05 Nov Navigating Insurance Coverage For M+D Crutches
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 the short-term,
- a long-term user who has a life-long condition (amputation, condition like Multiple Sclerosis, EDS or Cerebral Palsy),
- a caregiver of someone who needs short-term or long-term mobility devices,
- or someone who’s looking at a 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 and maximize your possible insurance reimbursement.
Keep reading if you want to get reimbursed for the cost of your M+D Crutches and if you:
- 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, and/or
- are covered by a medical insurance plan.
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.
Total or partial reimbursement
We saved the option most people prefer (but feels the most daunting) for last: getting the cost of your crutch PAID for (partially or fully) through your insurance. While possible, it’s not guaranteed, and requires a few steps. Some of our users share with us that their insurance plans can’t or won’t tell them how much of their M+D Crutches (a.k.a. medical device or Durable Medical Equipment) will be reimbursed until after the individual has purchased them. That is one of the reasons we also wanted to give you information on options like FSA, HSA and HRA, so those can be your fallback options if your crutches aren’t fully covered.
- Is it covered? Call your insurance carrier and tell the representative you want to find out if crutches (or if you want to impress with your vocabulary, ask if “Durable Medical Equipment” or “DME” is covered within your particular plan). Coverage varies between plans and the representative will confirm the details of your specific plan. Make sure to clarify that the M+D Crutch is a “forearm crutch” (although you know it’s so much better!) and has an HCPCS code of E0110. They might also ask for Mobility Designed’s NPI (National Provider Identifier), which is 1598254856.
- Do you need a prescription? While on the phone with your insurance rep, ask what type of prescription (if any) you need to get from your doctor. Does your doctor need to write a prescription with the exact language that includes “medically-necessary?” This is sometimes what makes the difference between an insurance plan approving M+D Crutches versus typical, old-school crutches that cause pain and discomfort in your wrists, shoulders and armpits. Your doctor will 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.
- Click here to download helpful information for submitting a claim to your insurance, including an insurance code for M+D Crutches and beneficial statistics about the M+D Crutch. Remember, you’ll need an invoice and if you purchase your Mobility Designed product through our website, we will attach your invoice to your order confirmation email.
- Keep in mind: If you haven’t met your deductible yet, crutches often fall in the list of items insurance will not cover before your deductible has been met. Consider possible alternatives -FSA/HSA/HRA – that we mentioned earlier in this post. 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!