Q: How long does the funding process take?
A: This depends on the type of funding you will be using and the number of insurance policies that you carry. As a general rule, it takes 30-60 days from the time we receive your completed packet for the funding process to be completed and an order to be shipped.
Q: What type of documentation is required?
A: Most funding sources require a speech evaluation report and a physician’s prescription listing all the specific equipment being recommended for purchase. Tobii Dynavox will request that you complete a “Client Information Form”, a “Release of Information Form” as well as send front and back copies of your insurance cards and provide an equipment quote with your funding packet to ensure that we have all of the information necessary to process the funding request with your insurer(s) and that the correct device and accessories are ordered. See the Funding Documents section.
Q: Where do I send the paperwork?
A: You can email it to: firstname.lastname@example.org
You can fax it to: 866-336-2737
And documentation can be mailed to:
Attn: Funding Department
2100 Wharton Street, Suite 400
Pittsburgh, PA 15203
Q: Can I fax the documentation?
A: Yes, our fax number is 866-336-2737.
Q: Can I submit to my insurance company myself?
A: In some situations, yes. However, we recommend that you utilize our funding department, especially if you would like us to file the claim on your behalf. Your funding coordinator is aware of the coding and authorization guidelines that most insurers use.
Q: I have an older device. How long do I need to wait before I can get a new one?
A: Most funding sources are in agreement that a speech device should last for at least 5 years. However, it may be possible to get another device before that time if your communication needs have changed. Contact your Local Consultant for more information.
Q: My family member lives in a nursing home setting. Are we able to use their Medicare coverage to receive a device?
A: Nursing home residents are not able to receive Durable Medical Equipment (DME) through Medicare. Medicare Part B only covers the cost if you are living at home or in a group home setting. Certain residents who have been diagnosed with mental retardation and are living in intermediate care facilities are also eligible.
Note: Persons receiving hospice care are not able to use their Medicare benefits to purchase a speech device. This applies to both in home hospice care as well as facility based hospice care.
Q: Can I purchase the device and then be reimbursed by Medicare?
A: Unfortunately, no.
Q: Why can’t Tobii Dynavox just waive the 20% co-payment?
A: While we understand that this co-payment may be difficult to come up with, it is against Medicare policy to waive this cost. Please let your funding coordinator know as soon as possible if you do not have a secondary insurance carrier, as we may be able to recommend an alternate funding source or setup an interest free payment plan.
Q: Can I fax the documentation?
A: Yes, our fax number is 866-336-2737.
Q: How long will it take until I receive my device?
A: There is no prior authorization process with Medicare. When the required documentation has been received by Tobii Dynavox, we can ship your device to you.
Q: Can you ship the device directly to the speech therapist?
A: No. We understand that it often is convenient to have someone else receive the device for programming and training. However, Medicare requires us to furnish proof that the device was delivered to the device user. It is our policy without exception to deliver only to the client’s residence. We apologize for any inconvenience.
Q: I was informed that I need to get a new prescription. I don’t understand why the first prescription was not good enough.
A: Medicare does have strict guidelines for prescriptions. The prescription must specifically list all equipment being ordered. The best way to ensure that this happens is to provide your doctor with a copy of the quotation. Our prescription form may be used to ensure that the guidelines have been met.
Note: If you do not have a quotation, you can call our Customer Sales and Support Department at (800) 344-1778. It is always a good idea to have a quotation on file. It helps to ensure that your order is correct and that all necessary accessories are included.
Q: I had a speech evaluation 2 years ago. Can the speech therapist use the old evaluation?
A: No. The speech evaluation must be no more than 6 months old at the time the device is shipped to you. A new evaluation will be needed.
Q: I have a Medicare replacement policy. What steps do I need to take to obtain a device?
A: Obtaining funding through a Medicare replacement policy is slightly different than traditional Medicare funding. The Medicare guidelines should still be followed. However, a prior authorization review is required in these cases. In other words, the speech therapy report, prescription, and Face to Face should follow Medicare rules, but we will also need to follow the rules of your insurance carrier. Please see the Private Insurance FAQ section for additional details.
Q: I was informed by my funding coordinator that the approval my insurance company gave us does not meet our guidelines. What does this mean?
A: Imagine receiving a bill in the mail for $2,000.00 because we had to estimate what your insurer was going to pay! Getting the right documentation up front helps to ensure that the claim is paid correctly. If Tobii Dynavox is not a participating provider with your insurer, a written approval from your insurer that provides the following is required: the dates of service that have been authorized, the equipment that has been authorized, the dollar amount that will be allowed on the claim, the codes that they would like us to use on the claim, and the billing address.
Q: I have an approval from my insurance company. How long will it take before my device is shipped?
A: The shipping of your new device will largely depend on whether the authorization that your insurer sent you is compliant with our authorization guidelines. We will also need to collect any co-payments or deductibles before your device is shipped to you. A signed release of information form is also required.
Q: My insurance plan is refusing to list the amount that they will allow for the device. I was informed that we cannot receive our device without this information. What can I do to help?
A: Call your insurance company and speak to someone in customer service to obtain this information in writing then send a copy to Tobii Dynavox. Sometimes a number of phone calls are required by both the member and Tobii Dynavox to obtain the needed information. Don’t give up. It may also help to have your employer’s human resource department call as well.
