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Frequently Asked Questions
Funding FAQs
Follow this link for more information about Funding News and Medicaid Approval Status
Neyda Rodriguez and her Gemini: How Her Family Fought Medicaid and Won
| Q |
What funding sources can I approach to help pay for one of your devices? |
| A |
There are many funding sources available. Private insurance, Medicaid, Medicare, Vocational Rehabilitation, Veterans' Administration, school systems, clinics, hospitals, non-profit organizations, and foundations have all funded augmentative communication devices. In addition, grants and trust funds have been set up to provide specific types of devices. |
| Q |
How do I determine which funding source to approach? |
| A |
Medicare is usually the primary carrier. Private insurance and HMO's
are next, with Medicaid being the payor of last resort. |
| Q |
If I have a combination of insurance carriers (private insurance, HMO, Medicare, Medicaid), which should I approach first? |
| A |
Private insurance and HMO's are the primary payers of medically necessary communication devices. Medicare is next, with Medicaid being the payer of last resort. If your private insurance carrier, HMO, or Medicare carrier denies a claim for a communication device for any reason, you will need a statement of denial for the claim to be processed through Medicaid. |
| Q |
Who can assist me in the funding process? |
| A |
Our Funding Coordinator at ATI can answer any questions you may have regarding the ideal funding plan. It is a good idea to have a funding advocate who is knowledgeable about the different types of funding options in your area and can gather and coordinate all the necessary information and documents on your behalf. This funding advocate can be a parent, teacher, case manager, or speech language pathologist, and needs to be in close contact with the client's family, the professionals working with the client, and the Funding Coordinator here at ATI. |
| Q |
What documentation do I need to obtain funding for a communication device from an insurance carrier? |
| A |
To process a claim through any insurance carrier (private insurance, HMO, Medicare or Medicaid), the following documents are required:- Prescription from the patient's primary care physician outlining the exact equipment required (including configuration and all accessories)
- Letter or certificate of medical necessity from the physician or speech language pathologist
- Written evaluation by speech language pathologist describing patient's diagnosis, prognosis, communication capabilities, educational ability, and need for device
- Assistive Technology, Inc. order form listing all required items
- Client's date of birth, complete address, and phone number
- Additional supporting documentation (evaluation from occupational/physical therapist or case manager, school evaluation) would be helpful in making a case for the desired device.
Generally, the more documentation, the better. Some insurance companies and Medicaid offices may also require a trial rental period, a comparison between the requested device and other devices, or photos or videos of the client using the device. Contact ATI for more details. |
| Q |
How is "medical necessity" justified? |
| A |
Letters of medical necessity and evaluations should clearly indicate how the absence of the communication device could pose a substantial risk to the patient's health or safety. If possible, specific examples should be given (i.e., that the communication device is the patient's only way of indicating that he or she is not feeling well, is cold or hungry, or needs to use the facilities). |
| Q |
How are insurance claims processed? |
| A |
All paperwork for Medicare, private insurance or Medicaid should be submitted either to ATI or the authorized dealer in your area. |
| Q |
What happens if a claim is denied? |
| A |
If the payer of last resort denies the claim, you can appeal the denial. Claims denied on the first try are frequently funded after an appeal. Contact ATI for assistance in the appeal process or for the name of the Protection and Advocacy center in your area. |
| Q |
Will I be required to pay a portion of the cost of a device approved through insurance? |
| A |
Many insurance policies require a copayment from the policyholder for the purchase of the device. The amount of the copayment depends on the insurance carrier and the policy. Medicaid payments are considered payments in full and the recipient is generally not responsible for any copayment. |
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