Author Topic: dme and private ins  (Read 1129 times)

Trisha

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dme and private ins
« on: May 21, 2009, 04:41:11 PM »
I am billing for a dme company, primarily WC, if they want to supply to patients of private ins. such as BCBS of texas do they need to be on contract with that carrier or is the w-9 ok for the info they will need for billing on a referral basis.  I thought that if the MD is seeing the patient and referrs the patient to our dme for equipment the dr NPI and Lic# as the referrig would be enough. Is that correct? If not, will I need the dme company on contract with all private insurances. Thank you

Michele

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Re: dme and private ins
« Reply #1 on: May 22, 2009, 06:33:08 AM »
They certainly can submit as out of network, it's just that some plans don't have out of network benefits.  You would need to verify their coverage.  Many plans do allow DME out of network, but again it varies from plan to plan.  Also many plans pay out of network benefits to the patient.

Michele
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MMBS1

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Re: dme and private ins
« Reply #2 on: May 28, 2009, 11:13:37 AM »
Hi Trisha

From my experience, you should try and get the DME supplier contracted with the private insurance by contacting the plan directly. It doesn't hurt to have this knowledge on hand for the future. If this is not possible, then I would check the patient's benefits to see if the plan allows for out of network services.

Ashley