Will insurance pay for my FOOTBAR® Walker?

Health insurance companies may be willing to reimburse for the FOOTBAR Walker such as Medicare Advantage, United Healthcare, Blue Cross / Blue Shield, Aetna, Anthem, Cigna, Humana and others. Whether your insurance company will reimburse your FOOTBAR Walker purchase depends on your company and your plan. We’ve tried to simplify the process so you can determine if your FOOTBAR Walker purchase will be reimbursed. It’s best to call and ask about your benefit coverage and what information you need to provide for reimbursement (medical professional written proof, paid receipt, etc.).

Will Medicare & Medicaid cover the FOOTBAR Walker?

Although HCPCS codes were assigned to the FOOTBAR Walker on June 16, 2022, at this time, Medicare & Medicaid do not offer full reimburse.

Will Medicare Advantage plans cover the FOOTBAR Walker?

In 2018, the Centers for Medicare & Medicaid Services (CMS) expanded its definition of “primary health-related” benefits that private insurance companies are allowed to include in their Medicare Advantage plan offerings.

Some of the benefits that were added to the approved list include:

• Transportation to doctor’s offices
• Grab bars in home bathrooms
• Healthier food options
• Air conditioners for people with asthma
• Home-delivered meals
• **Aides to help with daily activities like dressing or eating  (the FOOTBAR Walker falls under this category)

Expansion of the “primary health-related” definition includes care and devices that are used to:

• Treat or prevent injuries or illness
• **Compensate for physical impairments   (the FOOTBAR Walker meets this definition)
• Reduce emergency medical care
• Address the psychological effects of injuries or illness

While any new benefits would not require a doctor’s order or prescription, they would have to be deemed “medically appropriate” and recommended by a licensed health care provider. Follow recommended 3 Step process below.

Who is the FOOTBAR Walker appropriate for?

• For patients unable to perform Sit to Stand (STS) transfer function.
• For patients who are weak or suffer from physical or neurological conditions which impair the STS function.
• For patients at high risk for development of a pressure ulcer due to prolonged sitting and are unable to perform a functional weight shift.
• For patients with an inability to create enough personal momentum or force to safely push one’s self up to a standing position.

3 EASY STEPS TO REQUEST REIMBURSEMENT

STEP 1

Determine if your insurance requires that your FOOTBAR Walker is purchased “In-Network” or “Out-of-Network”. Many plans have allowances for both types. Some plans have different reimbursement amounts depending on which network option you use for your purchase.

In-Network – Your insurance company has negotiated contracts with these sellers of medical equipment. If In-Network purchases are required, you must contact your insurance company to find an In-Network dealer. When you have located an In-Network dealer, if they are not offering the FOOTBAR Walker currently, have them reach out to us’ we’ll be happy to work with them on your purchase. Proceed to Step 2.

Out-of-Network – Plans with this option allow you to purchase from wherever you choose. This Includes purchasing from our website. Proceed to Step 2.

STEP 2

Certificate of Medical Necessity (CMN) – Also referred to as Letter of Medical Necessity, some insurance companies may require this document. Your doctor is likely familiar with it. If possible, download our CMN form in advance and take it to your doctor’s appointment or email it to them after any recent visit, must be within the past 6 months, for completion.

When requesting the CMN from your physician ensure that the completed form includes the following:

1) It is medically necessary for the patient to use the FOOTBAR Walker instead of a standard walker as the standard provides no functional lifting option and is unsafe to meet the sit-to-stand function. A Sit-to-Stand Assessment must be performed (CDC STS Functional Assessment Tool available for download on our website, bring this with you). Patient must demonstrate inability to complete STS function AND it must be documented on the CMN by your physician.

Examples include: lack of lower body strength, generalized weakness, neurological diagnosis or disease progressions like Alzheimer’s, dementia(s) such as Lewy Bodies, Frontotemporal (FTD), Vascular, neuromuscular diseases, Parkinson’s, Multiple Sclerosis, Muscular Dystrophy, Cerebral Palsy, Progressive Supranuclear Palsy, Transverse Myelitis, Osteoarthritis, Chronic pain sufferers, amputation, Obesity, Stroke, and Sarcopenia to name a few which limit or inhibit STS function. Physical conditions such as surgery or injury may also prevent STS function.

OR

2) There are extenuating circumstances which require you to use the FOOTBAR Walker. Examples: Inability to safely push one’s self up to a standing position. Patient’s weight requires the use of 2 caregivers (which is not possible in the home due to expense of care, lack of availability of trained caregivers, or available family support for consistent daily need), sole/primary caregiver lacks the ability / strength to safely use other devices such as a gait belt without risking possible injury to caregiver or patient.

