What's up everyone? I promised that I would give back to the site to hopefully help out in anyway that I can. This site is amazing and it has been a big help understanding the process and what it entails.
Here are a couple things worth mentioning...
-I was prescribed the "UltraSling" by DonJoy for support.
-Tylox/Vicodin/Keflex for pain, fun (j/k), and antibiotic.
-I was prescribed the "GameReady" CPM Cold Therapy unit with pump. (
http://www.gameready.com/products/shoulder.htm)
I have seen different comments on here as to whether or not it is worth it to rent/purchase the cold therapy units that are out there for recovery. The "GameReady" unit is not your typical unit. My Doctor has been the team doctor of professional sports teams and this unit is what they use... THAT BEING SAID.... he stated that if insurance didn't cover the cost of the rental/purchase under DME - Durable Medical Equipment, then he didn't think it was worth it.
So, after hearing him tell me that...I got concerned because he was an in-network doctor and I was under the impression that in-network meant "COVERED"...think again friends. DME coverage varies from plan to plan. I have a pretty robust medical plan that pays 100% after the 250 annual deductible is met, so this is not that big of a deal, but this could cost you some big dollars. In addition to that, if the DME service or product is not from the approved vendor of your insurance company, you may be out of pocket the "FULL" amount.
Sorry for rambling, but here is what you need to ask your insurance companies when calling or reading your docs:
1. What is my DME - Durable Medical Equipment coverage?
2. What products/services are qualified?
3. What billing code is going to be sent in by your doctor and does that match up and qualify to what is covered in your plan?
4. If yes, then make sure that your pre-authorization homework is documented with a reference number from your insurance carrier. Take down Name, Date, Time, Ref# and any/all notes pertaining to your approval.
5. Also, before you give the companies that provide the products to you your insurance information...ask them how much the item costs if you just want to buy it WITHOUT insurance. The reason for this is simple. The insurance companies have contracted amounts that they will pay for your equipment. If you don't know if you met your deductible or know the costs of the equipment, then you are taking a chance that they will try to overbill you for the same equipment if you are paying separately for the unit.
Here are the codes:
E0218/E0236 are the ice therapy water circulating cold pad with pum
E0217/E0249 are the heat therapy water circulating pad with pump.
In this case, the company that the insurance company contracted with was CryoCuff. This was NOT the unit that I was prescribed by my IN-network doctor. Therefore, for me to rent the unit it was going to cost me $30/day with a minimum of 10 day rental. I considered doing this, but again my Dr. told me that he doesn't think that paying that much is that much better than the large Walgreens Cold Pad for $29.99 (Right now, BOGO at Walgreens!!
My surgery is tomorrow at 3:00pm so I'm not sure when I'm going to post my first post-op follow up messages, but please know that I will as soon as I can muster up the strength to type it out.
Again, thanks to all of you!!! I appreciate your time a committment to helping others!
-A
