Insurance Coverage for your Medical Alert Device

Insurance Coverage Procedures for STAT MEDICAL Personal Emergency GPS Safety Device

 

We always recommend contacting your primary insurance company or state Medicaid Program office to find out exactly what they cover and what documentation they require. This is just a basic outline of what is typically required.

  • Using the list of codes provided, obtain a prescription from the
  • Request a quote directly from Stat Medical.
  • Submit prescription and quote to either your case/ social worker or directly to your insurance company to make sure they will cover the Medical Alert device you have chosen.

 

***For individuals enrolled in Medicaid waiver programs, please contact us at 732-508-7800 to see if we are already on their authorized durable medical equipment provider list.

If you have any general questions, please send an email to info@statmedicalalert.net or go to the contact page at www.statmedicalalert.net

Please remember we are unable to bill Medicaid or your private insurance directly and therefore you are responsible for payment and submission of the paperwork required for reimbursement.

These devices are confirmed to be covered by: Kaiser Permanente, United Healthcare, Transatlantic Insurance, American Maritime Officers, and Select Health to name a few.

The concept of wandering was added to ICD-9CM effective with the October 1, 2000 update as an inclusion term under at code 294.11.

Prescription from Doctor: A prescription from your Physician needs to be requested and including the following information:

Name:  Exact name of the Medical Alert Device you have chosen for Wandering Prevention.

Example; MX-LOCare GPS Watch, AngelSense, Bell +, LOK8U.

Diagnoses Code

Alzheimer’s Disease (331.0)

Autism or Pervasive Development Disorder PDD (299.0-299.9)

Dementia, unspecified, with behavioral disturbance (294.21)

Intellectual disabilities (317-319)

Sub code: (See above) Wandering Code: V40.31

HCPCs: S5162 – Billing Code for Purchase

Submit this to the insurance company or state funded program with a receipt for your purchase.

Additional Codes (if needed)

Other: If denied – Use Enhanced Medical Assistive technology

HCPCs: S5199

 CPT Codes – X is HIPAA compliant code S is CPT or HCPCs code

X5012 Personal emergency response system S5160, S5161, S5162

 

S5160: Emergency response system; installation and testing S5161:

Emergency response system; service fee, per month (Excludes installation and testing)

S5162: Emergency response system; purchase only X5014 DME – personal emergency response system, Installation

The new HCPCs codes level 2 are for items not covered in level 1 coding. Try these new codes HSW is Health, Safety, & Welfare

HCPCs Code – S5160K

Units of Service – Maximum allowed based on 12 month plan

Personal Emergency Response System – install/test (HSW Only)

HCPCs Code – S5161HK Per Month

Unit of Event Personal Emergency Response System – monthly service fee (HSW only) S5161HK Per Month

HCPCs 2017 Code – E1399 Durable Medical Equipment, miscellaneous

 

Please feel free to contact us is you have any questions or feel you require further assistance.

 

PHYSICIAN SAMPLE LETTER: AUTISM ELOPEMENT (Can be used for Alzheimer’s, dementia or any other cognitive impairment)

 

NAME OF CHILD OR ADULT (DOB XX/XX/XX) carries a diagnosis , which poses certain cognitive challenges and safety risks. NAME currently attends NAME OF SCHOOL in NAME OF TOWN. If this is for an adult you can leave this part out.

NAME has a history of wandering from safe environments, including a YEAR incident where NAME wandered from LIST INCIDENT. According to Centers for Disease Control (CDC), Wandering places children and adults with autism spectrum disorders (ASDs) in harmful and potentially life-threatening situations—making this an important safety issue for individuals affected and their families and caregivers.

If given the opportunity, NAME will wander from safe environments. NAME’S wandering tendencies include goal-directed elopement, which means NAME will seek out items of interest, specifically roads and bodies of water. NAME’S history also includes fleeing incidents following a meltdown or escalation trigger.

It is for these reasons, and NAME’S history of elopement, that NAME now has a medical diagnosis of Wandering In Diseases Classified Elsewhere (ICD-10-CM Diagnosis Code Z91.83). To ensure NAME’s safety, it is medically necessary that NAME have close and constant adult supervision at all times, and that proper safeguards are in place. Safeguards may include architectural barriers, door alarms, visual prompts, and a school-wide response protocol.

A Functional Behavioral Assessment should be done to help identify root causes of NAME’s elopement behaviors. NAME must never be left unattended by any adult for any reason. Leaving NAME unattended poses serious safety and health risks.

 

Sincerely,

 

 

For more information on the wandering diagnostic code, visit http://www.cdc.gov/ncbddd/autism/code.html

Is your child being BULLIED? What can you do?

We all know we would do anything to protect our children.  When our children are bullied to the point that they don’t want to attend school and it is affecting their health and well-being, this is a MAJOR issue.  When and how does a parent step in?  What can you do to protect your child?  You can’t be there with them at school.  However, with our MX-LOCare watch, you can be.  TWO-Way Voice communication, SOS button to call 3 emergency contacts, GPS Locator and an anti-locking device so NO ONE can remove it off you child.  The best part is it looks like a NORMAL Watch.  There is a secret to it.  We can divulge that by speaking to us.  Don’t let the bullies win, don’t let the schools sit back and do little to help your child.  Be your child’s advocate.  We are here to help you every step of the way.  Call us today for more information

How to keep your loved one who wanders safe.

I’m going to start by telling you the hard facts, which as a special needs parent  myself don’t want to hear. Even as an adult child taking care of your parent with Dementia or Alzheimer’s or just plain memory loss due to age. As a special needs parent it is our responsibility to keep our special needs child safe,  because they can’t do this on their own.  With parents as they age or get diagnosed with Alzheimer’s, dementia or just aging, we can help by also keeping them safe and giving you the peace of mind you deserve.

Did you know that over 60% of patients with Alzheimer’s will wander? An even more serious statistic is that up to half of those individuals will suffer injuries or even death.

Roughly half, or 48%, of children with an ASD attempt to elope from a safe environment, a rate nearly four times higher than their unaffected siblings.

In 2009, 2010, and 2011, accidental drowning accounted for 91% total U.S. deaths reported in children with an ASD ages 14 and younger subsequent to wandering/elopement.

So the question is what can we do? The direct quote from “Autism Speaks” is this; Consider a Tracking Device.  

We know that if your loved one has a tracking device, you can find them within no time at all.  We can’t rely on others such as law enforcement to go out and find your loved one if they have wandered off.  We have all read multiple articles on “missing children” Multiple “Amber Alerts” and multiple “Silver Alerts” These all can be prevented.  We must be pro-active in keeping our loved ones safe.

With our GPS Tracker Watches, LOK8U, or AngelSense you can now know where they are at all times.

With our Wandering devices, such as Belle + (with GPS and Fall Detection), LOK8U you now can be pro-active if they wander.

Don’t wait, this is all preventative and we hope you never need to use them for finding your loved ones if they go missing.  However, know this we are with you every step of the way, through the entire process. PREVENTION IS KEY!

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