INSURANCE COVERAGE AND PAYMENT OPTIONS

WE ARE ONLY CONTRACTED WITH UNITED HEALTH CARE AND WITH MEDICARE DIRECT (NOT THROUGH 3RD PARTY INSURANCE COMPANIES LIKE AETNA, ANTHEM, SCAN, ETC.)

It is the insured’s duty to provide honest and accurate insurance information and to seek coverage determination information from their insurance company. Insurance is an agreement between you and your insurance provider not between your healthcare provider and your insurance. Insurance is not a guarantee of coverage. We cannot render services on the assumption that the charges will be paid by an insurance company. However, we will help in every way we can in filing your claim, handling insurance queries, processing follow-ups, etc., on your behalf. If you have questions about this or any other office policy or procedure, we will be happy to discuss them with you. We value you and will strive to provide you with our best professional care.

Without already having your insurance on file, we cannot check your coverage. The best way to know if you are covered by your insurance for the prescribed services for OUT-OF-NETWORK providers is to contact your insurance company or to provide us with your insurance information to check on your behalf.

Most PPO's only cover a portion of in-network and out-of-network Durable Medical Equipment (DME) Including Ankle Foot Orthotics (AFO's/Braces), Custom Foot Orthotics (FO's), and Diabetic Shoes and Inserts and in most cases coverage only kicks in after your deductible is met.

All HMO's, besides United Health Care, are not accepted at Tenni-Moc's.

PATIENTS WITH MEDICARE

If you are covered by Medicare we happily accept Medicare Assignment and will submit your claims and appeals for you.

COMMON COVERAGE INFORMATION:

PPO

Again, Most PPO's only cover a portion of in-network and out-of-network Durable Medical Equipment (DME) Including Ankle Foot Orthotics (AFO's/Braces), Custom Foot Orthotics (FO's), and Diabetic Shoes and Inserts and in most cases coverage only kicks in after your deductible is met, If it is included in the insurance plan. We are Out-of-Network (OON) with all PPO's and HMO's with the exception of United Health Care. For PPO's - You will need to check coverage and plan benefits with your Insurance provider, This is the best option. We can check with your insurance at the time of your appointment but it could take up the entire appointment time as most insurance companies have long phone wait times and extensive hold times. We can also submit a claim to your insurance on your behalf however you will remain financially responsible for anything not covered by your insurance.

HMO

We ONLY accept United Health Care HMO's. Unfortunately any and all others will not and do not cover anything out-of-network and without referral. You can call your insurance company to get referred to you nearest in-network provider. If you choose to still get care with us, we have payment plans available, offer sign-up for and accept CARE CREDIT, accept HSA/FSA, Cash, and All Major Credit Cards.

The Diabetic Shoe & Diabetic Orthotic Program by Medicare

REQUIREMENTS

A Prescription is REQUIRED and must only be from the following types of physician:

MD or DO like a Primary Care Physician or Endocrinologist
Physician’s Assistant (PA)
Nurse Practitioner (NP)
Clinical Nurse Specialist (CNS)
Podiatrist (DPM) - Most common

A Statement of Certifying Physician is also REQUIRED and must only be from the following types of doctor:

MD or DO like a Primary Care Physician or Endocrinologist

Medicare covers 80%. Your secondary insurance will cover the other 20%.

Typically most other insurance companies follow a similar level of coverage

Medicare Part B (Medical Insurance) covers 80% the furnishing and fitting of either of these each calendar year, if you have diabetes and severe diabetic foot disease:

One pair of custom-molded shoes
One pair of extra-depth shoes

Medicare also covers 80% of either of these:

3 pairs of inserts each calendar year for custom-molded shoes
3 pairs of inserts each calendar year for extra-depth shoes

*Medicare will cover shoe modifications, such as a lift, instead of inserts if shoe modifications are necessary.

We proudly participate in and accept Medicare Assignment.

Medicare will only cover your diabetic shoes if your doctors and pedorthists are enrolled in Medicare. Doctors and pedorthists have to meet strict standards to enroll and stay

enrolled in Medicare. If your doctors or pedorthists aren't enrolled, Medicare won't pay the claims submitted by them. If your pedorthists are participating suppliers, they must

accept Medicare Assignment. If your pedorthists are enrolled in Medicare but aren't "participating," they may choose not to accept Medicare Assignment. If your pedorthists

don't accept Medicare Assignment, there's no limit on the amount they can charge you.

*Medicare does not cover shoes, shoe modifications like lifts, or custom foot orthotics unless you are diabetic and meet certain qualifying conditions or if the shoe, shoe modification, or custom foot orthotic is an integral part of a leg/ankle/foot brace. Additionally the shoe, shoe modification, and/or custom foot orthotic, and brace has to be fabricated and dispensed at the same time by the same provider and Medicare only covers the devices for the limb with the brace. The devices for the other limb/foot are not covered. Post-op shoes are statutorily not covered.

PATIENTS PAYING OUT-OF-POCKET

We have payment plans available
We offer sign-up for and accept CARE CREDIT
We accept HSA/FSA
We accept Cash and All Major Credit Cards.