Insurance Questions

What insurances do you accept?
Therap-Ease accepts the following insurances: Medicare, Blue Cross Blue Shield, TriCare, Tufts Network Health, Harvard Pilgrim, GIC, United Healthcare PPOs, Commonwealth Care Alliance and several others. If you do not see your insurance listed please call with your insurance information so we can assist you.

What is prior authorization? Why do I need prior authorization?
Prior authorization is the process of obtaining approval from a health insurance carrier to provide a product or service prior to providing that product or service. This is in order to ensure that the insurance carrier will cover the charges for the product or service. This approval or authorization from the health insurance carrier can be quick or it can take some time. You may need prior authorization for a number of reasons including medical necessity or because of the availability of a cheaper option.

What is the difference between a deductible, coinsurance, and a copay?
A deductible is the amount you pay for a health care service covered by your insurance before your insurance plan starts to pay. After paying off your deductible your insurance will start to pay for anything it covers. Coinsurance is how much you pay for a covered health care service after paying off your deductible. Coinsurance is a percentage of the costs of a service. A copay is a fixed-fee set by your insurance that you pay for healthcare services. For the products and services, we offer there may be a coinsurance but there will never be a copay.

Do you accept assignment on Medicare claims?
We are a non-participating provider with Medicare. What this means is that we can choose which items we provide through Medicare and which items we accept assignment on through Medicare. If we accept assignment on an item, that means we accept the Medicare fee schedule payment amount for the item and the only cost to you would be any remaining deductible or coinsurance.

For items we do not accept assignment on, we set the price of the item and you must pay up front for the item. We will then bill Medicare on your behalf and Medicare will reimburse you up to 80% of the Medicare fee schedule amount for the item. If you have a secondary insurance, it may reimburse you the remaining 20%. This fee schedule amount may be less than the total amount you are required to pay.

Regardless of whether we accept assignment or not on an item, we must still follow Medicare guidelines in order to bill Medicare and we must have all the necessary documents to prove medical necessity for any items to be billed.

For items we do not provide through Medicare at all, you cannot get them covered or any reimbursement through Medicare if you choose to purchase the items through us. The following is a list of items we do not provide through Medicare:
  • Hospital Beds
  • Wheelchairs and Transport Chairs
  • Wheelchair and Transport Chair Accessories
  • Nebulizers and Nebulizer Supplies
  • Hoyer Lifts and Hoyer Lift Slings
  • Commodes
  • Suction Machines

Why won’t Medicare cover my claim through Therap-Ease?

The Competitive Bid Program is currently on hold. We may be able to bill Medicare for your products or services now, but we may not accept assignment on or provide certain products through Medicare as discussed above.
In the past several years Medicare has started a “Competitive Bid” program which has limited where you can get your durable medical equipment from. Medicare determines which companies can provide you with equipment based on where you live. As such, we may not be able to bill Medicare for your product or service. It is possible to still purchase products that Medicare will not cover through Therap-Ease via private pay or they may be covered by a secondary or tertiary insurance. To learn more about Competitive Bidding click here.

For the rest of our frequently asked questions CLICK HERE.
For information regarding Medicare's Competitive Bid Program CLICK HERE.