EHCS strives to help our customers meet the goals that have been discussed with their healthcare professional. We supply the prescribed product, provide instruction manuals and/or videos, and follow up to see if any additional assistance is required.
We serve the continental United States with disposable supplies that include but are not limited to: diabetes testing supplies, insulin pumps and supplies, ostomy, urological products, wound care items, breast pumps, and breast pump supplies.
Any EHCS representative is permitted to process a referral. A large number of our referrals are received directly from the customer or a member of his/her family.
After completion of the customer application, it is forwarded to the verification department to process. The process is as follows:
- Insurance company is called to obtain verification of benefits.
- The customer is called to inform him/her of any financial responsibility, if applicable.
- The physician is called to obtain address, fax number, Unique Physician Identification Number (UPIN), National Provider Identification (NPI), and to verify the customer order.
- The order is shipped and put on billing hold until all of the appropriate documentation is received.
- The pending application is updated accordingly.
- The order is released for claim submission once the proper paperwork has been received.
The eligibility of all customers is determined prior to shipment.
After an EHCS representative takes an application, the verification department will determine:
- If a customer has eligible insurance coverage (his/her policy is currently active for the date of service).
- If the product that the customer is requesting is a covered benefit under his/her insurance.
- If the customer meets any needed clinical/medical guidelines that are required in order for the product to be covered (making sure that his/her diagnoses warrants the item).
- If the customer meets any financial responsibility that he/she may have.
EHCS may have limitations including but not limited to:
- Out of network insurance policies
- Products that are not obtainable
- Financial responsibility that cannot be met by the customer
We makes every attempt to help each customer referral in need of medical supplies. There are occasions when:
- A customer has limited insurance coverage, cannot afford his/her co-payment, and stresses to the customer service representative that it is a financial hardship for him/her to pay. The representative will obtain approval from a supervisor to offer a financial hardship to the customer waiving him/her of the co payment responsibility (deductibles will not be waived). Approval is determined on a case-by-case basis.
- A customer has no insurance coverage and indicates that he/she cannot afford to pay for his/her supplies. The customer service representative instructs the customer to call the Partnership for Prescription Assistance Program at 1-888-477-2669. This facility will assist the customer in obtaining medical supplies. The customer may also be referred to call their local county Department of Jobs/Health and Family Services.
Prior to shipping a new customer’s order, he/she is informed of any possible financial responsibility for the order.
If an application is taken for a customer and he/she only has Medicare:
- Inform the customer that Medicare will pay for 80% of the supplies that are medically necessary and it will be the responsibility of the customer to pay the other 20%.
- If the customer agrees to the charges, note it on the application that he/she is aware of his/her financial responsibility.
- If the customer states that it is a financial hardship to pay the 20% portion, you may offer a financial hardship to the customer.
- Inform the customer that the financial hardship form needs to be signed and returned to Direct Healthcare Supply.
- Inform the customer that it is for the 20% co pay only and not for any deductible that may get applied when the bill is submitted.
- Obtain approval from your supervisor to send the financial hardship and note the application to include the letter with the welcome packet (all financial hardships are approved on a case-by-case basis).
If an application is taken for a customer and he/she is covered by a secondary insurance in addition to Medicare:
- Verify the coverage for the customer.
- If there is limited or no coverage, follow the same procedure as above.