For certain eligible medical expenses, customers can often apply for insurance reimbursement after they have made their approved purchases. This article simplifies the medical expense reimbursement process by letting you know what you can expect.

Background

At AvaCare Medical, one of the nation’s largest online suppliers of medical supplies and equipment, our customers have four payment options:

  • Credit cards
  • PayPal
  • Checks and money orders (mailed in prior to the shipment of the order)
  • Purchase orders

In other words, customers of AvaCare Medical pay out-of-pocket for their medical supply and equipment purchases. This is because, as a private-paying company, we do not work directly with insurance companies. However, there is one way that customers can have their insurance pay for their AvaCare Medical purchases: through insurance reimbursement.

How Do I Apply for Reimbursement?

The process, when explained briefly, is really very simple:

  1. Contact your insurance and obtain prior authorization
  2. Place your order online, paying via credit card or PayPal
  3. Send your invoice to insurance and request reimbursement

However, this process may or may not be as simple as it sounds; obtaining prior authorization may be a process including forms, ensuring the provider is approved by Medicare or your Private Sector insurance company, and more. In addition, your insurance provider may have a process that must be followed when applying for reimbursement after the order is completed.

Which Products Are Eligible?

Whether or not a product is eligible for reimbursement is decided based on general rules established by the IRS Regulations and Rulings. In general, the costs of equipment, supplies and diagnostic devices needed for the purpose of diagnosing, curing, treating, preventing or mitigating diseases, as well as costs for treatments affecting any function or part of the body.

Items primarily used for cosmetic purposes or overall wellness are not eligible for reimbursement.

The following chart provides a helpful overview of the types of products that may be eligible for reimbursement, itemized according to AvaCare Medical categories. Keep in mind that this list is merely intended to provide an overall idea of eligible products and is not comprehensive or definite in any way; be sure to consult your insurance company before making any purchases to ensure approval.

 General Product Category  Eligible *  Letter of Medical Necessity or Prescription Needed *
 Wheelchairs  Yes  No
 Walking Aids  Yes  No
 Bathroom Safety  Unknown  —
 Incontinence  Yes  No
 Bedroom [e.g. Hospital Beds]  Yes  Unknown
 Daily Living Aids [e.g. Bedwetting Alarms]  Yes  Letter of Medical Necessity
 Skin & Wound Care [e.g. Bandages]  Yes  No
 Respiratory  Yes  No
 Diagnostic [e.g. Blood Pressure, Diabetes]  Yes  No
 Dietary & Nutrition [e.g. Vitamins & Supplements]  Yes  Letter
 Orthopedic [e.g. Shoes, Compression, Maternity]  Yes  Varies
 Personal Care [e.g. Breast Feeding]  Yes  No
 Urological & Ostomy  Unknown  —
 Professional Equipment [e.g. Exercise]  Yes  Letter of Medical Necessity

∗ Based on information provided by the Medical Reimbursement Guide by FlexPlan.

 

Medicare Resource: Master List of DMEPOS Items for Prior Authorization

 

Disclaimer: The information on this page is derived from publicly available sources. AvaCare Medical is not affiliated with any insurance companies and cannot guarantee accuracy of this information nor for the coverage for any medical supplies and equipment.