Funding a device can feel like navigating a maze. Here are some of the more frequently asked questions we receive in our Funding Department. Your question not here? Contact us for assistance. Return to Overview
Start by determining your paying source(s) and take note of their guidelines: paperwork needed, submission requirements, etc.
As paying sources will require a current speech/language evaluation, be sure this has been completed before submitting documents. You may also need a prescription from your physician; again, check your paying source(s) guidelines to be sure.
If your paying source is Medicaid, give special attention to any state-specific forms.
To find out if you need any additional paperwork, review our checklists and templates. These forms were created to assist with specific requirements.
If you have questions, call the PRC Funding Department at 800.268.5224.
Submit your paperwork to PRC Corporate Headquarters at 1022 Heyl Road, Wooster, OH 44691. We will submit the paperwork to the proper paying source(s) on behalf of the client.
The requirements vary depending on the paying source, although typically the report needs to be dated within six months to one year of the funding application. 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 PRC so we may begin a 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).
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.
The length of time the process takes depends on the paying source. As a general rule, it may take 30 to 60 days from the date your paperwork was received at PRC.
You may submit to your insurance company directly for a medical review; however, we recommend that you send the request to the PRC Funding Department. When insurance companies review a funding packet, they not only are reviewing it for medical necessity, but also look for 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.
One option is to call your insurance carrier and ask them if your policy has benefits to cover speech-generating devices. Or, 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.
It’s 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 appealing their decision.
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.
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.
PRC is extending credit by shipping the device before we receive payment. A Social Security number is required for such an extension of credit.
At a minimum, PRC requires 60 days to process the order but cannot make any guarantees that it will be processed in time due to factors outside our control.
Your SLP will work with the PRC funding specialist to file an appeal. Learn more about deferrals and denials.