service that have been authorized, the equipment that has been authorized, the dollar amount that will be allowed on the claim, the codes that they would like us to use on the claim, and the billing address.
Q: I have an approval from my insurance company. How long will it take before my device is shipped?
A: The shipping of your new device will largely depend on whether the authorization that your insurer sent you is compliant with our authorization guidelines. We will also need to collect any co-payments or deductibles before your device is shipped to you. A signed release of information form is also required.
Q: My insurance plan is refusing to list the amount that they will allow for the device. I was informed that we cannot receive our device without this information. What can I do to help?
A: Call your insurance company and speak to someone in customer service to obtain this information in writing then send a copy to Tobii Dynavox. Sometimes a number of phone calls are required by both the member and Tobii Dynavox to obtain the needed information. Don’t give up. It may also help to have your employer’s human resource department call as well.
Q: I have an insurance policy from my employer as well as an insurance policy from my spouse’s employer. How does this work?
A: We will request authorization from both insurers when we receive your funding request. Your funding coordinator will follow-up with the insurance companies to determine how the benefits will be coordinated. A signed release of information form from each policy holder is also required.
Q: My insurance company said that I could not receive equipment from Tobii Dynavox because I have to use an in network provider. Is this true?
A: Maybe. However, most insurers recognize that this is specialized equipment that can only by provided by Tobii Dynavox and a select few vendors. For this reason they will often grant an exception allowing the member to use Tobii Dynavox as a provider at the in network coverage level. Only a handful of funding requests have resulted in the use of an outside vendor at a higher cost for the insurance company.
Q: What if I have Medicaid as well as private insurance? Will Medicaid pick up the co-pay and deductible?
A: Yes, as long as we obtained a prior authorization from them first. Please contact us for more details at firstname.lastname@example.org.
Q: I was asked to sign a release of information form. What does this mean?
A: The signed release of information form allows Tobii Dynavox to exchange the required benefit, authorization and billing information with the insurance company that is necessary to process the funding for the equipment. Without this signed form Tobii Dynavox would not be permitted to collect or release any of your insurance information. The only time you would not be asked to sign the release of information form would be if you were pre-paying in full by check or credit card for your order and our funding department were not processing the funding through your insurance company for you.
Q: When I called my insurance company, they asked me for a procedure code. What should I tell them?
A: Insurers use procedure codes or HCPC Codes for all medical services. If your insurer informs you that speech devices are not covered because they could not find the code in their listing, we may be able to utilize a miscellaneous code. Your benefit booklet will give a better indication of whether they will cover the device.
Q: Can I submit documentation to my insurer myself?
A: In general, insurance companies will accept a request from a beneficiary. However, it is best to use your funding coordinator, as your funding coordinator is familiar with the authorization process and coding guidelines.
Q: Will my insurance company pay for an extended warranty?
A: Most insurers will not cover warranties. Warranties are highly recommended, as they will alleviate a long repair funding process of 2 months or more. If it is possible to pay for a warranty out of pocket, it is worthwhile.
Q: I have an HMO. Will I need a referral?
A: Yes. For most HMO plans, the Primary Care Physician’s office will need to fax us a copy of the referral and assist us in submitting to the insurer or the IPA.
Q: My insurance company won’t review the documentation. How do I know if this will be covered?
A: Without a written approval, we can’t be sure that your equipment is covered. For this reason, we insist that the insurance company provide us with a pre-determination of benefits.
Q: My insurance company called me and said that they are approving our request. I asked for a letter, and they said they don’t provide letters. What should I do?
A: We can provide your insurer with an approval form if they do not want to generate a letter on their letterhead. Either the completed approval form or a detailed authorization letter must be provided for us to ship your equipment.
Q: Can I pay for the Tobii Dynavox device now, and get reimbursed? I don’t want to wait for an approval.
A: Yes. However, please keep in mind that we cannot guarantee that you will be reimbursed without an approval on file. If you choose to submit to your insurer yourself, please remember to fax (866-336-2737) or Email a copy of the documentation to Tobii Dynavox.