FAQ

 

Why does my statement say “no insurance info”? I have insurance.

If your statement says “no insurance info” but you have insurance, the paperwork we received from your doctor’s office was either incomplete or inaccurate. This is easily fixed. All you need to do is contact us with your complete insurance information and once received, we will begin the process of re-filing with your insurance provider. Please contact IMS Experts, at 817-453-9767, ext.1 (billing).

 

Why did I receive a bill? I already paid my co-insurance/co-pay at the doctor’s office.

You may have paid your co-pay at the doctor’s office for the doctor’s services. However, this statement is referring to a separate benefit under your insurance for the product you received at your doctor’s office. Depending on the product, your insurance is telling us that you owe a percentage for co-insurance. The co-pay is the flat rate you pay for the doctor’s office visit only. If you have any questions in regards to your patient balance for IMS Experts services and products, please call us at 817-453-9767, ext.1 (billing).

 

What’s the correct way to wear my brace and how often do I wear it?

  • Examine the brace before putting it on. Do not proceed if you see signs of wear in the padding or exposed metal parts.

  • Put the brace on according to the manufacturer’s instructions. It should provide a snug fit around your midsection and support the lower back. Use the adjustment mechanisms; such as straps to tailor the fit to your body shape. Same applies for ankle and knee braces.

  • Wear your brace during the day, particularly when you are active. You may remove the brace at night-time if you wish. Wear it under or over your clothing, depending on which you prefer. Do not wear any brace to bed. Replace or repair your existing brace if it slips or requires frequent adjustment while it is on.

  • Address any additional questions about wearing a medically prescribed back brace to your doctor. Your physician and/or his staff can discuss with you on how often and how long you should wear your brace.

  • Clean and care for brace per manufacturer’s instructions.

 

What should I bring to my appointment?

On the day of your appointment, we ask that you bring two things:

  • A valid form of photo ID, such as your driver’s license or passport; and

  • If insured, your health insurance card.

**Minors (individuals under the age of 18) are also required to bring their parent or legal guardian.

 

What is co-insurance?

Co-insurance is an insurance policy provision under which the insurer and the insured share costs incurred after the deductible is met. It is similar to a co-payment, but instead of being a set amount per visit, the co-insurance is a percentage of the approved charges.

Your insurance company should indicate the amount of co-insurance due on the explanation of benefits (“EOB”) when they process a claim.

 

What is a deductible?

In an insurance policy, the deductible is the amount that must be paid out-of-pocket before an insurer will pay any expenses. The deductible must be “met”; that is, paid by the insured before the benefits of the policy can apply. Therefore, you would have to pay the provider out-of-pocket before reimbursement begins. If you have a question or are disputing the fact that you haven’t met your deductible, we recommend calling your insurance company.

 

What is “Stock & Bill”?

As its name implies, “Stock & Bill” is a program we offer to medical professionals and facilities where we stock and bill their orthopedic products for them. This allows the physicians to deliver better patient care while alleviating the financial and administrative burdens often associated with maintaining an orthopedic bracing inventory.

 

What does “transfer balance” mean?

If the term “transfer balance” appears on your statement or patient responsibility notice, this means that after your insurance processed the claim, a remaining balance was transferred back to you. This sometimes occurs because you still owe a co-insurance or deductible amount. It could also be a non-covered benefit. The explanation of benefits (“EOB”) that you receive from your insurance company should provide additional details regarding any payment amounts that you are responsible for.

 

What does “exceeded benefit limit” mean?

Some insurance companies limit the dollar amount they will pay per year for certain services, or they limit the quantity of services eligible for coverage per year. If your statement shows that you have a balance due because you exceeded your benefit limit, this is information we received from your insurance company. They are stating that they have paid up to the maximum limit they provide coverage for; and that the patient is responsible for the remaining balance.

 

My insurance denied coverage for the product I received. Is there anything else I can do?

Insurance companies are more likely to listen to their members than to the provider of the service. While IMS Experts will attempt to appeal denials that have provider appeal rights, there are some denials that can only be appealed by the member. We highly recommend appealing this decision with your insurance company if you disagree with it. For example; if your insurance denies payment for our product because it is “not medically necessary”, it is helpful to get a letter of medical necessity from your physician and we can assist in providing the letter of medical necessity to your provider in order to “re-process” the denied claim.. In addition, IMS Experts is open to discuss an individual payment plan that best suits your financial situation. Please call us to make and discuss payment arrangements at 817-453-9767, ext. 1 (billing).

 

My doctor is in network with my insurance. Why did IMS Experts process my claim as out-of-network?

It is possible that your doctor is in network with your insurance and IMS Experts is not. If your insurance states that we need to charge you a higher co-insurance or deductible because we are out-of-network, we suggest you submit an appeal to your insurance and state that you were not aware we were not in network or that we were a non-participating provider at the time you received the product at the doctor’s office.

Are orthopedic devices covered by my insurance?An orthopedic device may be covered in full, partially, or not at all by your insurance. Coverage of your orthopedic device varies according to a multitude of variables including, but not limited to;

  • Your insurance plan

  • Whether your insurance plan has a deductible, and whether that deductible has been met

  • The reason your doctor prescribed the device

  • Whether there is sufficient documentation to justify the medical necessity of the product.

 

For any questions or to inquire further about IMS Experts products and services please click on the CONTACT TAB to contact us directly.