FAQ and Policies

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FAQ

Why does my statement say “no insurance info”? I have insurance.

If your statement says “no insurance info” but you have insurance, the paperwork we received from your doctor’s office was either incomplete or inaccurate. This is easily fixed. All you need to do is contact us with your complete insurance information and once received, we will begin the process of re-filing with your insurance provider. Please contact IMS Experts, at 817-453-9767, ext.1 (billing).

Why did I receive a bill? I already paid my co-insurance/co-pay at the doctor’s office.

You may have paid your co-pay at the doctor’s office for the doctor’s services. However, this statement is referring to a separate benefit under your insurance for the product you received at your doctor’s office. Depending on the product, your insurance is telling us that you owe a percentage for co-insurance. The co-pay is the flat rate you pay for the doctor’s office visit only. If you have any questions in regards to your patient balance for IMS Experts services and products, please call us at 817-453-9767, ext.1 (billing).

What’s the correct way to wear my brace and how often do I wear it?

  • Examine the brace before putting it on. Do not proceed if you see signs of wear in the padding or exposed metal parts.

  • Put the brace on according to the manufacturer’s instructions. It should provide a snug fit around your midsection and support the lower back. Use the adjustment mechanisms; such as straps to tailor the fit to your body shape. Same applies for ankle and knee braces.

  • Wear your brace during the day, particularly when you are active. You may remove the brace at night-time if you wish. Wear it under or over your clothing, depending on which you prefer. Do not wear any brace to bed. Replace or repair your existing brace if it slips or requires frequent adjustment while it is on.

  • Address any additional questions about wearing a medically prescribed back brace to your doctor. Your physician and/or his staff can discuss with you on how often and how long you should wear your brace.

  • Clean and care for brace per manufacturer’s instructions.

What should I bring to my appointment?

On the day of your appointment, we ask that you bring two things:

  • A valid form of photo ID, such as your driver’s license or passport; and

  • If insured, your health insurance card.

**Minors (individuals under the age of 18) are also required to bring their parent or legal guardian.

What is co-insurance?

Co-insurance is an insurance policy provision under which the insurer and the insured share costs incurred after the deductible is met. It is similar to a co-payment, but instead of being a set amount per visit, the co-insurance is a percentage of the approved charges.

Your insurance company should indicate the amount of co-insurance due on the explanation of benefits (“EOB”) when they process a claim.

What is a deductible?

In an insurance policy, the deductible is the amount that must be paid out-of-pocket before an insurer will pay any expenses. The deductible must be “met”; that is, paid by the insured before the benefits of the policy can apply. Therefore, you would have to pay the provider out-of-pocket before reimbursement begins. If you have a question or are disputing the fact that you haven’t met your deductible, we recommend calling your insurance company.

What is “Stock & Bill”?

As its name implies, “Stock & Bill” is a program we offer to medical professionals and facilities where we stock and bill their orthopedic products for them. This allows the physicians to deliver better patient care while alleviating the financial and administrative burdens often associated with maintaining an orthopedic bracing inventory.

What does “transfer balance” mean?

If the term “transfer balance” appears on your statement or patient responsibility notice, this means that after your insurance processed the claim, a remaining balance was transferred back to you. This sometimes occurs because you still owe a co-insurance or deductible amount. It could also be a non-covered benefit. The explanation of benefits (“EOB”) that you receive from your insurance company should provide additional details regarding any payment amounts that you are responsible for.

What does “exceeded benefit limit” mean?

Some insurance companies limit the dollar amount they will pay per year for certain services, or they limit the quantity of services eligible for coverage per year. If your statement shows that you have a balance due because you exceeded your benefit limit, this is information we received from your insurance company. They are stating that they have paid up to the maximum limit they provide coverage for; and that the patient is responsible for the remaining balance.

My insurance denied coverage for the product I received. Is there anything else I can do?

