Insurance
Medical Art Resources works regularly with insurance companies to help our patients access the care they need. We strive to set fees that are affordable, including reduced fees for replacement prostheses. Please be assured that we will help you navigate the complexity of billing for medical care. We are patient advocates. We take an active role in making sure insurance companies understand the needs of our patients and we help our patients maximize their benefits. Our office routinely submits pre-determination of benefits and insurance claims for our patients.
Most insurance programs, including Medicare, provide coverage for facial prostheses needed due to birth difference, trauma or disease. Nipple and breast prostheses are covered by law in the United States. Coverage for finger, hand, and toe prostheses is more challenging because specific procedure codes used to submit insurance claims do not exist. However, if we have documentation regarding medical necessity from your physician we can request prior authorization and will submit a claim for you.
If you decide to proceed with your prosthetic treatment plan, we will ask you to provide us with insurance or other payer information. With your permission we will request a physician’s order and clinical notes from your doctor. This information will help us predetermine your insurance benefits and submit a prior authorization request.
Patients may be asked to assign benefits directly to our office and pay any deductible or co-payments upon completion of the prosthesis. In cases of hardship, payment plans can be arranged.
We accept MasterCard, Visa, as well as Care Credit.
Cindy - Our Insurance Specialist
Cindy is our insurance specialist. She will likely be the person to pick up the phone when you call us. We know that our patients are concerned about cost and insurance coverage. Cindy can answer your questions and help with insurance predetermination of benefits, prior authorization, and claim submission. Her knowledge combined with a thoughtful and caring demeanor helps our patients to navigate complex and sometimes stressful issues.
Insurance Networks
We have contracts with insurance networks such as:
Anthem Blue Cross Blue Shield
Dean Health Plan
Exceedent
Quartz through a contract with Chartwell
If we are not a participating provider with your insurance network, we can often negotiate a single case agreement or geographic gap exception with your insurance provider when your physician is referring you to our office and network inadequacy can be established.
Medicare
Medical Art Resources–Milwaukee, is a Medicare provider. If you are part of a Medicare Advantage plan, we will prior authorize with your insurance network.
Veterans
We work with veterans through William S. Middleton Memorial Veterans Hospital in Madison, Wisconsin and Clement J. Zablocki Veterans Affairs Medical Center in Milwaukee, Wisconsin. Referrals from other veterans’ facilities can also be arranged.
Workers Compensation Insurance
When traumatic injury occurs during work, your reconstructive prosthesis is usually covered through worker compensation insurance. Your nurse case manager can help facilitate an authorization and coordinate your initial consultation.