Your Medical Insurance
Your medical insurance policy is a contract between you, your employer and
the insurance company. A Leg Up, LLC is not a party to that contract.
Your coverage, the requirements for pre-authorization, pre-certification, deductibles
and co-payments are all defined in your policy. You are responsible for reading,
understanding, and following the procedures outlined in your policy handbook.
Please note we are not a preferred provider with most major insurance companies.
We cannot file for Medicare or Medicaid on your behalf.
Insurance Billing
Your insurance company may reimburse you part or in full for scooter
charges. Our policy is for the patient to pay for all
services in full at the time service is rendered. At
the end of rental or completion of purchase to submit
a claim to insurance, you will need:
Prescription and/or a
letter of medical necessity from your doctor that
includes the diagnosis code and their NPI number.
Statement provided by A
Leg Up, with HCPC Code, itemized charges and length of
rental.
However, if your rental
is for 4 or more weeks and you wish A Leg Up, LLC to
submit a claim directly to your insurance company, you
must provide us with the following:
Security deposit; either
by a credit card, or a check to be held on file in the
amount of $150.
Photo copy, front and
back of your insurance card.
Completed and signed
�Authorization to Release Medical Information and
Assignment of Benefits� form.
Prescription from your
doctor including the diagnosis code and their NPI
number.
If we do not receive all
the items as required above, we are unable to submit a
claim and you will be charged directly for the full
amount of rental or purchase.
Customer remains
responsible for all charges not covered by insurance.
Any uncovered costs will be charged directly to
your credit card on file. If your security deposit was
by check, it will be cashed to cover any amount still
due. You will then either receive a refund or be
billed for the balance.
Work Related Injury Claims
A Leg Up will bill most state Labor and Industries Departments or Workers' Compensation
Departments (except WA State L&I), as well as most companies who are privately insured. If you have a work
work related claim, please provide us with your claim number, along with the name
and phone number of your case worker or case manager, as soon as you have a claim.
Written authorization for rent or purchase must be received by A Leg Up prior
to rental or sale of a knee scooter.
In order for A Leg Up to submit an insurance
reimbursement claim on my behalf, I understand that
I must read and comply with the above insurance
information and policy. Enter your name to confirm your
agreement and compliance with this requirement before proceeding to the form.
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