FAQ

Will my insurance cover this? This is by far the most frequently asked question. In many cases, medical equipment is “covered” by insurance. Each insurance plan is different and needs to be considered on a case-by-case basis; however, the following are always applicable: 1) Any benefits or expected insurance coverage relayed to you by us is NEVER a guarantee of coverage. 2) We have no control over your policy nor the manner in which the insurance adjudicates claims. We will do our best to provide complete information when we perform our coverage determination; however, you must be prepared to pay in-full for any product you choose to receive from us in the event that your insurance denies the claim or processes it in a manner different than expected. 3) A prescription, often accompanied by chart notes, and an ICD-10 coded diagnosis is always required to bill an insurance. 4) In some cases, insurance limits coverage for certain equipment to specific diagnosis codes. 5) Most of the time we will need a copy of your patient medical record from the prescriber from the face-to-face appointment where you and your doctor discussed the need for the item. 6) Please note, insurance does not consider a “letter” or “note” from your doctor as part of the medical record and therefore is not admissible. 7) Additional information may be required for specific medical equipment. Please contact us with any questions! We’ll do our best to help you maximize your insurance benefit.

My doctor wrote a prescription, why won’t my insurance pay for it? Insurance plans have different coverage parameters. The insurance decides which item categories are included in their plans, but in most cases they are limited to Federally-approved medical products that are made for a generally-acceptable medical need that is supported in your chart record. Without this documentation, you are welcome to pay out of pocket.

Can my doctor write a letter stating why I need an item, to get the insurance to pay for it? No. According to Medicare policy, a letter is not considered a legitimate part of your medical chart. Any information supporting the medical justification for an item must be explicitly included in your formal medical records.

Why do I need a prescription if the item is not covered by my insurance? While a prescription is always required for insurance coverage, United States Federal Law further limits many medical items to sale only via a prescription, regardless of coverage policies.

I can purchase this same item online, why do I need a prescription here? We are Pharmacy, regulated by the Washington State Department of Health (WSDOH). Other pharmacies outside the state or other non-pharmacy businesses may not be subject to WSDOH oversight.

How do I dispose of medications? Due to our small retail space, we don’t have accommodation for secure, anonymous take-back drop-boxes; however, there are several available at chain pharmacies. Please refer to the FDA website for proper disposal of medications: “Where and How to Dispose of Unused Medicines”

Do you deliver? We contract with a third party for area delivery. This is a for-fee service. In some instances, at our discretion, we may waive the delivery fee. Inquire with the pharmacy for information about your specific situation.

Do you take my insurance? We are in network with the following plans for Durable Medical Equipment: (NOTE! Prescription drug processing is another story, and we can process most prescription drug insurances. Kaiser and Tricare are exceptions and we aren’t able to process drug claims with those payers. Call with questions on any insurance questions regarding medication.)

  • Asuris | Asuris Northwest Health | Asuris Medicare Advantage

  • Wellpoint | Wellpoint Medicare Advantage (formerly Amerigroup)

  • BlueCross BlueShield (via Local Blue)

  • Community Health Plan of Washington (Apple Health, Medicare Advantage)

  • DSHS (Apple Health/Medicaid)

  • First Choice Health Administrators

  • Washington State Labor & Industries

  • Medicare (CMS Medicare, “traditional” Medicare)

    • NOTE: When Medicare is primary, we need detailed chart notes to go along with the prescriber’s detailed written order (click here for more info)

  • Medicaid

    • Montana

    • Washington

  • Molina Healthcare of Washington (Apple Health, Medicare, Marketplace) (except no incontinence through Molina Apple Health)

  • Premera

  • Premera Blue Cross

  • Regence (via Local Blue)

  • Tricare West | Tricare Prime | Tricare for Life

  • United Healthcare | United Healthcare Choice Plus | United Healthcare AARP Medicare Complete | United Healthcare Community Plan (Apple Health)

Out of network: Aetna, Cigna, Coordinated Care, Kaiser, Humana, Idaho Blue Cross