Frequently Asked Questions Does insurance cover Orthotic and Prosthetic services? Most health insurance policies cover Orthotic and Prosthetic services. We are in-network providers for many insurance carriers. Please contact your insurance carrier for your specific coverage information. Will my insurance pay for Orthotic and Prosthetic Services? Each insurance policy is different and coverage for orthotic and prosthetic services can vary depending on the particular device. If you are insured privately or through your employer, we suggest that you contact your insurance carrier directly to determine policy coverage, restrictions, and deductibles. To find out if you are covered you can: Call your insurance company. There should be a toll-free number on the back of your insurance card. Look in your policy booklet Check with your employers human resources department Your insurance carrier may require you to pay a co-pay. If so, you will receive a statement from the Patient Accounts Office after your insurance has been billed. You will be responsible for any unpaid balance after reimbursement from your insurance. What if I don't have any insurance? It is important to discuss this issue in advance so appropriate arrangements can be made. Payment plans that meet your budget can be set up through the Patient Accounts Office. Assistance is available through the Strong Health Charity Care Program for patients who qualify. Will Medicare cover O&P services? We do accept Medicare. However, we are not ‘Medicare Providers’ and do not 'accept assignment'. Some devices (or parts of devices) are covered, others are not. There are Medicare funding guidelines, based upon medical necessity, diagnosis, and service frequency, that may effect your eligibility. Your practitioner will refer you to our office manager to discuss eligability once they have done an evaulation and determinded you specific needs. Will Medicaid cover O&P services? We do accept Medicaid. However some devices (or parts of devices) are covered, others are not. And, some devices require 'prior approval' which can cause a delay in their delivery. If this is the case with your device, we will inform you prior to providing any services. What methods are available for patients to pay their accounts? Cash, check, Visa, Master Card, private insurance, Medicare, Medicaid and approved Workers' Compensation, and MVA. What if I have a co-payment amount with my insurance? You will receive a bill from the Patient Accounts Office. How much will my orthosis/prosthesis cost? We cannot give estimates on the cost of a device without evaluating what your specific needs are. The coding system used for O&P billing (established by Medicare, but used by all payors) has over a thousand codes. Specific ‘base codes’ describe various orthotic/prosthetic devices in their most basic/generic form. Additional codes are utilized to account for the additions that are needed to customize the device to meet the patient’s specific, unique functional needs. Often the discrepancies between one quoted price and another relates to the inclusion/exclusion of these critical additions. Our Orthotists, Prosthetists and Pedorthists provide free, no obligation consultations and can help determine what will best meet your needs. Once that is established, an accurate set of codes can be determined to confirm your coverage. Do I need to make an appointment? Yes. Making an appointment ensures that you are scheduled to see the practitioner who is best able to meet your needs. When repairs or maintenance are required, a scheduled appointment helps ensure that parts are ordered (if possible) and that one of our skilled technicians is available to perform the repair. We are able to provide simple off-the-shelf devices or minor adjustments to existing orthoses as a ‘walk-in’ but request that you call ahead as scheduled patients will take priority and there may be a significant wait What are your hours of operation? We are open from 8:00 a.m. to 4:30 p.m. Monday thru Friday. Do I need a referral to make an appointment? A referral is not necessary. However, a doctor’s prescription is required for us to provide a new device, or make modifications or repairs to an existing one. A consultation does not require a prescription, but a prescription would be required before we could provide further services. Do I need to bring my prescription to my appointment? Yes, your prescription allows us to immediately begin our work. It is best to pursue a prescription two weeks prior to your appointment in our department. This way you can be sure to receive it in time. If you are unable to obtain a prescription we can request one for you, however (depending upon your physicians availability) this could cause a delay in your care. What if I have to cancel my appointment? We understand that emergencies do arise and that appointments need to be cancelled. We request that you give us 24-hours notice in order that we may allow another patient to fill that time slot. I need to have a strap/rivet/buckle