Frequently Asked Questions
At Georgia Brace & Spine, we provide professional orthopaedic bracing and durable medical equipment services for patients, physicians, hospitals, and healthcare practices throughout Georgia. Below are answers to some of the questions we hear most often.
Patient Questions
Where does the brace fitting take place?
Georgia Brace & Spine provides professional brace fittings at our office, hospitals, and patient homes, depending on the patient's needs and circumstances.
Non-trauma patients are typically scheduled for fittings at our office or in their home.
Trauma and post-operative patients who are unable to travel may receive fittings at the hospital or in their home when appropriate.
Our goal is to provide timely, convenient service while ensuring that each product is properly fitted and adjusted for the patient.
Does insurance cover my brace?
Many insurance plans provide coverage for medically necessary orthopaedic braces and durable medical equipment. However, coverage varies by insurance company and by individual plan.
Coverage may depend on factors such as:
The patient's specific insurance benefits
Medical necessity requirements
The type of brace or equipment prescribed
The patient's diagnosis and clinical documentation
Whether the provider and product are covered under the patient's plan
Deductible, copayment, and coinsurance requirements
Prior authorization or other payer requirements
Georgia Brace & Spine can verify available insurance benefits and assist with the billing process. However, insurance verification is not a guarantee of coverage or payment. Final coverage and payment are determined by the patient's insurance provider when the claim is processed.
How much will my brace cost?
The amount you pay depends on your insurance coverage, the specific product, and your individual benefits.
Before providing a product when possible, Georgia Brace & Spine can review available insurance information and provide an estimate of your potential financial responsibility.
Please remember that an estimate is not a guarantee of your final cost. Your insurance company determines the final amount it pays and the amount applied to your deductible, coinsurance, copayment, or other patient responsibility.
Do I need a prescription for a brace?
Many orthopaedic braces and DME products require a prescription or other documentation from a qualified healthcare provider, particularly when the item is being billed to insurance or Medicare.
The specific requirements vary depending on the product, payer, and patient's circumstances.
If you have been prescribed a brace by your physician, Georgia Brace & Spine can help determine what documentation is required to provide the product.
How long does it take to receive my brace?
Delivery times vary depending on the type of brace, product availability, insurance requirements, authorization requirements, and the patient's clinical needs.
Many commonly prescribed products can be provided quickly, while custom or specially ordered products may require additional time.
Our team will work with the patient and prescribing provider to coordinate delivery and fitting as efficiently as possible.
Do you provide same-day fittings?
Same-day fittings may be available depending on the product, inventory, scheduling availability, insurance requirements, and the patient's clinical circumstances.
Patients with urgent post-operative or trauma-related needs should contact us as soon as possible so we can determine the fastest appropriate option.
Can you come to my home to fit my brace?
Yes. Home fittings may be available when appropriate.
Home delivery and fitting can be particularly helpful for patients who are recovering from surgery, have mobility limitations, or are otherwise unable to travel to our office.
Availability depends on the patient's location, product, scheduling, and clinical circumstances.
What happens if my insurance doesn't cover my brace?
If your insurance does not cover a particular product or determines that you have a patient responsibility, Georgia Brace & Spine can discuss the available options with you.
Depending on the circumstances, options may include:
Reviewing the insurance determination
Providing information regarding the claim
Discussing available product alternatives when clinically appropriate
Reviewing self-pay options when available
Patients are responsible for amounts properly determined to be their financial responsibility.
Do you work with Workers' Compensation?
Yes. Georgia Brace & Spine works with Workers' Compensation programs and carriers when applicable.
Workers' Compensation claims may have specific requirements regarding authorization, approved providers, documentation, billing, and product coverage. Our team can work with the appropriate parties to help coordinate the process.
Do you accept Medicare?
Yes. Georgia Brace & Spine is enrolled with Medicare as a DMEPOS supplier and accepts Medicare assignment for applicable Medicare-covered products and services.
For Medicare Part B, patients are generally responsible for their applicable deductible and 20% coinsurance of the Medicare-approved amount after the deductible has been met, unless another insurance plan or secondary coverage pays some or all of that responsibility.
Coverage and patient responsibility are subject to Medicare guidelines and the patient's individual benefits.
Do you accept Medicare Advantage plans?
Georgia Brace & Spine works with a variety of Medicare Advantage plans. Medicare Advantage plans are administered by private insurance companies and may have different networks, authorization requirements, benefits, and patient cost-sharing than Original Medicare.