Insurance companies are more likely to listen to their members than to the provider of the service. While IMS Experts will attempt to appeal denials that have provider appeal rights, there are some denials that can only be appealed by the member. We highly recommend appealing this decision with your insurance company if you disagree with it. For example; if your insurance denies payment for our product because it is “not medically necessary”, it is helpful to get a letter of medical necessity from your physician and we can assist in providing the letter of medical necessity to your provider in order to “re-process” the denied claim.. In addition, IMS Experts is open to discuss an individual payment plan that best suits your financial situation. Please call us to make and discuss payment arrangements at 817-453-9767, ext. 1 (billing).

My doctor is in network with my insurance. Why did IMS Experts process my claim as out-of-network?

It is possible that your doctor is in network with your insurance and IMS Experts is not. If your insurance states that we need to charge you a higher co-insurance or deductible because we are out-of-network, we suggest you submit an appeal to your insurance and state that you were not aware we were not in network or that we were a non-participating provider at the time you received the product at the doctor’s office.

Are orthopedic devices covered by my insurance?An orthopedic device may be covered in full, partially, or not at all by your insurance. Coverage of your orthopedic device varies according to a multitude of variables including, but not limited to;

  • Your insurance plan

  • Whether your insurance plan has a deductible, and whether that deductible has been met

  • The reason your doctor prescribed the device

  • Whether there is sufficient documentation to justify the medical necessity of the product.

For any questions or to inquire further about IMS Experts products and services please click on the CONTACT TAB to contact us directly.

Patient Medical Glossary

So often when you or a loved one becomes ill, you begin to hear or read complicated and unfamiliar medical terminology. To help you learn the meaning of various medical terms, we’ve provided a medical glossary featuring the most common types of medical terms associated with durable medical equipment.

Anterior Cervical Discectomy

Anterior cervical discectomy and fusion: A procedure that reaches the cervical spine (neck) through a small incision in the front of the neck. The intervertebral disc is removed and replaced with a small plug of bone or other graft substitute, and in time, that will fuse the vertebrae.

Arthritis

Arthritis is inflammation of one or more of your joints. The main symptoms of arthritis are joint pain and stiffness, which typically worsen with age. The two most common types of arthritis are osteoarthritis and rheumatoid arthritis.

Cervical Brace

A Cervical Brace (also known as cervical collar) is an orthopedic medical device used to support a patient’s neck and head. It is also used by emergency personnel for those who have had traumatic head or neck injuries,[1] and can be used to treat chronic medical conditions.

Cervical Radiculopathy

Cervical radiculopathy is the damage or disturbance of nerve function that results if one of the nerve roots near the cervical vertebrae is compressed. Damage to nerve roots in the cervical area can cause pain and the loss of sensation in different parts of the upper extremities, depending on where the damaged roots are located.

Cervical Spine

The cervical spine (neck) is delicate – housing the spinal cord that sends messages from the brain to control all aspects of the body – while also remarkably flexible, allowing movement in all directions, and strong

Cervical Spondylosis

Cervical spondylosis is a general term for age-related wear and tear affecting the spinal disks in your neck. As the disks dehydrate and shrink, bone spurs and other signs of osteoarthritis develop.

Cervical spondylosis is very common and worsens with age. There also appears to be a genetic component involved because some families will have more of these changes over time, while other families will develop less. More than 90 percent of people older than age 65 have evidence of cervical spondylosis and osteoarthritis that can be seen on neck X-rays. Most of these people experience no symptoms from these problems. When symptoms do occur, nonsurgical treatments often are effective.

Cervical Traction

A Cervical traction has been utilized for many years for relief of pain associated with neck muscle spasms or nerve root compression. Traction is a medical techniques in which opposite forces are applied to separate parts of the body to stretch soft tissues, and/or separate bony structures.

