With so much to remember when it comes to funding, you may have additional questions. Don't see your question below? Contact us for answers. Return to Overview
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 to Medicaid.
Depending on where you live, some paying sources will not cover speech-generating devices. For example, if an AAC user lives in a skilled nursing facility, Medicare pays the skilled nursing facility and the cost of a speech-generating device is included in that fee. Medicare will not pay for the additional expense to cover the cost of our equipment.
The length of time the process takes depends on the paying source and whether there was any missing information in the initial packet. Unfortunately, this is rarely a quick process, but the more you are involved the faster it becomes!
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 need procedure codes, ICD-10 codes, pricing, and other pertinent information. Our Funding Department is well trained on these guidelines and can provide your insurance company with proper documentation.
The requirements vary depending on the paying source. 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.
Unfortunately, this is a possibility. If a submission is denied or deferred, our funding specialists and your regional consultant will work with the SLP and family to write and submit an appeal letter addressing the reason for the denial.
Also, visit our list of alternate funding sources. Many states and national organizations offer options to help fund a device.
Yes. Because the funding process is sometimes lengthy and PRC recognizes that your device may be your only means of communication, we will 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.
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.
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.