FREQUENTLY ASKED QUESTIONS
Q: Is OrthoRx a manufacturer?
A: No, OrthoRx does not manufacture any brace or soft good. We buy from numerous vendors in accordance with the physician's preference.
Q: What is Accreditation?
A: OrthoRx has been surveyed by the ACHC, a national standards organization, and has been found to be one of the top 5% of all DME suppliers who meet the high standards needed to become accredited.
Q: What insurance companies does OrthoRx have contracts with?
A: OrthoRx has numerous national contracts and many of the local providers as well. (Please see the Insurance Contracts link for a partial listing).
Q: Why does OrthoRx bill under L Codes?
A: The Health Care Financing Administration (HCFA) designed L Codes to describe Orthotic Devices. HCFA is now called The Center for Medicare & Medicaid Services (CMMS). L Codes help ensure a consistency in billing from DME (Durable Medical Equipment) providers and to help facilitate the processing and payment of claims. Each manufacturer of a product provides the SADMERC (governing body) with a detailed description and/or sample of their particular product or brace. The L Code is then assigned to the product by the governing body.
Q: Who established the L Code pricing system?
A: The L Code pricing system is set by the Durable Medical Equipment Regional Carriers (DMERC) who is mandated by the federal government.
Q: Why can't OrthoRx items be returned?
A: By law medically prescribed products cannot be returned because they cannot be re-dispensed. OSHA standards do not allow medical products that have come in contact with the body to be placed on another person. The items cannot be cleaned well enough to satisfy OSHA standards. The only time a product may be returned is if there is a defect in that product within 30 days after being dispensed. That is why the OrthoRx Representative takes great care to ensure that the product is appropriate and is fit to the patient before they leave the physician's office. The patient is also informed of the price at that time and has the right to refuse to take the product.
Q: What is a deductible?
A: This is the contractual obligation the insurance policy designates that must be paid by the patient before any benefits will be paid on any claims it recurs annually.
Q: What does "Co-Pay" mean?
A: This is the percentage the patient is responsible for according to their insurance policy on each medical service or product received after their insurance company has processed their claim.
Q: Why do OrthoRx products appear costly when they don't look that complicated?
A: The DMERC determines the price for braces based on the composition and complexity of fitting. All pricing includes the fitting and patient education of the product.
Q: Why should I get the product from OrthoRx when I can get something similar at a drugstore?
A: Every patient has the right to choose to take their prescription and obtain their product from a source other than OrthoRx. All patients are informed of this at the time of service. OrthoRx is contracted with most major insurance carriers and as a courtesy will bill the insurance carrier on the patient's behalf. The pharmacy will not. OrthoRx incurs the cost of billing and collections.
Quality – The braces that OrthoRx offers to the patients have been handpicked by the physicians of the practice for their abilities to facilitate the healing process of the patient.
Also, the specific brace that the physician has in mind is not always readily available at other local vendors (Pharmacies/ O&P Shops), and may require you to make an appointment to be fitted at a later date.
Q: How does the OrthoRx representative know which brace to put on me?
A: The physicians at the office where you were seen personally chose each product to stock at that site. You physician writes a prescription detailing the exact brace he or she wants placed on you and the OrthoRx representative follows that order.
Q: Do braces and soft goods have the same co-pays as office visits?
A: No, in most case the co-pays are different than an office visit.
Q: Will my insurance cover my brace 100%?
A: Very few insurance companies cover braces and soft goods at 100%. Most insurance companies pay at best 80%, leaving the patient to cover the remaining 20%
Q: Are all braces covered by insurance?
A: No, some policies do not cover braces at all. Some insurances have certain items they consider non-covered, such as arm slings and cast shoes. Your individual policy should provide you with a list of policy exclusions. It is the patient's responsibility to understand their policy.
Q: Will the prescribed product alleviate all my pain?
A: No, most braces are designed to correct some type of problem. They are not designed to relieve pain. Pain may be reduced because the body part is placed in a more stable position, which in turn alleviates some of the pain caused by the injury. The prescribed product is only one part of the treatment plan your physician has prescribed; your adherence to all parts of this protocol will help you heal in the most efficient manner.