[DMEPOS]

We are a new pharmacy getting into the HME world. That being said, i was wondering how many of you contact the non-medicare/medicaid payors prior to determine eligibility prior to dispensing a piece of equipment ? We have been doing this and it has worked, but it is starting to become a little cumbersome.

[Sleeping410]

That should be part of your routine process. If you are tempted to stop, be prepared for the denials to start piling up.

It's easier to explain to a patient that their insurance doesn't cover a specific item when they need it (and they will most likely pay you on the spot) instead of explaining that they will have to pay for it 2 months later when you get the EOB.

[KarenAMS]

Another advantage to checking eligibility and benefits before dispensing is that we collect deductibles and copays upfront at time of delivery. Most have not met their deductible.

[Cat]

This should be routine regardless of the time it takes to verify. I am over the DME department of our pharmacy and it is stated in our P&P to verify ALL insurance prior to dispensing the item. It does save time in the long run and also lets us know if for example if the patient's card is even valid. Everything is documented on a insurance form including who we spoke with, date and time. Also if anything specific is required prior to submission of the claim. Good luck, but I promise in the end you'll be happy that you kept this process in place.