replaced. Do I need an appointment? We can often make minor repairs without an appointment; however, if your device requires further adjustment or major repairs you will need to schedule an appointment with a practitioner to ensure that all of your needs are appropriately met. What do I need to bring with me to my first visit? On your initial visit, please bring your physician prescription, your insurance card, and any other related billing information. We have gowns available for the evaluation but you may be more comfortable if you bring a pair of shorts (for a lower extremity evaluation) or a t-shirt (for an upper extremity or spinal evaluation). How long is each visit? Depending upon the complexity of your needs, appointments range from 15-90 minutes. Will the item/service being requested by the physician be available to be picked up at the first appointment? Many times patients’ needs can be met with a prefabricated device. We keep a large inventory of orthoses on hand and may be able to meet your needs in one appointment. If we do not have the particular device prescribed, and a substitution is not permissible, we can order a device for you. In most cases, we would be able to fit you within a couple of days. How long will it take to receive my custom-made orthosis or prosthesis? The fabrication time will vary depending upon several factors, such as the complexity of the device. Most orthotic and prosthetic services require between one to three weeks to be completed. For complex designs, you can expect to be seen for a fitting within 1-2 weeks. Additional fittings, if necessary, would ensue weekly until completion of the device. Are follow-up and adjustment appointments included as part of the total service? There is no charge for follow-up appointments for the first 90-days. During this period fine-tuning adjustments necessary to optimize the fit and function of the device are provided at no charge. There may be a charge for adjustments or modifications that become necessary as result of: a change in your condition, anatomical change (growth, weight gain/loss), or misuse/abuse. How often do I need to replace my orthosis or prosthesis? Most orthoses/prostheses will last for several years. However, if there is a change in your condition, such as weight loss/gain, or growth (in the case of a child) you may require a replacement sooner. We recommend a yearly follow-up with your practitioner to assess the effectiveness and safety of your current orthosis/prosthesis. We encourage you to call immediately if you notice a decrease in effectiveness, comfort or a change in the performance of your device. What is your warranty policy? The warranty period for custom orthoses and prostheses is three months for workmanship and materials. Normal adjustments will be made at the discretion of the practitioner at no charge for a three month period. Strong Orthotics and Prosthetics cannot be responsible for physiological or anatomical changes or changes in patient’s medical condition. There will be a separate charge for adjustments due to physiological or anatomical changes or changes in a patient’s medical condition. Prescribed additions of componentry, straps, lifts, supplies, etc., will incur a charge. There will be a separate charge for adjustments or repairs that are made as a result of abuse, or rough wear, such as may occur from sports, vocational, or unusual activities. Since orthoses and prostheses are prescribed at the direction of the physician, and custom fabricated for the anatomy and medical condition of each individual, they cannot be returned for credit or refund. It is in your best interest to communicate with your practitioner on a timely basis and to allow us to resolve any problems you are experiencing as efficiently and quickly as possible. We will make every attempt to meet your needs. Please contact the Clinical Director if there is a question or concern that your practitioner cannot resolve for you. What is your return/exchange policy? Prefabricated O&P devices and DME purchased from Strong Orthotics and Prosthetics may be exchanged, or returned and the account credited, if all the following criteria are met: The item is returned within 5 days of purchase date in original packaging, and original condition (ie. not worn). The item must be faulty or poorly fitting. Item must have been purchased and billed through Strong Orthotics and Prosthetics. An exchange will be made using the same type of device, if within 5 days of purchased date. NYS Department of Health forbids the return of items which have been worn. Special or custom orders are not returnable or refundable. No refund/exchange will be issued for items that were not used in accordance with the manufacturer’s guidelines. If a device is no longer needed (change in diagnosis, alternate treatment sought, change in health status, death, etc.) and it is only ‘slightly worn’ can it be returned for credit or refund? Devices that have been worn cannot be used on other patients and therefore can not be returned for credit.