FUNDING FREQUENTLY ASKED QUESTIONS (FAQ)

Q. � How long does the funding process take?

A. This depends on the funding source and the completeness of the documentation. As a general rule, it takes 30-60 days for the funding process to be completed and an order shipped.

Q. What type of documentation is required?

A. � Most funding sources require a prescription and a speech evaluation or letter of medical necessity. � You must also provide us with the following information necessary to process an insurance claim.

�           Completed Client Profile
�           Copy of all insurance cards (front and back)
�          Assignment of Benefits signed by client
�          Consent Form, signed by client
�          Co-pay and deductible if there is no secondary insurance
�          Speech Therapist's Comprehensive evaluation (dated prior to prescription)
�          Physician's prescription (prescribing an itemized list of equipment)

Q.     Where do I send the paperwork? �

A.     Mail the complete packet of documentation to your local dealer or durable medical provider in your state. For private insurance claims, and some state Medicaid claims, send the entire packet to:

ZYGO Industries, Inc.
Funding Department
P.O. Box 1008
Portland, OR 97207-1008

Q. � Can I fax the documentation? �

A. � Yes, but you must also mail the original documentation. We can receive faxes prior to receipt of final paperwork to allow our funding department to go over the documentation and contact you if we see any problems that may need to be corrected. However, we do require that you mail the original paperwork to us even if a copy has been faxed. � Most funding sources require us to maintain the original, signed paperwork in your file.

Q. � Who can assist me in the funding process?

A. � Anyone in our Funding Department can answer questions you may have regarding funding. You may also get a better understanding of the process from our Funding Program page on our website. Please contact us at toll-free (800)234-6006, direct at (503)684-6006, or by e-mail at [email protected].

Q. � How are insurance claims processed? �

A. � All paperwork for Medicare, private insurance or Medicaid should be submitted either to ZYGO Industries, Inc., our local dealer, or a Durable Medical Equipment provider who can process your claim with your state Medicaid office. � We submit the claim for equipment to Medicare for you. Our dealers and DME providers submit on your behalf for state Medicaid and Medicare/Medicaid/private insurance split claims.

Q. � Can I submit to my insurance policy myself? �

A. � In some situations, yes. However, we recommend that you utilize our funding department to ensure the greatest likelihood of receiving reimbursement.

Q. � I have an older device. How long do I need to wait before I can get a new device? �

A. � Most funding sources are in agreement that a speech device should last for at least five years. It may be possible to get another device before that time if your communication needs have changed.

Q. � What funding sources might help pay for speech generating devices? �

A. � There are many funding sources available. Private insurance, Medicaid, Medicare, Vocational Rehabilitation, Department of Developmental Disability, Veterans’ Administration, state telecommunications programs, school systems, clinics, hospitals, non-profit organizations like the ALS Association or Muscular Dystrophy Association, and foundations have all funded augmentative communication devices. � Local charity functions have also been quite generous in raising funds for its citizens in need.

Q. � How do I determine which funding source to approach? �

A. � Start with the list of funding sources above. Look for the most obvious source for your current situation. � For example, your medical insurance is interested in satisfying your medically related needs, school funding is obviously education based, whereas vocational rehabilitation focuses on providing equipment that allows you to return to or retain your job.

Q. � If I have a combination of health plans (private insurance, HMO, Medicare, Medicaid), which should I approach first? �

A. � Provide all your insurance information to our funding department and we will determine who is the primary, secondary, etc, insurance plan. We will request prior authorization if necessary and keep you advised of the status of your request.

Q. � How is "medical necessity" justified? �

A. Medicare and Medicaid have specific criteria that must be addressed in the speech evaluation report that is generated by your Speech Language Pathologist. � Most health plans require a letter of medical necessity that clearly indicates how the absence of the communication device could pose a substantial risk to the patient's health or safety. If possible, specific examples should be given that the communication device is the patient’s only way of indicating that he or she is not feeling well, speaking with a medical professional, or contacting 9-1-1 for emergency assistance.

Q. � What happens if a claim is denied? �

A. � If any funding source denies the claim, you can appeal the denial. Claims denied on the first try are frequently funded after an appeal. Contact our Funding Department for assistance in the appeal process or for the name of the Protection and Advocacy center in your area.

Q. � Will I be required to pay a portion of the cost of a device approved through insurance? �

A. � Many insurance policies require a co-payment from the policyholder for the purchase of the device. The amount of the co-payment depends on the health plan and the policy. Often times the co-payment is paid by a secondary policy, such as Medicare/Medicaid. Medicaid payments are considered payments in full and the recipient is generally not responsible for any co-payment.