Q: I have an insurance policy from my employer as well as an insurance policy from my spouse’s employer. How does this work?
A: We will request authorization from both insurers when we receive your funding request. Your funding coordinator will follow-up with the insurance companies to determine how the benefits will be coordinated. A signed release of information form from each policy holder is also required.
Q: My insurance company said that I could not receive equipment from Tobii Dynavox because I have to use an in network provider. Is this true?
A: Maybe. However, most insurers recognize that this is specialized equipment that can only by provided by Tobii Dynavox and a select few vendors. For this reason they will often grant an exception allowing the member to use Tobii Dynavox as a provider at the in network coverage level. Only a handful of funding requests have resulted in the use of an outside vendor at a higher cost for the insurance company.
Q: What if I have Medicaid as well as private insurance? Will Medicaid pick up the co-pay and deductible?
A: Yes, as long as we obtained a prior authorization from them first. Please contact us for more details at email@example.com.
Q: I was asked to sign a release of information form. What does this mean?
A: The signed release of information form allows Tobii Dynavox to exchange the required benefit, authorization and billing information with the insurance company that is necessary to process the funding for the equipment. Without this signed form Tobii Dynavox would not be permitted to collect or release any of your insurance information. The only time you would not be asked to sign the release of information form would be if you were pre-paying in full by check or credit card for your order and our funding department were not processing the funding through your insurance company for you.
Q: When I called my insurance company, they asked me for a procedure code. What should I tell them?
A: Insurers use procedure codes or HCPC Codes for all medical services. If your insurer informs you that speech devices are not covered because they could not find the code in their listing, we may be able to utilize a miscellaneous code. Your benefit booklet will give a better indication of whether they will cover the device.
Q: Can I submit documentation to my insurer myself?
A: In general, insurance companies will accept a request from a beneficiary. However, it is best to use your funding coordinator, as your funding coordinator is familiar with the authorization process and coding guidelines.
Q: Will my insurance company pay for an extended warranty?
A: Most insurers will not cover warranties. Warranties are highly recommended, as they will alleviate a long repair funding process of 2 months or more. If it is possible to pay for a warranty out of pocket, it is worthwhile.
Q: I have an HMO. Will I need a referral?
A: Yes. For most HMO plans, the Primary Care Physician’s office will need to fax us a copy of the referral and assist us in submitting to the insurer or the IPA.
Q: My insurance company won’t review the documentation. How do I know if this will be covered?
A: Without a written approval, we can’t be sure that your equipment is covered. For this reason, we insist that the insurance company provide us with a pre-determination of benefits.
Q: My insurance company called me and said that they are approving our request. I asked for a letter, and they said they don’t provide letters. What should I do?
A: We can provide your insurer with an approval form if they do not want to generate a letter on their letterhead. Either the completed approval form or a detailed authorization letter must be provided for us to ship your equipment.
Q: Can I pay for the Tobii Dynavox device now, and get reimbursed? I don’t want to wait for an approval.
A: Yes. However, please keep in mind that we cannot guarantee that you will be reimbursed without an approval on file. If you choose to submit to your insurer yourself, please remember to fax (866-336-2737) or Email a copy of the documentation to Tobii Dynavox.
Q: What is the Face-to-Face requirement?
A: As a condition of payment, insurance requires a physician document a Face-to-Face examination with a beneficiary prior to prescribing Durable Medical Equipment (DME). Speech generating devices are considered DME, and therefore, a recent physician’s visit must be on file within 6 months of the speech device prescription date.
Q: I recently had a doctor’s visit for the flu. This should satisfy the requirement, correct?
A: Possibly. The requirement would be met only if the physician also examined and/or discussed treatment for the diagnosis resulting in the need for the speech device. For example, if your physician only treated your flu symptoms and did not discuss the need for a speech device, you will need to arrange a separate office visit.
Q: I usually see a Nurse Practitioner within the practice. Do I need to switch to a physician?
A: No. Insurance allows the Face-to-Face exam to be conducted by a Nurse Practitioner, Physician Assistant or Clinical Nurse Specialist.
Q: I have never heard of this requirement before. I receive other medical equipment, and no other company has mentioned this. Is this a speech generating device policy only?
A: No, the Face-to-Face requirement applies to other DME items including hospital beds, oxygen, nebulizers and wheelchairs.
Q: I just saw my specialist. Do I really need to go back to my general doctor?
A: There is no need to see your general doctor if your specialist examines you, makes notes in their records about the communication impairment, and writes the prescription. But if your specialist did not treat or examine you for the communication disorder, another visit will be needed.
Q: I have an HMO through a private insurance company. Does this requirement apply to me?
A: Maybe. Most Commercial Insurers have their own medical necessity criteria. Tobii Dynavox has a team of funding associates who review each file to ensure the medical records meet the criteria of your insurance company. At the current time, most insurers are not requiring Face-to-Face exams. For the most up-to-date information on your insurance plan’s criteria, please contact your insurance company.
Q: How will you know the physician recorded my last visit? Will you call my physician, or do I need to ask my doctor’s office for documentation?
A: The Tobii Dynavox prescription form contains a section for the physician to note the date of your last visit. In most cases, the Funding team at Tobii Dynavox will also contact your physician upon receipt of your funding request to confirm the Face-to-Face requirement was met.