Frequently Asked Questions

A wide range of health insurance policies and health care plans provide reimbursement and/or coverage for durable medical equipment (DME) from Perfect Fit Medical Supply. In order to know what is covered by your specific health insurance plan or policy, you will need to review the benefits and coverage under your specific plan.

Member Services representatives from your health plan or health insurance company are available to assist you with the review of your benefits and coverage amounts for services and durable medical equipment. Be sure to check your insurance card for the best telephone number to reach them for questions and information on coverage.

You will pay the balance due by the member (patient) after the insurance claim is processed and member (patient) applies any deductible, copayment, coinsurance, or non-covered service.

Your deductible is the amount you owe for health care services before your health plan will start paying for your health care. Depending upon your specific insurance policy or health plan, the deductible may not apply to all services. Be sure to check your insurance card for the best telephone number to reach them for questions and information on coverage.

Co-payments are the fixed amount you pay for a covered health care service or supply. For example, $15 for a doctor visit. Be sure to check your insurance card for the best telephone number to reach them for questions and information on co-payments.

Co-insurance is your share (a percent) of the costs of a covered service. For example, if your co-insurance is 20%, and the service cost $100, you pay $20. You will need to check with your insurance company or health plan to find out if co-insurance applies to durable medical equipment from Perfect Fit Medical Supply. Be sure to check your insurance card for the best telephone number to reach them for questions and information on co-insurance.

A non-covered service is determined by an insurance plan when the service is not considered to be medically reasonable to the patient’s condition and reported diagnosis will not be covered. Be sure to check your insurance card for the best telephone number to reach them for questions and information on co-insurance.

If your health plan does not cover all or part of Perfect Fit Medical Supply services or products, some of these services may qualify for payment through a flexible spending account, health savings account, or health reimbursement account offered by some employers.

Product Pricing (or fees) is determined by each individual insurance plan under their contracted Fee Schedule with Perfect Fit Medical Supply. Once your health insurance claim is processed, your insurance plan will review individual Health Insurance Coverage and determine the portion the insurance will pay and the portion that should be billed to the member (patient).

The HCPCS Code stands for the “Healthcare Common Procedure Coding System” and is used to submit a claim to the insurance company for the product and/or health service a member (patient) receives during their medical visit.

For Durable Medical Equipment (DME), this code is determined by the Medicare Pricing, Data Analysis and Coding (PDAC) system a government office. PDAC works with manufacturers to review and determine the HCPCS assigned to each DME for claim submission purposes.

Item A co-pay is a fixed payment for a covered service, paid when an individual receives service. In the United States, copayment is a payment defined in an insurance policy and paid by an insured person each time a medical service is accessed. It is technically a form of coinsurance, but is defined differently in health insurance where a coinsurance is a percentage payment after the deductible up to a certain limit. It must be paid before any policy benefit is payable by an insurance company. Copayments do not usually contribute towards any policy out-of-pocket maxima whereas coinsurance payments do.

A deductible is the amount of expenses that must be paid out of pocket before an insurer will pay any expenses. In general usage, the term deductible may be used to describe one of several types of clauses (see below) that are used by insurance companies as a threshold for policy payments.