Determine your paying source(s). Once that has been established, you must follow their guidelines. It is possible to have multiple paying sources. Regardless of the paying source, you will need a current speech/language evaluation as well as a prescription from your physician. Give special attention to any state-specific forms if your paying source is Medicaid. Please review our checklists and templates. These forms were created to assist you with your specific requirements. If you have questions, call the PRC Funding Department at (800) 268-5224.
Submit your paperwork to PRC's corporate headquarters. We will submit the paperwork to the proper paying source(s) on behalf of the client. Our address is 1022 Heyl Road, Wooster, OH 44691.
My child's speech evaluation was completed over a year ago. Will I need to have it updated?
The requirements vary depending on the paying source. Typically, the report needs to be dated within six months to a year of the application for funding. We recommend that all funding documentation be completed within six months of the evaluation.
Some sources require original signatures on the documentation. We suggest that you fax the request to us, so that we may begin our review of your documentation. In addition, please mail the request. If you are unclear if your paying source requires original documentation, please call our Funding Specialist(s).
How do I know that I have included all the required documentation?
Once your funding request is received at PRC, our trained funding specialist will review the packet. If pertinent information is missing, we will contact you and/or your advocate by telephone, mail, fax or e-mail. In any case, PRC will generate a letter informing the advocate that your packet of information has been received.
This length of time the process takes depends on the paying source. As a general rule, it may take 30 to 60 days from receipt of your paperwork by PRC.
May I submit a request to my insurance policy on my own?
You may submit to your insurance company directly for a medical review; however, we recommend that you send the request to our Funding Department. When insurance companies review a funding packet, they not only are reviewing it for medical necessity, but also need procedure codes, ICD-9 codes, pricing, and other pertinent information. Our Funding Department is well trained on these guidelines and can provide your insurance company with proper documentation.
How can I determine if the equipment I need is a covered benefit under my insurance policy?
You may call your insurance carrier and ask them if your policy has benefits to cover speech-generating devices. If you have an insurance manual, review the sections pertaining to durable medical equipment, augmentative communication devices, or even speech prosthesis. Please keep in mind that any benefit quoted by the insurance representative is not a guarantee of payment.
My insurance company informed me that I would not be reimbursed for equipment from a non-participating provider. Does this mean I cannot obtain a PRC device?
It is important to inform your insurance company that PRC is the sole provider and manufacturer of all equipment bearing the PRC label. Many insurance companies make exceptions to your policy due to this fact and treat us as an in-network provider. If your insurance company will not allow this exception, we recommend you appeal this decision.
What significance does the client's place of residence have in the process?
Depending on where you live, some paying sources will not cover speech-generating devices. For example, if the AAC user lives in a skilled nursing facility, Medicare will not cover the cost of our equipment. Medicare pays the skilled nursing facility a per-diem rate. The cost of the speech-generating device is included in this per-diem rate.
Why am I required to sign an Assignment of Benefits form? What does it mean?
By signing the Assignment of Benefit (AOB) form, the policyholder is giving their permission for the paying source to pay PRC directly instead of paying the client. If the equipment is prepaid by a private source, an AOB will not be necessary.
My client is eligible for both Medicare and Medicaid. Will I still need to pay my Medicare co-pay?
In this case, Medicare will be the primary carrier. Medicaid should take care of the co-pay obligation if the medical necessity for the equipment has been documented. Medicaid may have to pre-approve the request. Depending on the reason Medicaid did not pay, you may need to appeal your Medicaid policy.
I have purchased a device with my own funds. Can PRC help me get reimbursement?
It is possible depending on the paying source. If this is an insurance policy or Medicare claim, the answer is yes. We would highly recommend that a pre-determination through your insurance company be completed and your benefits verified before you institute the purchase of PRC equipment. It is also critical that all the documentation meet Medicare's requirements before they will pay. In this case, we highly recommend that you send our Funding Specialist the Medicare documentation to review. Medicaid is payer of last resort. If payment is collected for services prior to Medicaid, there will be no reimbursement due to Medicaid's guidelines.
My current device is broken. Will I receive a service loaner to use while my device is being repaired?
Yes. PRC recognizes that your device may be your only means of communication. Because the funding process is sometimes lengthy, we are pleased to loan you a device while you are going through the funding process. PRC requires that all proper medical documentation as well as the broken device be received before the service loaner is shipped. Please view the information on the web site for details on the required paperwork.
Why do I need to send paperwork again for my broken device if Medicaid paid for it?
Some Medicaid offices require pre-approval for repairs even if they funded the device. Typically, the paperwork needed for a repair does not need to be as detailed as the paperwork for a new purchase. We recommend that you contact our Funding Specialist(s) to see if your state requires a medical review.
I need to replace my device. How long am I required to wait between device purchases?
Most funding sources require five years before a new device will be considered. Some will allow a new device sooner if the current device is not meeting the client's medical needs. The medical necessity for the new device must be documented regardless of the age of your current device. Please view our state specific pages for details on what documentation is required.