FAQ

FAQs

What is the process of obtaining my device?

 1)    Visit your physician for a face-to-face assessment and obtain a prescription
2)    Contact our office to schedule an appointment. At this time we will require your demographic information, such as patient’s name, date of birth, address, telephone number, etc. We will also collect your insurance information at this time.
3)    At your initial appointment, our certified practitioner will review your prescription, evaluate each patient, and will likely cast or measure you that day for your item. 
4)    We will provide you with your out-of-pocket cost. Please know this is an estimate only, based on the information your insurance carrier provided to us. 
5)    Our Authorizations and Records Specialists will begin the process of gathering the required documentation from your physician. Upon receipt, they will then submit documentation to your insurance carrier to obtain prior authorization.
6)    Once we have approval from your insurance carrier and all documentation requirements are met, we will begin fabrication of your device if it’s custom, or place an order for your item from the manufacturer. 
7)    Once the device is finalized, or received, we will contact you and schedule an appointment to come in and receive your item.
8)    At the end of this appointment, you will likely be scheduled for a follow-up appointment to review any issues or answer any questions.

What will I need at my visit?
          - When you arrive for your first appointment, please have the following available:

•  Prescription from your face-to-face visit with your physician
•  Driver’s License or Photo ID
• Insurance Card(s)

-When you arrive for your appointment to receive your item, if you’re receiving a leg brace or insert, please wear or bring supportive shoes. Your practitioner can provide more information regarding this if there are any questions.

Am I required to see my physician in the office, or can I have them call in a prescription to Prevail? 
-Many insurance carriers require Prevail to prove that your physician physically saw you in their office for orthotic or prosthetic assessment. To comply with this requirement, our patients are asked to visit their physician’s office to ensure payment of their device. There are some exceptions to this rule. If you require prosthetic supplies, such as socks or liners, it may not be required for you to visit your physician. Please contact our office for clarification on this guideline. 

After my first appointment, when will I receive my device or prosthetic? 
-This will depend largely on the response time from your physician’s office for medical records/appointment notes, and your insurance carrier’s turn-around time for prior authorization. We cannot submit for prior approval until after we have obtained documentation from your physician. In some cases, an appeal will be required which will add additional time. In most cases, it will take 1-4 weeks to complete all of the insurance documentation requirements and precertification. However, additional time may be required in certain instances. 

Will I be required to pay co-pays for each visit? 
 -No. Prevail only bills for the item itself. Our evaluation, consultation, adjustments,     and follow-up appointments are always free. If a repair is required outside of the warranty period, charges will apply. 

Does Prevail rent any equipment? 
-No. All of our items are worn against the body, and in many cases are custom fabricated. As a result, we do not rent any equipment. 
**Medicare beneficiaries please be aware that is it your right to purchase or rent routinely purchased or inexpensive items of durable medical equipment.

Is Prevail an accredited facility? 
-Yes. Prevail and each of our practitioners are ABC certified. ABC is an accrediting agency also known as the American Board for Certification in Orthotics, Prosthetics, and Pedorthics. We are also recognized as a teaching facility through NCOPE – National Commission on Orthotic and Prosthetic Education.

How does Prevail know my insurance carrier’s guidelines and requirements? 
- Our highly skilled and experienced team of Authorizations and Records Specialists are well versed in documentation and precertification requirements implemented by each insurance carrier. We regularly participate in educational webinars, attend conferences and seminars, and have signed up to receive policy and guideline updates via email. This ensures we’re up-to-date on the most recent insurance guidelines. In addition, we have a certified biller on staff to ensure proper coding and insurance submission.

Will my insurance company pay for my device? 
-There are several factors that will determine insurance payment of your item. Our team will contact your insurance carrier to determine if your item will be covered. Please note: We make every effort to provide each patient with accurate information. Our information is only as good as what is given to us by your insurance carrier. Actual coverage determination will be made by your insurance carrier once the claim processes.  Some items, regardless of if it has been prescribed by your physician, may not be covered. This varies by insurance carrier.

Will I owe money at my appointment? 
-Your cost estimate will be provided to you at your initial appointment. You are responsible for payment before the item is received. Our staff may ask you for payment on the day you are casted, however, in most cases, we will collect payment on the date of delivery. In some instances, payment plans may be available for larger expenses, with half down at delivery.

I have Medicare, or an insurance company that follows Medicare guidelines, are there general guidelines I need to be aware of? 
-Medicare coverage is based on many parameters. A few standard policies are as follows:

·         Unless the item is attached to a brace, or the patient is diabetic with specific complications, Medicare and any company following Medicare guidelines will not generally cover; shoes, shoe inserts, shoe modifications, or brace socks. 

·         Medicare has specific diagnosis code parameters for certain items, such as knee braces, static AFOs, and CROW boots. If the patient has not been diagnosed with one of the approved diagnoses, Medicare will deny. 

·         Medicare will only pay for most braces once every 5 years. They will not cover a replacement brace due to normal wear and tear. They will also deny a change in the style of brace, such as prefabricated to custom. The item must be, lost, stolen, irreparably damaged by an accident or disaster, or the patient must have a significant change in medical condition. If a replacement is needed for one of the approved reasons, the physician must document in their clinical notes if the item was lost, stolen, irreparably damaged, or if there is a significant change in condition.  

·         Medicare requires that each patient is seen by their physician for a face-to-face assessment for new orders of orthotic or prosthetic devices.

Can I return my device? 
-Generally, no. Our items are fit directly to the patient’s body, or are custom fabricated. As a result, items cannot be returned to the manufacturer or used on another patient. If you’re unhappy with the fit of your device, we offer no charge adjustment and follow-up appointments to ensure that you’re comfortable. If there is a fabrication or manufacturer defect, we will replace the item at no charge. See our “warranty” statement for additional information.

Please contact our office with any additional questions.