Insurance Has No In-Network DME Supplier

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Hi guys…

I spent almost 2 hours yesterday checking every single listed in-network DME supplier on my insurance app to find a covered and required pair of leg boots. I went through 67 different suppliers, checked about 50 websites, and called the rest one by one, but had no luck.

When I opened a chat window on my insurance app, I was given four different suppliers’ names and phone numbers to call while the chat person waited on the line. We did this multiple times, but I ended up calling about 13 different suppliers without success—none of their in-network suppliers sell these items. When I mentioned I have an out-of-network supplier that can provide them, I was told it wouldn’t be covered as in-network.

Does anyone know of a regulation I can quote or any magic words I can use to have them cover this as in-network?

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Requesting a coverage exception because of the unavailability of in-network suppliers might result in approval. Be sure to provide detailed documentation of your search efforts.

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The problem is that the provider can bill you in full even though they are not on the network, thus you might need to file a network gap exception. The insurance provider may pay the claim as in network thanks to the network gap exemption. The provider merely needs to accept the insurance premium and sign a single case agreement; they won’t balance bill you.

Checking out Amazon is an additional choice; in most cases, it will be less expensive than insurance.