This is a question we hear frequently, and we understand why! The significant costs associated with medical equipment can be stressful and burdensome for AAC users and their loved ones. It’s helpful for people to have an idea of what types of costs they may be facing as early on in the process as is feasible. Unfortunately, it’s nearly impossible for us to accurately estimate potential out-of-pocket costs for communication devices because this amount depends on several factors, including:
- The insurance plan(s). Different insurance providers cover AAC systems at varying levels (ranging from no coverage to 100% coverage). Having secondary or tertiary insurance coverage can also affect an individual’s out-of-pocket costs (i.e. a primary insurance might not cover a communication device at all, but a secondary insurance might).
- Medical plan use. The extent to which a device is covered can also be affected by how you have made use of your medical plan so far this year.
Once a funding packet is submitted to us, our Funding Team runs a benefits check with the patient’s insurance(s) to determine if the billing code for high-tech communication devices (E2510) is covered. They also verify the deductible(s) and co-insurance rate(s) for the insurance plan(s). If, based on that information, our team suspects a large out-of-pocket cost, we will send you an “Insurance Verification Form” when we submit the prior authorization to insurance.
The “Insurance Verification Form” will provide you with the information we learned about the details of the insurance coverage.
We will answer any follow-up questions you might have, and you can decide how you would like to proceed with the rest of the funding process (continue the funding process or pause/cancel).
We will only officially know what insurance will pay once they have finalized the claim submission. At that point…
- If you have no outstanding payment, the device will be “converted to order,” added to our production schedule. It will be shipped to you once it’s complete!
- If you have a remaining out-of-pocket payment, we will contact you to provide a detailed cost breakdown. We realize that access to effective communication is a basic human right, and we want to do our best to ensure that large out-of-pocket costs are never a reason that someone is denied access to a voice. Should you have a remaining payment that would result in undue financial hardship, there are alternative funding sources that you can access to help cover the cost.
Questions? You are more than welcome to reach out to your local Assistive Technology Specialist: Find a Specialist | Forbes AAC | Augmentative Communication
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