Our funding department is staffed by a team of experts with over 50 years of combined experience managing claims for Medicare, Medicaid, and Private Insurance Carriers. With a daily focus on the specific documentation and ever changing regulatory requirements, our experts will always have the latest information and be ready and able to assist in the process. Please contact us at any time with questions, comments, or just to find out the latest update on what is required and the best way to process the necessary. Our goal is to make this as easy as possible for everyone involved.
COMMON FUNDING QUESTIONS FOR AAC DEVICES...
Q: Is funding available for AAC/SGD?
A: YES – AAC/SGD’s are most commonly funded by health insurance, school districts, alternative funding grants, or by individuals and family members.
Q: Will my health insurance cover the cost of the AAC/SGD?
A: Most insurance policies cover AAC/SGD when the device is found to be medically necessary by an evaluating Speech Language Pathologist.
Q: Will my health insurance cover all of the cost or will I have to pay out of pocket?
A: Each health insurance policy is different. All Medicaid patients are covered at 100% upon review and authorization. Some private health insurances may have a deductible, out of pocket, or copay expenses which vary greatly based upon each individual plan.
Q: How do I know if I have to pay any amount towards the device?
A: Our funding coordinator will verify all insurances and determine if an AAC/SGD is a covered benefit and if the patient will have a deductible, out of pocket or copay or any other expenses in the process.
Q: If my health insurance only covers at 80% who will pay the remaining 20% copay.
A: The family/guardian would be responsible unless the child has a secondary insurance that may cover the copay or funding is available from a grant or other funding organization.
Q: Will I be using up insurance coverage that I might need later?
A: NO – the determination to fund the device will be based upon medical necessity and will not ‘use up’ insurance that may be needed at a later date. Most insurances allow for the replacement of a device every five years and will pay for a new device after five years if medically necessary. Additional funding may also be available if the needs of the child change or progress.
Q: Will the AAC/SGD be able to go home if paid for by insurance?
A: If the device is paid for by health insurance it is the property of the individual/family covered by that insurance. Typically a family/guardian will then determine where the device is used and if it will go back and forth between school and home.
Q: What paper work is needed in order to start the process of obtaining an AAC/SGD for my child?
A: The primary items needed for the paper work process include but may not be limited to a Prescription, a SLP Evaluation, Orders from the Medical Doctor, and any additional documentation required by a specific funding source. Monroe Speech Designs will manage all aspects of the paperwork process and insure all documentation is acquired and submitted for review.
Q: How long will it take to get the device for my child?
A: After the completion of the SLP evaluation, any and all additional documentation will be gathered (SLP report, chart notes, prescription from the doctor) and submitted to the child’s health insurance for authorization. Once authorization is obtained the device is ordered. The process can take up to 8-12 weeks from the device evaluation to delivery depending upon how quickly all documentation is submitted and the review process of the funding source.
Q: Will my insurance only cover certain devices?
A: NO - Insurance does not make a determination based upon the specific manufacturer of the device chosen, they will only make decisions based upon the medical need of the device.
Q: Will the cost of my insurance go up?
A: NO - Insurance policy premiums will not be raised because you exercise your right to a benefit of that plan.
Q: Do I need to contact my insurance company and start the process?
A: NO – the Monroe Speech Designs team will facilitate this process from start to finish and can contact your health insurance on your behalf.
Q: What do I need to say when I contact my insurance company to inquire about coverage?
A: The Monroe Speech Designs team is happy to manage the entire process including contacting your health insurance to verify specific coverage criteria and availability.
Q: Are the AAC/SGD devices covered by warranty and who handles the repairs?
A: Each devices does carry a warranty; but it is limited to the specific type of device as well as the make and model. For individualized questions on service, repair, or a specific warranty claim, please contact the Monroe Speech Designs team and we would be happy to assist you. Typically repairs needed outside the warranty period will be paid for by insurance if the device is deemed medically necessary.
Q: Who takes responsibility for maintaining and programming the device when it is funded by health insurance?
A: This is typically a collaborative effort between the family, school, and SLP involved in each situation. While basic maintenance – cleaning, charging, etc. are often handled by the family or caregiver – the programming or set up of the device will be done by either a SLP or Assistive Technology Consultant.
Q: What is the success rate of pursuing health insurance funding for an AAC/SGD?
A: When a device is deemed to be medical necessary and to enable to communication ability of the user, they will most often be covered. Our current approval rate is approximately 90% with most denials being covered by a secondary funding source.