Chondromalacia Patella

The cartilage under your kneecap is a natural shock absorber. Overuse, injury or other factors may lead to a condition known as chondromalacia patella (kon-droh-muh-LAY-shuh puh-TEL-uh) — a general term indicating damage to the cartilage under your kneecap. A more accurate term for chondromalacia patella is patellofemoral (puh-tel-o-FEM-uh-rul) pain syndrome.

The most common symptom is knee pain that increases when you walk up or down stairs. Simple treatments — such as rest and ice — often help, but sometimes physical therapy or even surgery is needed to ease patellofemoral pain.

Chronic Knee Pain

Chronic knee pain is long-term pain, swelling, or sensitivity in one or both knees. The cause of your knee pain can determine the exact signs and symptoms you may experience. Chronic knee pain is a broad condition; many conditions can cause it or contribute to it, and many treatments exist for it. Each person’s experience with chronic knee pain may be different.

Chronic Venous Insufficiency

Chronic venous insufficiency (CVI) of the lower extremities is a condition caused by abnormalities of the venous wall and valves, leading to obstruction or reflux of blood flow in the veins. Signs of CVI include hyperpigmentation, stasis dermatitis, chronic edema, and venous ulcers.

Congenital Deformities of the Knee

Congenital deformities about the knee are the result of abnormalities of all the anatomical structures that make up this joint. In some cases the structural changes observed are due to primary disorders of formation and growth of one or more of the anatomical components of the knee. Disorders are known to occur in the integumentary, muscular, ligamentous supporting, and skeletal systems.

Delayed Union

Delayed union, by definition, is present when an adequate period of time has elapsed since the initial injury without achieving bone union. The fact that a bone is delayed in its union does not mean that it will become a nonunion. Nonunion is one end result of a delayed union, and the differentiation between the two is sometimes difficult to make. Classically the stated reasons for delayed union are problems such as inadequate reduction, inadequate immobilization, distraction, loss of blood supply, and infection.

Degenerative Disc Disorder

Degeneration of one or more intervertebral disc(s) of the spine, often called “degenerative disc disease” (DDD) or “degenerative disc disorder,” is a condition that can be painful and can greatly affect the quality of one’s life.

DiscVertebra of the Neck

The cervical spine consists of seven vertebrae, and they are the smallest of the spinal column. Together, the vertebrae support the skull, move the spine, and protect the spinal cord, a bundle of nerves connected to the brain.

Disc Degeneration

Disc degeneration is a disease of aging, and though for most people is not a problem, in certain individuals a degenerated disc can cause severe chronic pain if left untreated.

Herniated Disc

A herniated disk refers to a problem with one of the rubbery cushions (disks) between the individual bones (vertebrae) that stack up to make your spine.

  • A herniated disk can irritate nearby nerves and result in pain, numbness or weakness in an arm or leg. On the other hand, many people experience no symptoms from a herniated disk. Most people who have a herniated disk don’t need surgery to correct the problem.

  • A spinal disk is a little like a jelly donut, with a softer center encased within a tougher exterior. Sometimes called a slipped disk or a ruptured disk, a herniated disk occurs when some of the softer “jelly” pushes out through a crack in the tougher exterior.

Laminectomy

Laminectomy is surgery to remove the lamina — the back part of the vertebra that covers your spinal canal. Also known as decompression surgery, laminectomy enlarges your spinal canal to relieve pressure on the spinal cord or nerves. This pressure can be caused by a variety of problems, including bony overgrowths within the spinal canal (spinal stenosis) or by a herniated disk. Laminectomy is most commonly performed on the vertebrae in the lower back and in the neck.

Laminectomy is generally used only when more-conservative treatments — such as medication and physical therapy — have failed to relieve symptoms. Laminectomy also may be recommended if symptoms are severe or worsening dramatically.

