Q: Is OFS a
manufacturer?
- A: No,
OFS does not manufacture any Brace or
soft good. We buy from numerous vendors in
accordance with the physician's preference.
Q: What insurance companies
does OFS have contracts with?
- A: OFS has numerous
national contracts and many of the local providers
as well. (Please see the Insurance Contracts link
for a partial listing).
Q: What is a deductible?
- A: This
is the contractual obligation the insurance policy
designates that must be paid by the patient before
any benefits will be paid on any claim. It reoccurs
annually.
Q: What does "Co-Pay" mean?
- A:
This is the percentage the patient is
responsible for according to their insurance
policy on each medical service or product
received after their insurance company has
processed their claim.
Q: Will my insurance
cover 100%?
- A: A
few insurance companies cover braces and
soft goods at 100%. Most insurance
companies pay at best 80%, leaving the
patient to cover the remaining 20%.
Q: Why can't OFS
items be returned?
- A:
By law medically prescribed products
cannot be returned because they cannot
be re-dispensed. OSHA standards do not
allow medical products that have come in
contact with the body to be placed on
another person. The items cannot be
cleaned well enough to satisfy OSHA
standards. The only time a product may
be returned is if there is a defect in
that product within 30 days after being
dispensed. That is why the OFS
Representative takes great care to
ensure that the product is appropriate
and is fit to the patient before they
leave the physician's office. The
patient is also informed of the price at
that time and has the right to refuse to
take the product.
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Q:
Who established the L Code pricing system?
- A: The
L Code pricing system is set by the Durable Medical
Equipment Regional Carriers (DMERC) who is mandated
by the federal government.
Q: Why does OFS
bill under L Codes?
- A: The
Health Care Financing Administration (HCFA) designed
L Codes to describe Orthotic Devices. HCFA is now
called The Center for Medicare & Medicaid Services
(CMMS). L Codes help ensure a consistency in billing
from DME (Durable Medical Equipment) providers and
to help facilitate the processing and payment of
claims. Each manufacturer of a product provides the
SADMERC (governing body) with a detailed description
and/or sample of their particular product or brace.
The L Code is then assigned to the product by the
governing body.
Q: Are all Braces covered by
insurance?
- A: No,
some policies do not cover braces at all. Some
insurances have certain items they consider
non-covered, such as arm slings and cast shoes. Your
individual policy should provide you with a list of
policy exclusions. It is the patient's
responsibility to understand their policy.
Q: Will the prescribed product
alleviate all my pain?
- A: No, most
Braces are designed to correct some type of problem.
They are not designed to relieve pain. Pain may be
reduced because the body part is placed in a more
stable position, which in turn alleviates some of
the pain caused by the injury. The prescribed
product is only one part of the treatment plan your
physician has prescribed, your adherence to all
parts of this protocol will help you heal in the
most efficient manner.
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