1	Insurance – Make that claim Amjo can help
2	The first steps You have medical insurance. Let’s use it. Remember, you’ll need a prescription or letter of medical necessity. We don’t know your insurance coverage. Companies offer many different plans. What plan did your employer buy? Call your Insurance Company. Coverage amount Reasonable & Customary Try to get a fix on what they mean by “Reasonable and Customary”
3	Prepare for the call Become familiar with terms TLA Three Letter Abbreviations. DME Durable Medical Equipment. CPT Current Procedural Terminology. ICD International Classification of Disease. HMO Health Maintenance Organization. PPO Preferred Provider Organization. HBO Home Box Office IRS Internal Revenue Service Pre-authorization? It’s best to ask!
4	Who’s In Plan? In Plan NBC have contracts with some insurers, we can help with Cigna and one or two others. Out of Plan Most insurers will consider us “in-plan” as there are no providers “in-plan”. Network Deficient Fancy name for “Out of Plan”.
5	Insurance Codes Insurance companies use codes to describe the treatment (CPT Code) and the diagnosis code (ICD) CPT Codes - Current Procedural Terminology E0690 – Old Catchall Code – Now Obsolete E0691 – Panosol II 2’ Model, HandiSol NB, Hand/Foot Units E0692 – Panosol II 4’ models. (UVB NB Not Available) E0693 – Panosol II 6’ models E0694 – Multi-Directional Foldalite-B and UVISOL A4633 – Replacement Lamps for above ICD Diagnosis Code – International Classification of Disease (ICD) 709.01 (Vitiligo)
6	Questions to ask Am I covered for DME? Am I covered for ICD Code 709.01 (Vitiligo) CPT Code E0691,2,3,4 (UV Equipment) What is my coverage? Fixed amount Percentage Deductible Do you require pre-authorization? Can you mail me a letter describing coverage?
7	Let’s do lunch!
8	Then call Amjo To assist you with the claim we need. Insurance/Patient Information. Web Based – on-line form. Printed blank form (download). Beneficiary assignment Signed form that tells insurer to pay Amjo. Blank form available on website. Prescription. Be Specific “UVB” and “Narrow Band UVB” are different protocols. Letter of Medical Necessity. Very beneficial. Treatment history may be requested.
9	Health Insurance – Claim Form
10	On Line – Form (Secure)
11	We’ll submit the claim We’ll submit the claim for you. Include Invoice or Proforma Invoice. Include Beneficiary Assignment Sheet. Prescription and/or the Letter of medical necessity. We send copies to you. Be patient. Delay tactics now start!
12	Denied – Don’t Panic (yet) If you’re not covered for DME then you can panic. Some companies are still in the dark ages Vitiligo is cosmetic only Fortunately in the last 2-3 years most insurance companies no longer say that Vitiligo is cosmetic If they do then fight. Some companies have different rules in different states BCBS has 50 plus offices, each with their own rules!
13	Delay Tactics & Denial Post office loses the copy that went to the insurance company but you got your copy. Isn’t that amazing! Missing information Insurance company people don’t read! We just mail or fax it again. Plan does not cover “Vitiligo” because it’s cosmetic (in their opinion). The fight starts here. We send some letters of justification/necessity written by other doctors/sources. Get your doctor involved if possible.
14	Amjo is appealing Will pay for office treatments only Let’s do a Cost Benefits Analysis Treatments (Clinic or Derm’s office) 3 per week, 50 weeks = 150 visits 150 x $50.00/visit = $7,500.00 Typical home system is about $2,000.00 Money talks! Write them a letter explaining what they’ll save.
15	Payment Options 20% Down and agree to pay what your insurance company does not and we ship immediately Pay in full and we ship immediately We wait for payment from the insurance company With the help of NBC we can now help by offering credit terms and allowing you to pay monthly. Requires 20% down Credit Approval Monthly terms Let’s find a way to help you.
16	Got questions?