If your insurance company does not typically cover “Durable Medical Equipment” or a “pre-authorization” is required, it may be necessary for you to supply your physician with a copy of this Doctor’s Letter of Medical Necessity template, and ask if they have time to create a personalized version of this for you on their stationery, or have them simply fill in the blanks. There may be a cost for this. You can make this request at the same time you get a prescription. You may also be required to submit your medical records and past insurance claims; also available from your physician’s office.
Once this work is complete, there are two approaches:
1. Make your claim directly to your insurance company.
This is the simplest approach, but will require that you pay for the product in advance, then be reimbursed by your insurance company. Because there is no intermediary, this will ensure the lowest possible product cost to your insurance company and minimize the deductible that you will have to pay. You may wish to complement your claim with a letter to your insurance company using this Patient’s Letter to Insurance Company template. This is your opportunity to make a “business case” for acquiring the device. In other words, based on your usage of drugs and other costs, will the device pay for itself? If you need a “Proforma Invoice”, please contact Solarc Systems and we will fax or email one to you promptly. Once your claim is approved, you will receive an authorization letter from your insurance company. Then submit your order to Solarc online. The product will be shipped directly to your home and include a signed and dated invoice that you can use as proof of purchase. Complete your claim by submitting the invoice to your insurance company for reimbursement. Keep a copy of the invoice for your own records.
2. Go to a local “Home Medical Equipment” (HME) supplier.
This is a company that deals in supplies like wheelchairs and home oxygen, and could even be the pharmacy you use now. The HME can deal directly with your insurance company, and eliminate the need for you to pay for the product in advance. The HME collects from your insurance company, and in turn purchases the product from Solarc. Solarc then normally “drop-ships” the product directly to your home, but in some cases the HME will make the delivery. Solarc traditionally compensates the HME by providing a discount off the standard price. However, the HME may also substantially increase the price further to your insurance company, which could result in a much larger deductible. The deductible and any other amounts are normally payable to the HME before the product will be shipped. The HME will need the following information:
- Patient legal name including middle initial
- Patient date of birth
- Name of insurance company
- Insurance company address and phone number
- Insurance web site address if known
- Member Identification Number
- Group/Network number
- Employer name or ID#
- Name of Primary Insured. (This is when someone is covered by a spouse or parent)
- Primary Insured date of birth
- Primary Insured address if different
- Name of Primary Care Physician (PCP) (often different than prescribing physician and many times necessary to place the referral) Primary
- Care Physician (PCP) phone number
- Solarc product & contact information (use Solarc’s “Standard Information Package”)
- Device CPT / HCPCS “Procedure Code” listed above. (E0694, E0693 or E0691)