Lateral Traction

Lateral traction moves part of your body, such as your leg, slightly to the side to correct a dislocation. A system of weights and tension holds your body part in place as a form of orthopedic treatment, a form of treatment for…

Lower Back Pain

The lower back is an intricate structure of interconnected and overlapping elements:

  • Tendons and muscles and other soft tissues;

  • Highly sensitive nerves and nerve roots that travel from the lower back down into the legs and feet;

  • Small and complex joints;

  • Spinal discs with their gelatinous inner cores;

An irritation or problem with any of these structures can cause lower back pain and/or pain that radiates or is referred to other parts of the body. Pain from resultant lower back muscle spasms can be severe, and pain from a number of syndromes can become chronic. While lower back pain is extremely common, the symptoms and severity of lower back pain vary greatly. A simple lower back muscle strain might be excruciating enough to necessitate an emergency room visit, while a degenerating disc might cause only mild, intermittent discomfort. Identifying the symptoms, along with an accurate diagnosis of the underlying cause of the pain, is the first step in obtaining effective pain relief.

Lumbago

Lumbago, pain in the lower (lumbar) portion of the back. Lumbago is considered by health professionals to be an antiquated term that designates nothing more than lower back pain caused by any of a number of underlying conditions. The pain may be mild or severe, acute or chronic, confined to the lower back or radiating into the buttocks and upper thighs. It may be caused by a weak or strained back muscle, torn ligaments, a herniated disk, compression of the sciatic nerve (sciatica), degenerative disease of the vertebrae (spondylosis), curvature of the spine (scoliosis), or loss of bone

Lumbar Brace

Lumbar Back braces are designed to support the lower back and are indicated for many common back conditions.  From back strains, post-op laminectomy, spinal stenosis and bulging discs.

Lumbar Spine

The lumbar spine refers to the lower back, where the spine curves inward toward the abdomen. It starts about five or six inches below the shoulder blades, and connects with the thoracic spine at the top and extends downward to the sacral spine.

Lumbar Spondylosis

Also known as spinal osteoarthritis, can affect the lumbar, thoracic, and/or the cervical regions of the spine. The intervertebral discs and facet joints are affected with this degenerative disorder. The biochemical changes that occur as an individual ages affects tissue throughout the body and may have a detrimental effect on the structure of the discs.

Lumbar Traction

A lumbar traction uses manually or mechanically created forces to stretch and mobilize the spine. Traction may alleviate back pain by stretching tight spinal muscles that result from spasm and widen intervertebral foramen to relieve nerve root impingement.

Lymphedema

Lymphedema is the swelling of subcutaneous tissues due to the accumulation of excessive lymph fluid. The accumulation of lymph fluid results from impairment to the normal clearing function of the lymphatic system and/or from an excessive production of lymph.

Lymphedema is divided into two broad classes according to etiology.

  • Primary lymphedema is a relatively uncommon, chronic condition which may be due to such causes as Milroy’s Disease or congenital anomalies.

  • Secondary lymphedema, which is much more common, results from the destruction of or damage to formerly functioning lymphatic channels, such as radical surgical procedures with removal of regional groups of lymph nodes (for example, after radical mastectomy), post-radiation fibrosis, and spread of malignant tumors to regional lymph nodes with lymphatic obstruction, among other causes.

Malunion

Malunion is defined as a healing of the bones in an abnormal position; Malunions can be classified as functional or nonfunctional. Functional malunions are usually those that have small deviations from normal axes that do not incapacitate the patient. Some of these functional malunions may be unacceptable in dogs, especially if the animal is a show specimen. Nonfunctional malunions will be discussed in this section. Malunions can occur with both axial deviations and rotational deformities.

Meniscus Disorder (Knee)

Knee meniscus disorders involve the medial meniscus or lateral meniscus, two semicircular pads of cartilage in the knee between the joint surfaces (femoral and tibial condyles) of the upper leg bone (femur) and lower leg bone (tibia). Menisci serve as shock absorbers. The most common meniscus disorder is a tear. The medial meniscus is more commonly torn than the lateral, because it is more firmly anchored to the joint capsule and surrounding ligaments. Tears are classified according to location, shape, size, and stability.

