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 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? A doctor could write a prescription for anything, including for products without a medical use, or even if you don’t have medical need. Ultimately, 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.

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 permanent, 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 to send a claim to an insurance, 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 a physical pharmacy location (“bricks and mortar”), regulated by the Washington State Department of Health (WSDOH) and must follow their rules. 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

  • Amerigroup (as of 12/2023 changed to Wellpoint)

  • BlueCross BlueShield (via Local Blue)

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

  • 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)

  • Premera

  • Premera Blue Cross

  • Premera Medicare Advantage

  • 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)

  • Wellpoint (formerly Amerigroup)

Out of network: Aetna, Cigna, Coordinated Care, Kaiser, Humana