Insurance Questions

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Welcome

EliteCare Patients

Find information and links to the products and services that we offer, as well information and frequently asked questions regarding patient insurance.

Why did I receive this bill?

Most of the orthotic services provided by EliteCare are covered by health insurance, including Medicare Part B. The amount of coverage available for services can vary quite a bit depending on the type of policy you hold. If you have more than one insurance plan, it is possible that the entire cost of your care could be covered.

In most cases, some percentage of “co-pay” is required to be paid out-of-pocket by the patient at the time the orthotics or prosthesis is delivered. Before your first appointment, it is a good idea to visit with your insurance company, or prospective insurance company, to understand exactly what benefits are available for EliteCare services.

For more questions on your bill call: 800-897-2734

General Insurance Information

What is a "health insurance policy"?
A contract between an insurance provider (i.e. an insurance company or a government) and an individual or their sponsor (i.e. an employer). The type and amount of health care costs that will be covered by health insurance provider are specified in writing in a member contract.
What is a "Premium"?
The amount the policy-holder or their sponsor (i.e. an employer) pays to the health plan to purchase health coverage.​
What is a "Deductible"?
The amount that the insured must pay out-of-pocket before the health insurer pays its share. For example, policy-holders might have to pay a $500 deductible per year, before any of their health care is covered by the health insurer. It may take several doctor’s visits or prescription refills before the insured person reaches the deductible and the insurance company starts to pay for care. Some plans may have separate deductibles for specific services.​​
What is a "Co-payment"?
The amount that the insured person must pay out-of-pocket before the health insurer pays for a particular visit or service. For example, an insured person might pay a $45 co-payment for a doctor’s visit, or to obtain a prescription.​​
What is "Coinsurance"?
Instead of, or in addition to, paying a fixed amount up front (a co-payment), the co-insurance is a percentage of the total cost that insured person may also pay. For example, the member might have to pay 20% of the cost of a service over and above a co-payment, while the insurance company pays the other 80%.​​
What are "Exclusions"?
Not all services are covered. The insured are generally expected to pay the full cost of non-covered services out of their own pockets.​
Why is my HSA card declined?

Many HSA issuers are no longer approving certain transactions, even though EliteCare, LLC is registered as an HSA merchant. EliteCare, LLC has no control over issuer decisions and has limited visibility into the reason for a decline.

If your HSA transaction is declined, please submit an alternative form of payment and submit a claim form with your receipt to your HSA issuer for reimbursement.

Most Frequent Valid Decline Reasons:

  1. The card has not been activated or has been suspended.
  2. The card has no funds remaining, or the card has insufficient funds.
  3. The card has not been loaded with funds for the new plan year because of delays by the employer or the plan administrator in getting the enrollment file to the issuer processor.
  4. The merchant sent an expiration date that does not match the date in the issuer processor’s system. This can happen when there is an error manually entering the expiration date.
  5. The manually entered card number does not match a valid card on file with the issuer.
  6. The cardholder was issued a new card, either because their employer changed plan administrators, or they changed employers but is continuing to use the old card that has been closed.
  7. The participant’s benefit plan does not allow the participant to use their card at certain registered merchants.
What are "Coverage Limits"?
Some health insurance policies only pay for health care up to a certain dollar amount. The insured person may be expected to pay any charges in excess of the health plan’s maximum payment for a specific service. In addition, some insurance company schemes have annual or lifetime coverage maximums. In these cases, the health plan will stop payment when they reach the benefit maximum and the policy-holder must pay all remaining costs.​
What are "Out-of-pocket maximums"?
Similar to coverage limits, except that in this case, the insured person’s payment obligation ends when they reach the out-of-pocket maximum, and health insurance pays all further covered costs. Out-of-pocket maximums can be limited to a specific benefit category (such as prescription drugs) or can apply to all coverage provided during a specific benefit year.​
What is an "In-Network Provider"?
A health care provider on a list of providers preselected by the insurer. The insurer will offer discounted coinsurance or co-payments, or additional benefits, to a plan member to see an in-network provider. Generally, providers in network are providers who have a contract with the insurer to accept rates further discounted from the “usual and customary” charges the insurer pays to out-of-network providers.
What is "Prior Authorization"?
A certification or authorization that an insurer provides prior to medical service occurring and typically contingent upon eligibility, medical necessity, and benefits however not a guarantee of payment.
What is an "Explanation of Benefits"?
A document that may be sent by an insurer to a patient explaining what was covered for a medical service.
What is a "Referral"?
A recommendation to consult the (professional) person or group to whom one has been referred; “the insurance company says that you need a written referral from your physician before seeing a specialist”.​​​​