The major classes of tears include the vertical longitudinal, oblique (often called parrot-beaked, or flap tear), displaced (bucket handle), degenerative, transverse, horizontal, or complex (involving multiple tears). Oblique and vertical longitudinal tears are the most common.

Muscle Atrophy

Muscle atrophy is the wasting or loss of muscle tissue.

There are two types of muscle atrophy:

  • Disuse atrophy occurs from a lack of physical activity. In most people, muscle atrophy is caused by not using the muscles enough. People with seated jobs, medical conditions that limit their movement, or decreased activity levels can lose muscle tone and develop atrophy. This type of atrophy can be reversed with exercise and better nutrition. Bedridden people can have significant muscle wasting. Astronauts who are away from the Earth’s gravity can develop decreased muscle tone after just a few days of weightlessness.

  • The most severe type of muscle atrophy is neurogenic atrophy. It occurs when there is an injury to, or disease of, a nerve that connects to the muscle. This type of muscle atrophy tends to occur more suddenly than disuse atrophy.

Nonunion

Nonunion is defined as the cessation of all reparative processes of healing without bony union. Since all of the factors discussed under delayed union usually occur to a more severe degree in nonunion, the differentiation between delayed and nonunion is often based on radiographic criteria and time.

Patellar (Kneecap) Fractures

Because your kneecap (patella) acts like a shield for your knee joint, it can easily be broken. Falling directly onto your knee, for example, is a common cause of patellar fractures. These fractures are serious injuries and often require surgery to heal. Over the long term, they may cause arthritis in the knee.

Pulsed electromagnetic field therapy (PEMFT),

A PEMFT, also called pulsed magnetic therapy, pulse magnetotherapy, or PEMF, is a reparative technique most commonly used in the field of orthopedics for the treatment of non-union fractures, failed fusions, congenital pseudarthrosis and depression. In the case of bone healing, PEMF uses directed pulsed magnetic fields through injured tissue. This is believed to stimulate cellular repair. The FDA has approved several such stimulation devices. These devices provide a complementary solution that may aid in bone repair.

Sacroiliitis

Sacroiliitis (say-kroe-il-e-I-tis) is an inflammation of one or both of your sacroiliac joints — the places where your lower spine and pelvis connect. Sacroiliitis can cause pain in your buttocks or lower back, and may even extend down one or both legs.

Sciatica

Sciatica refers to pain that radiates along the path of the sciatic nerve — which branches from your lower back through your hips and buttocks and down each leg. Typically, sciatica affects only one side of your body. Sciatica most commonly occurs when a herniated disk or a bone spur on the spine compresses part of the nerve. This causes inflammation, pain and often some numbness in the affected leg.

Although the pain associated with sciatica can be severe, most cases resolve with just conservative treatments in a few weeks. People who continue to have severe sciatica after six weeks of treatment might be helped by surgery to relieve the pressure on the nerve.

Slipped Disc

Slipped disc is a medical condition in which a tear in the outer, fibrous ring (annulus fibrosus) of an intervertebral disc (discus intervertebralis) allows the soft, central portion (nucleus pulposus) to bulge out beyond the damaged outer rings. This tear in the disc ring may result in the release of inflammatory chemical mediators, which may directly cause severe pain, even in the absence of nerve root compression.

Spinal Column

Your spinal column is made of up 26 bones (vertebrae) that are cushioned by disks. The disks protect the bones by absorbing the shocks from daily activities like walking, lifting, and twisting. Each disk has two parts—a soft, gelatinous inner portion and a tough outer ring. Injury or weakness can cause the inner portion of the disk to protrude through the outer ring.

Spinal Decompression

Spinal decompression: A non-invasive procedure that enlarges the Intra Vertebral Foramen (IVF) by aiding in the rehydration of the spinal discs.

