Author Topic: OON Bill Claim Prior to Dispensing Custom DME  (Read 495 times)


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OON Bill Claim Prior to Dispensing Custom DME
« on: September 05, 2017, 09:57:15 AM »
I handle contract negotiations and payer relations for a DME company.  We specialize in Custom Rehab Technology Wheelchairs and Augmentative and Alternative Communication Devices (think Stephen Hawking).We've recently expanded our AAC division nationally, and we have been having some issues when we are billing out-of-network claims for states in which we do not have a brick and mortar location (our techs work in the sp office or in the patient's home).  These claims are being paid out to the Insurer Subscriber, not directly to us, even when we bill assigned.  From what we have heard, this is a typical billing procedure.  The majority of our patients are pediatric, so many times the Insurer Subscriber is not the custodial parent.  We are having issues retrieving our money from the patients, or the person who carries their insurance.  These claims are thousands of dollars.

We have heard that some of the larger manufacturers of these products bill the insurer *prior* to dispensing the product, so that in this case the patient would need to present the money for the product, or the payment would come in to our company and we would then dispense the product.  Has anyone heard of this type of billing, and is it even legal?  I'm looking for even a direction of where to research this type of billing, as all of my research has turned up nothing.  Our company would never do anything that is illegal or immoral- however after hearing that other larger companies bill this way, we are hoping that this may be the answer to our profit losses.
Thank you very much in advance!


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Re: OON Bill Claim Prior to Dispensing Custom DME
« Reply #1 on: September 06, 2017, 10:27:42 AM »
I'd be more curious about these companies billing an insurer prior to dispensing the equipment as this indeed would constitute billing for services NOT rendered.

There are many plan policies by carriers who don't have to honor assignment, BCBS is one of the biggest, they don't have to honor assignment on out of network providers/suppliers.

This can be very challenging for your business but I would research those options first, maybe also look over financial policies that patients can sign where you collect up front deposits?

Linda Walker
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