• • Patient has a physical condition that prevents them from performing sit-to-stand function, whether temporary or permanent, and limits or prevents them from completing daily activities such as toileting, grooming, bathing, feeding.

• • Patient has a neurological condition that prevents them from performing sit-to-stand function, whether temporary or permanent.

According to CMS:

1) The patient has a mobility limitation that significantly impairs his/her ability to participate in one or more MRADLs in the home. A mobility limitation is one that:

• • Prevents the patient from accomplishing the MRADL entirely,

• • Places the patient at reasonably determined heightened risk of morbidity or mortality secondary to the attempts to perform the MRADL,

• • Prevents the patient from completing the MRADL within a reasonable time frame.

2) The patient is able to safely use the walker.

3) The functional mobility deficit can be sufficiently resolved with the use of a walker.

Is a Prescription needed?

Certificates of Medical Necessity include the information provided in a prescription and may replace a prescription document due to more information is provided as required for coverage/reimbursement. If you do not have a Certificate of Medical Necessity, then a prescription may be accepted by your insurance as long as the above information is clearly documented to prove medical necessity.

STEP 3

Submit your claim – Obtain a claim form from your insurance company. Gather all the documents previously obtained and submit them to your insurance company with your completed claim form. If the form asks for an insurance code, often referred to as the “HCPCS code”, use E0143 + A9900.

Most states require that your insurance company respond to your claim within 30 days.

Frequently Asked Questions

Q: WHAT IS AN FSA OR HSA?

Flexible Spending Accounts (FSAs) and Health Savings Accounts (HSAs) are health benefit accounts that let you set aside money (before tax) from your paycheck to cover medical expenses. In most cases, a debit card is provided for your account and you can use the card to pay for qualifying expenses. Please check with your employer or plan administrator for any clarifications.

Q: CAN I USE MY FSA OR HSA ACCOUNT TO MAKE PURCHASES ON THEFOOTBARWALKER.COM? YES!

Yes. The FOOTBAR® Walker, tax and shipping are all FSA and HSA approved items when purchasing on thefootbarwalker.com website.

Q: CAN I USE MY FSA OR HSA CARDS ON THEFOOTBARWALKER.COM? YES!

Yes. We accept both FSA or HSA cards as payment options. Please follow normal steps at checkout.

Q: IS THERE ANOTHER WAY TO GET REIMBURSED BY MY FSA OR HSA ACCOUNT WITHOUT USING A FSA OR HSA DEBIT CARD? YES!

Yes. Contact your plan administrator or employer for more information on how to provide appropriate documentation for reimbursement. Typically to receive reimbursement, you will need to submit your saved FOOTBAR Walker receipt along with an online or paper reimbursement form in accordance to your plan’s policies. When submitting reimbursements, you can typically elect to receive the reimbursed payments in the form of a direct deposit to a selected bank account, or as a paper check

Q: ARE THE SAME ITEMS ELIGIBLE FOR AN FSA ACCOUNT AS AN HSA ACCOUNT? YES!

Yes, the FOOTBAR Walker, tax and shipping are eligible items for both FSA and HSA.

Q. WHAT SHOULD I DO IF MY FSA OR HSA CARD IS DECLINED?

If your card is declined, contact your employer or plan administrator for the account to ensure: your FSA funds have not expired, a new FSA/HSA card has not been issued, and the account has sufficient funds. Typically, you can find the number to your plan administrator on the back of your FSA or HSA card.

Q. WHAT SHOULD I DO IF MY LOCAL MEDICAL EQUIPMENT PROVIDER DOES NOT CARRY THE FOOTBAR WALKER?

Tell the medical equipment provider you want to buy the FOOTBAR Walker; and if they are not currently a supplier, have them contact us. They can also sign up using our online form to become a supplier. The online form is located on our website at TheFOOTBARWalker.com We’ll coordinate the purchase and ship the walker directly to the patient’s home.

Disclaimer: All insurance plans and provider/Payer contracts are different. GANM, LLC / FOOTBAR Walker company cannot guarantee coverage. The information provided here and elsewhere is based on our limited and most current knowledge of the Payer organizations and contracts. It is not intended to provide, and should not be relied on for patient access, Payer coverage, tax, legal, medical or accounting advice. The content is from other public sources and is reproduced here for the convenience of consumers. The FOOTBAR Walker nor its representatives guarantee accuracy of this information.