Three Step Process
Insurance Billing
Thank you for visiting Brunner HealthCare’s online store. Most online health care and medical equipment stores do not allow you the ability to fully utilize your Medicare Insurance. At Brunner HealthCare our goal is 100% customer satisfaction, with that in mind, we will bill your Medicare for eligible items. It is a simple process that will get you reimbursed directly from Medicare.
Not sure what is covered? No problem, if an item is Medicare eligible, you will be prompted upon purchasing the product whether or not you would like us to bill your Medicare.
Medicare typically reimburses up to 80% of an allowable amount, which varies by product category and state. Due to the fact that Brunner HealthCare’s prices are below most allowables, you will most likely be reimbursed 80% of the Brunner HealthCare price. Also, our always-low prices will help you pay a considerably less amount for your 20% co-pay. You can contact a Brunner HealthCare billing specialist before you place your order to determine the allowable amount(s) for any product(s) you are considering purchasing.
All Medicare billing is handled as a “non-assigned claim”, this is also referred to as “courtesy billing”. What this means is that you complete your purchase with Brunner HealthCare and working with a billing specialist, we obtain all necessary documentation from you and your physician and we file the claim on your behalf. This will result in you being directly reimbursed in typically 30-120 days.
Brunner HealthCare can file claims for customers whom have Medicare as their primary insurance and we can typically notify you of what your reimbursement will be. If you have a HMO or PPO as your insurance, we can still file a claim, but cannot guarantee reimbursement for the following reasons: You may have not met your deductible yet and/or Brunner HealthCare may be an “out of network” provider, thus decreasing your chances of being reimbursed.
Eligible items include: Lift Chairs, Power Wheelchairs, Scooters, Walkers, Rollators, Commodes and Quad Canes.
Insurance Billing Process with Brunner HealthCare
1. You complete your order with Brunner HealthCare paying with credit card, check or money order. If it is an eligible item, you will be prompted to decide whether or not you wish for us to bill Medicare on your behalf. If you select yes, you will be contacted by a customer service representative to receive the following information:
· Insurance Company Name
· Name as it appears on the card, ID # and Group #.
· Date of birth
· Insurance company claims mailing address and service phone number
2. Brunner HealthCare will email, fax or mail you the HIPPA release form, which allows Brunner HealthCare the ability to retrieve any and all relevant information from your physician and/or insurance company to assist us with getting your product covered. We will also need a prescription from your physician in order to bill.
It is important to get these documents signed and returned to Brunner HealthCare ASAP, we cannot bill on your behalf without it. There may also be other documents signed depending on what product(s) is purchased. Finally, we must receive the prescription and applicable documents before the product(s) can be delivered.
3. Once we have received all necessary information/documents, we will file the claim with your insurance company within 3-7 business days.
Coverage Criteria
Power Wheelchairs and Scooters:
In order for the customer to be eligible for reimbursement, the following criteria must be met:
· The user must have mobility limitations, which prevent him/her from performing daily activities such as: eating, bathing, grooming, or going to the bathroom.
· The user must demonstrate the ability and compliance to safely operate the product.
· No other walking aid (cane, walker/rollator or manual wheelchair) alleviates the issues with mobility.
· The users living conditions must have ample space to allow the user to perform daily activities without continued limitations.
· There cannot be other conditions that limit the user from performing daily activities, such as impairments of cognition/judgment and/or vision. If these issues can be solved with other solutions, including caregiver support, the user may not be eligible.
Lift Chairs
Lift chairs are not a Medicare covered item, but the seat lift mechanism is. Typically, the reimbursement for the seat lift mechanism is around $300.00 depending on which state you live in.
In order for the customer to be eligible for reimbursement, the following criteria must be met:
· The patient must have severe arthritis of the hip or knee, or have a severe neuromuscular disease.
· The patient must be completely incapable of standing up from a regular armchair or any chair in their home.
· The prescribing physician must list that the seat lift mechanism is a cause of treatment to enhance/improve the customers’ condition.
· Medicare requires that the physician ordering the seat lift mechanism must be the attending physician or a consulting physician for the disease or condition resulting in the need for a seat lift.
1) Eligibility
Determine your eligibility for reimbursement of your healthcare products cost by contacting Brunner HealthCare, your local Medicare State Agency or click the following link to find out more, Medicare Eligibility Tool. Please contact your Medicare State Agency for more details. If you do not know the telephone number for Medicare, please go to Medicare Contact Page.
2) Simple PDF Form
If you are eligible for reimbursement, you will need to file a FORM CMS-1500.
Click here to download a printable version of Form CMS-1500
(You will need the latest version of Adobe Reader. Get the latest version here)
The CMS-1500 form and instructions are used by non-institutional providers and suppliers to bill Medicare, Part B covered services. Please contact your Brunner HealthCare or your local Medicare State Agency for more details. If you do not know the telephone number for your Medicare, please go to Medicare Contact Page.
3) Select Your Region
Locate your processing center to send in your completed CMS-1500
Region A DMERC
United Healthcare
PO Box 6800
Wilkes-Barre PA 18773
800-842-2052
Region B DMERC
AdminaStar Federal
PO BOx 6128
Indianapolis, IN 46206
800-270-2313
Region C DMERC
Palmetto GBA
PO Box 100236
Columbia, SC 29202
800-213-5447
Region D DMERC
CIGNA Healthcare
PO Box 950
Nashville, TN 37202
800-899-7095
