Posted on Nov 18, 2015
• Cape Medical Supply deals almost 100% with health insurers. We have no say in what your insurance will pay for, or how much they will pay for it - we will advocate for you at all times and will do everything we can to continue providing you the service and products your physician has prescribed. Your insurance company also dictates your copayment, co-insurance and deductible amounts. Deductibles, thanks to the proliferation of high deductible plans in recent years, are causing increasing concern among patients and healthcare professionals alike. A deductible is the amount of money a patient must pay before their insurance company will cover claims - similar to auto insurance, when you get in an accident and the repair bill is $5,000 and you have a $1,000 deductible on your auto policy, you have to pay $1,000 and your auto insurance company will pay the remaining $4,000. Both you and your insurance company pay the company making the repairs. In our situation, both you and your insurance company are responsible for paying Cape Medical Supply.
• We are a private business dedicated to providing the highest level of care possible to our patients. We are bound to provide you service in the way your insurance dictates to us via regulations and rules, many of which are over 100 pages long – even if we don’t agree with them. They dictate nearly everything we do and how we can do it - from replacement requests to the frequency with which you can be resupplied. Many times these rules, such as prior authorization, cause delays in care. We are committed to following every applicable federal, state and insurance regulation and we understand that sometimes this gets in the way of timely care. Just as we don’t take shortcuts with the care and service we provide our patients, we also refuse to take shortcuts in our payer relations and billing processes because to do so would ultimately harm our patients.
• Thus the answer for how much do we get paid varies from patient to patient and policy to policy. It’s the reason you might be paying less than your neighbor for the exact same care - and we get paid different amounts as well. We have no control over what those amounts are – they are handed down to us in a “take it or leave it” contract from the health insurance organizations.
• We do not benefit from not providing you equipment. Ever. Delays in care can be frequent and frustrating but they are a mandated and unfortunate part of relying on a third party (your insurance company) to pay for something. Just like you sign up for a plan with an insurance company, we sign a contract with insurance companies as well and are collectively bound by those terms - the fine print if you will - and we have to work together to meet the requirements dictated by the plan.
• So, to recap:
◦ We are reimbursed for the services we provide to you by your insurance at a rate that they set. Sometimes it covers everything, sometimes it only covers some. We can typically answer questions on price and policies, however we are merely reciting to you the rules/regulations/rates that were set by the insurance company you bought a policy from.
◦ We do not benefit by not providing services. If we stop providing services or there is an initial delay in providing services to you, it is likely because you have not met insurance mandated benchmarks in keeping up with your care, you have a diagnosis that does not qualify for services (based on their criteria) or we are pending authorization for services your physician has prescribed. We are motivated to provide products to you as quickly as we can; it’s how we generate revenue and maintain strong employment, delays are not in your interest or ours. However, they are a fact of modern life when we want a third party like your insurance company to pay for something.
◦ We will try to work with your insurance company on your behalf, but are limited in what we can do.
Cape Medical Supply has been committed to excellence in patient care since 1977. Insurance rules and regulations, now more than ever, can make meeting that objective challenging and we understand it can be incredibly frustrating for patients to comprehend why they cannot simply come in and get what they need when they need it. Sometimes, it baffles us too. The reason is we are asking a third party, your insurance company, to pay for it. When someone is paying for something, they get to make the rules, whether we like it or not.