Prosthetic Insurance Support
Expert insurance support and advice for amputees
MCOP's Prosthetic Insurance and Billing Experts Are on Your Team
For all of our prosthetic and orthotic devices, MCOP provides a wide range of prosthetic insurance, billing, and support services to assist amputees and their families with navigating these complexities. Although we are not specifically contracted with all insurance carriers, MCOP is accustomed to working with all insurance providers to help clients obtain coverage for the device(s) they need. No stone is left unturned when it comes to helping you secure coverage, and we are 100% transparent about all potential costs.
Our experienced Billing Team can advise and assist with insurance claims, worker’s compensation claims, and disability insurance claims. We have experience gaining coverage for the most advanced prosthetic devices on the market today, including 5999/7499 coded technologies that represent the latest advances in prosthetic technology.
Insurance Assessment & Pre-authorization
Before providing any orthotic or prosthetic devices or services, we first run an exhaustive insurance assessment to determine the coverage implications for you. Every policy is different, but we comb through yours to get an idea for what types of prosthesis will be covered. We then openly discuss any and all potential costs with our clients to ensure expectations are aligned and to eliminate any future surprises in billing. We are always transparent about any potential out-of-pocket expenses and/or the potential risks for having your claim denied.
No Coverage?
In some cases, pre-authorization reveals there is limited or no coverage. But, we work directly with insurers on your behalf to challenge the coverage specifics and we have a high rate of success in these dealings.
- Policy Exclusions – Whether you are in or out of network, we will build a thorough case and present it to your insurance provider for consideration. We have vast experience securing authorization when presented with policy exclusions.
- Insurance Policy Consulting – If coverage is not possible with your current policy, we help you find a policy to better suit your needs as an amputee. We often work with clients during open enrollment periods to ensure they secure the coverage necessary, or we can even recommend new plans. Sometimes, a few months spent securing the right coverage can lead to an indefinite higher quality of life without having to go into financial debt.
- External Appeals – In the rare instance that coverage is denied after the fact, we work together as a team for a successful appeal.
We only move forward with treatment once all parties are informed of coverage specifics and cost implications.
In-network & Beyond
We are currently contracted with the following insurance providers: Carefirst Blue Cross Blue Shield/BlueChoice, DC Medicaid, MD Medicaid, Medicare, Informed/Adventist Healthcare, MD Physicians Care (MD Medicaid MCO), Amerigroup (MD Medicaid MCO), University of Maryland Health Partners – formerly Riverside Health (MD Medicaid MCO), Amerihealth (DC Medicaid MCO), Tricare, and Department of Labor.
Just because we’re out-of-network with your policy, it doesn’t mean that insurance coverage is out of the question entirely. Whether we are contracted with your specific insurance provider or not, MCOP goes the extra mile to ensure we explore all of your coverage options. MCOP accepts all types of health insurance and works with all major insurance companies to secure an out-of-network exception, if needed.
Contact us for more information about our prosthetic support services.
Frequently Asked Questions
For insurance pre-authorization, we first comb through your insurance policy to get an idea for what types of prosthesis will be covered. We then openly discuss any and all potential costs with our clients to ensure expectations are aligned and to eliminate any future surprises in billing. From there, we reach out to your insurance provider to discuss coverage options, working on your behalf to build a case for coverage if it’s not available currently.
It is pretty common that an initial insurance coverage assessment reveals there is no coverage. But, MCOP’s insurance and billing team works diligently with the insurer to compile documentation for, and obtain, a one-off exception that would provide coverage for your prosthetic or orthotic system.
Device type coverage specifics are different with each insurance provider, but we find that devices that have been on the market longer are more likely to be covered by insurers.
Yes! If your device was provided by MCOP and covered by insurance, then all maintenance and components of your prosthetic system are also covered.
Yes, Medicare does cover prosthetics. As well, other insurance providers often benchmark Medicare prosthetic standards for their own policies and plan offerings.
Yes, Medicaid also covers prosthetics.
When your prosthetic device is designed by MCOP Prosthetists, all of the necessary components and related appointments are normally covered, including fitting and therapy sessions. Future device maintenance is also covered.