Usually when dealing with Health Insurance to cover the cost of your equipment or collecting a prescription in order to sell your item to you (when applicable), we get into areas dealing with Private Health Information (PHI). This can come when your doctor provides us your charts and scripts, or your insurance company provides us with policy information.
Because companies in our industry are obliged ethically and legally to follow strict guidelines provisioned by industry watchdog groups, accreditation bodies and our legislators in regards to how we collect, handle and share this data between your insurance company and physician, it's absolutely necessary that you are made aware of these policies through a signed/completed 'notice of privacy practices' form as well as a 'new customer information' form. We also need the service ticket signed for proof of delivery in order to bill your insurance company, as we most often aren't allowed to bill prior to services being provided. We also collect a signed'plan of care' form that is correlated to your equipment, required by our accreditation organization, BOC.
We understand that paperwork is not the most desirable when dealing with care of yourself or a loved one, but due to the sensitive nature of your PHI and personal well-being as well as making sure we are following established laws and guidelines, it's necessary that this information is documented, and all businesses providing these services will require this information to be completed prior to dispensing equipment and services.
The only exception to this is if you are purchasing a non-prescription item and are paying cash/credit for goods and services up front, out of pocket. In this case, transactions are treated as typical retail transactions where you simply pay for your item and get a receipt. For those picking up equipment on location, we will usually still request for you to sign your service order confirming receipt of your equipment.
So using our example of an item that Summit bills $100 to the insurance company, the insurance company has a contracted allowable of $30 for this item. Your insurance policy dictates that you have a 20% co-pay, which is fairly common. In this case, your co-pay, providing your annual deductible is met and you have no secondary insurance to bill, would come out to $6. If you have a secondary, Summit will often bill the secondary insurance for the remaining co-pay amount. If the secondary pays in full, the customer isn't billed. If the secondary only pays a portion of the co-pay not covered by the primary insurance, then the remaining balance is passed to the customer.