Spinal Discs

Spinal discs are soft, compressible discs that separate the interlocking bones (vertebrae) that make up the spine. The discs act as shock absorbers for the spine, allowing it to flex, bend, and twist. Degenerative disc disease can take place throughout the spine, but it most often occurs in the discs in the lower back (lumbar region) and the neck (cervical region).

Spinal Fusion

Spinal fusion is surgery to permanently connect two or more vertebrae in your spine, eliminating motion between them.  Spinal fusion involves techniques designed to mimic the normal healing process of broken bones. During spinal fusion, your surgeon places bone or a bone-like material within the space between two spinal vertebrae. Metal plates, screws and rods may be used to hold the vertebrae together, so they can heal into one solid unit.Because spinal fusion surgery immobilizes parts of your spine, it changes the way your spine can move. This places additional stress and strain on the vertebrae above and below the fused portion, and may increase the rate at which those areas of your spine degenerate.

Spinal Laminectomy

A procedure for treating spinal stenosis by relieving pressure on the spinal cord. A part of the lamina is removed or trimmed to widen the spinal canal and create more space for the spinal nerves.

Spinal Nerve Roots

Spinal nerve roots branch out from each side of the spinal cord and then join to form the spinal nerves, which pass through openings between the spinal bones (vertebrae) and then form branches that extend throughout the body. Each spinal nerve is attached to the spinal cord by two nerve roots.

Spinal Stenosis

Spinal stenosis is a narrowing of the open spaces within your spine, which can put pressure on your spinal cord and the nerves that travel through the spine. Spinal stenosis occurs most often in the neck and lower back. While some people have no signs or symptoms, spinal stenosis can cause pain, numbness, muscle weakness, and problems with bladder or bowel function.  Spinal stenosis is most commonly caused by wear-and-tear changes in the spine related to aging. In severe cases of spinal stenosis, doctors may recommend surgery to create additional space for the spinal cord or nerves.

Spinal Traction

Spinal traction is a form of decompression therapy that relieves pressure on the spine. It can be performed manually or mechanically. Spinal traction is used to treat herniated discs, sciatica, degenerative disc disease, pinched nerves and many other back conditions.

Stress Fracture of Tibia or Fibula

The tibia, or shinbone, is the most common fractured long bone in your body. The long bones include the femur, humerus, tibia, and fibula. A tibial shaft fracture occurs along the length of the bone, below the knee and above the ankle. Because it typically takes a major force to break a long bone, other injuries often occur with these types of fractures.

A stress fracture of the fibula is a small fracture or hairline crack in the bone. It is not as common as a stress fracture of the tibia because the fibula is not used in load bearing in the same way.

TENS Unit

Transcutaneous electrical nerve stimulation (TENS) is the use of electric current produced by a device to stimulate the nerves for therapeutic purposes. TENS, by definition, covers the complete range of transcutaneously applied currents used for nerve excitation although the term is often used with a more restrictive intent, namely to describe the kind of pulses produced by portable stimulators used to treat pain.[1] The unit is usually connected to the skin using two or more electrodes. A typical battery-operated TENS unit is able to modulate pulse width, frequency and intensity.

Thoracic Spine

The thoracic spine refers to the upper- and middle-back. It joins the cervical spine and extends down about five inches past the bottom of the shoulder blades, where it connects with the lumbar spine. The thoracic spine is made up of twelve vertebrae, labeled T1-T12.

Traction

In medical terminology, traction refers to the practice of exerting a slow, gentle pull on a fractured or dislocated body part. The purpose is to guide the part back into place and to hold it steady. Traction may also be used to stretch the neck and prevent painful muscle spasms. Traction is often accomplished using ropes, pulleys, and even the weight of the patient’s own body.

Disclaimer

The content referenced above belongs solely to WebMD ©2014, WebMD, LLC. All rights reserved.  IMS Experts, LLC assumes no ownership for any of the information provided. In addition, the information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only.