05 Nov Navigating Insurance Coverage For M+D Crutches

M+D Products have been approved for reimbursement by private insurance and Medicare/Medicaid. Click here to learn more.

If you’re curious about medical insurance and how coverage and reimbursement work, you’re certainly not alone, whether you are:

• injured / recovering from surgery and using mobility aids for a short-term,
• a long-term user who has a life-long condition (amputation, conditions like Multiple Sclerosis, Ehlers Danlos Syndrome or EDS, Cerebral Palsy, Spina Bifida, RA, etc.),
• someone who’s looking at a future procedure whose recovery requires crutches.

Whichever category you fall under, you have probably dealt with medical insurance and reimbursement. In fact, your insurance company is probably one of your most frequently called numbers these days. We’re here to help you navigate the purchase of your M+D Crutches or Combo Stix and maximize your possible insurance reimbursement.

Keep reading if you want to get reimbursed for the cost of your M+D Crutches or Combo Stix and if you:

• are covered by a private medical insurance company such as Blue Cross Blue Shield, Cigna, United Healthcare, Aetna, or others,
• are covered by Medicare or Medicaid
• use a Flexible Spending Account (FSA) – annually through your employer,
• manage your own Health Savings Account (HSA)–in conjunction with high-deductible insurance,
• contribute to a Health Reimbursement Account (HRA) – to cover expenses not covered by insurance.

.

Full Coverage and/or Reimbursement

M+D Products have been approved for insurance coverage and reimbursement! Now getting your M+D Crutches or Combo Stix partially or fully PAID FOR by your insurance is easier than ever but still requires a few steps on your part. M+D products – M+D Crutch and Combo Stix – are medical devices and insurance companies categorize them as Durable Medical Equipment, or DME for short. Many insurance carriers, like Blue Cross Blue Shield and Medicare/Medicaid, already have M+D products in their database and with one phone call can confirm the amount of your coverage for crutches and give you an in-network DME store where you can purchase them so that they are covered by your insurance.

Step-by-step guide:

• What is my coverage? Call your insurance carrier and tell the representative you want to find out what the coverage is for crutches (or if you want to impress with your vocabulary, ask if “Durable Medical Equipment” or “DME”) within your particular plan and for how much. Coverage varies between states and individual plans and the representative will confirm the details of your specific scenario. The following CMS HCPCS codes (Healthcare Common Procedure Coding System) were assigned to M+D Products and may be relevant and helpful for confirming coverage:
  • E0110 – Crutches, forearm, includes crutches of various materials, adjustable or fixed, pair, complete with tips and handgrips (pair)
  • E0153 – Platform Attachment, forearm crutch, each

.

Do you need a prescription? More times than not you will need a prescription so while on the phone with your insurance rep, ask if your doctor needs to write a prescription? If so, what is the exact language required? Ask if the phrase “medically-necessary” is required.  This is sometimes what makes the difference between an insurance plan approving M+D Crutches or Combo Stix versus typical, old-school crutches that cause pain and discomfort in your wrists, shoulders and armpits. Your doctor should agree that preventing secondary and tertiary injuries by avoiding axillary (armpit) crutches is “medically necessary,” but might need a reminder to actually write that down in the prescription. And if there’s any question, share our PSI study results with your medical professional.

If your insurance requires a prescription, tell your doctor to include the following language when writing it for your M+D products:

• Specify the product by name: M+D Crutch or Combo Stix.
• Indicate the patient’s needs, for example:
  • Must be ‘non-weight-bearing’ or ‘need assistance for Safe Mobility’
  • Needs Hands-Free mobility and/or crutch with platform option due to:
    • Neuropathy, especially in hands, wrists, shoulders
    • Severe carpal tunnel syndrome, wrist injury, etc.
  • Needs to increase mobility to achieve/maintain/increase Disability Living Allowance (DLA)
  • Include the language “Medically Necessary”

.

IMPORTANT – For all insurance reimbursements, you will be required to purchase your M+D products through an “in-network” DME store, and Mobility Designed (or Amazon) may not be in-network with your insurance. Your insurance will connect you with an approved in-network DME store that can sell you the product and process your insurance paperwork on your behalf – that’s what they do! If you have any questions about where to buy M+D products you can always click here or email info@mobilitydesigned.com.

Download helpful information for submitting a reimbursement claim to your insurance, including an insurance code for M+D products and beneficial statistics about the M+D Crutch and Combo Stix. Click here for M+D Crutch and here for Combo Stix.

• Remember, you’ll need an invoice from an “in-network” or approved DME. If you purchase your M+D product through the Mobility Designed website or Amazon, your insurance may decline to cover or reimburse your purchase. Only DMEs can process insurance claims, M+D and Amazon can’t.

The majority of plans provide some coverage for crutches but if your insurance plan doesn’t, keep reading for possible alternatives: FSA, HAS, and HRA.

FSA – Flexible Spending Account (or Arrangement)

FSAs are accounts set up through your employer to pay for medical and dental expenses not paid for by insurance, usually deductibles, copayments, and coinsurance for your (the employee’s) health plan.

Over-the-counter medical devices, such as M+D Crutches ARE an allowable expense. So, if you have some money left to spend this year, you can make your purchase now. If you don’t have enough left in your FSA for this year , include the cost of the crutches in the total amount you set aside for the upcoming year during open enrollment (typically between November 1 and December 15). Taking advantage of FSA means you will get your crutches with pre-tax money, which is the same as buying them at a discount! [for example, if you pay 30 percent in taxes you just got a 30 percent discount!]

(Note: Mobility Designed isn’t giving you the discount. You’ll still pay full price for the crutches up front, but since you are paying from pretax funds, it’s LIKE a discount. Yes, it’s confusing, but your financial advisors would tell you it’s a wise move!)

HSA – Health Savings Account

Another option is to pay for your new (or refurbished) M+D Crutches through your HSA funds. You may have one of these accounts if you have a high deductible insurance plan. This type of account is owned by the individual, and the money rolls over from year to year and even after you leave your job, so you don’t have to be quite as precise with your yearly medical expense estimations.

Unlike an FSA however, you must already have money in your HSA account before you can spend it. So, make contributions to your HSA first, then use your HSA card just like you would any other credit card to purchase the crutches on our website. Or pay with any debit or credit card, we’ll give you a receipt, and you can submit that to your insurance for an HSA reimbursement. Similar to FSA, HSA is also a way to pay for the M+D Crutches with pre-tax money and (when it’s all said and done) possibly save up to 40 percent! (depending on your tax rate)

HRA  – Health Reimbursement Arrangement

This one is owned and funded by your employer and reimburses employees tax-free for eligible out-of-pocket medical expenses, including individual health insurance premiums….and crutches! You might have this in addition to an HSA. It works like this:

• The company sets HRA contribution amounts and designs the plan.
• Employees incur medical expenses.
• Employees submit a reimbursement request (usually to a third-party HRA administrator).
• After approval, the company reimburses employees tax-free for the approved expense via payroll, check, or direct deposit.

.

Feeling better and having more freedom to move around and stand comfortably is NOT a luxury. The longer you use regular crutches, the greater the chance of secondary injuries – damage to shoulders, wrists, hands and/or nerves! We don’t recommend waiting until you meet your deductible or another full year until your circumstances change. After considering all of your payment sources, if a new pair isn’t in the budget, consider purchasing a pair of refurbished crutches.

Most states require insurers to pay claims in 30-45 days. If you succeed in your crutches being partially or completely reimbursed by insurance, share your story with us so we can celebrate with you!