Participation can vary by plan. Contact us with your specific insurance information so we can verify participation and available benefits.
Do you accept Medicaid?
Georgia Brace & Spine may participate with certain Medicaid plans and programs. Medicaid coverage and DME benefits vary by program and managed care plan.
Please contact us with your specific Medicaid plan information so we can determine whether we participate with your plan and whether the prescribed product may be covered.
What should I bring to my brace fitting?
When coming to your fitting, please bring:
Your photo ID
Your current insurance information
Your prescription or referral, if applicable
Any paperwork provided by your physician
Comfortable clothing that allows access to the area being fitted, when appropriate
If your fitting is being performed at a hospital or your home, our team will let you know if anything additional is needed.
Physician & Healthcare Provider Questions
Can Georgia Brace & Spine provide products for physicians who prefer to bill patients directly?
Yes. Georgia Brace & Spine offers flexible DME programs designed to meet the needs of individual physician practices.
While we commonly manage the DME billing and fitting process directly, we can also work with practices that prefer to manage their own DME billing and patient billing.
Our team can work with your practice to develop a program that fits your workflow and operational needs.
Contact us to learn more about our physician and practice programs.
Can Georgia Brace & Spine provide products directly to a physician's office?
Yes. We work with physician practices, hospitals, surgery centers, and other healthcare facilities to coordinate the delivery and fitting of appropriate orthopaedic bracing and DME products.
Depending on the arrangement, products may be delivered to the facility for fitting or provided directly to the patient.
Can Georgia Brace & Spine handle insurance verification and billing?
Yes. Our team provides insurance verification, benefits review, authorization support, claims submission, and billing services for applicable products and payers.
We work with healthcare providers to help streamline the DME process and reduce the administrative burden associated with providing orthopaedic bracing to patients.
What information does Georgia Brace & Spine need from a physician's office?
Requirements vary depending on the product and payer, but commonly requested information includes:
Patient demographic information
Insurance information
Prescription or order
Diagnosis information
Relevant clinical documentation
Medical necessity documentation when required
Prior authorization information when applicable
Our team can let your office know exactly what is needed for a particular product or insurance plan.
Can you help with prior authorization?
Yes. When prior authorization is required, Georgia Brace & Spine can assist with the authorization process and communicate with the applicable insurance provider.
Authorization requirements vary by payer, product, and plan.
Do you work with hospitals and surgery centers?
Yes. Georgia Brace & Spine works with hospitals, surgery centers, physician practices, and other healthcare facilities to provide orthopaedic bracing and DME services.
Our team can coordinate fittings in the facility, at the patient's home, or at our office depending on the patient's circumstances and the requirements of the product and payer.
Insurance & Billing Questions
What insurance plans are accepted?
Georgia Brace & Spine is contracted with a variety of commercial and government-sponsored insurance plans and is enrolled with Medicare as a DMEPOS supplier.
Insurance participation and coverage can vary by individual plan. Being contracted with an insurance company does not necessarily mean that every product or service is covered under every plan.
Contact us directly to verify your specific insurance benefits and coverage.
Do you accept Medicare assignment?
Yes. Georgia Brace & Spine accepts Medicare assignment for applicable Medicare-covered products and services.
For Medicare Part B, patients are generally responsible for their applicable deductible and 20% coinsurance of the Medicare-approved amount after the deductible has been met, unless secondary insurance or another form of coverage pays some or all of that responsibility.
Georgia Brace & Spine submits applicable claims directly to Medicare and may bill eligible secondary insurance for remaining amounts when appropriate.
Coverage and patient responsibility are subject to Medicare guidelines, the patient's specific benefits, and claim processing.
What if I have a secondary insurance?
If you have secondary insurance, Georgia Brace & Spine may be able to submit eligible remaining amounts to your secondary insurance after the primary insurance processes the claim.
Secondary coverage varies by plan, and submission of a claim does not guarantee payment.
What if I have a high deductible?
If your deductible has not been met, your insurance provider may apply some or all of the allowed amount toward your deductible.
In that situation, your patient responsibility may be higher than it would be after your deductible has been satisfied.
Our team can review available benefits and provide an estimate when possible, but your insurance provider makes the final determination after processing the claim.
Is an insurance verification a guarantee that my insurance will pay?
No.
Insurance verification provides information about benefits available in the payer's system at the time of verification. It does not guarantee that a claim will be approved or paid.
Final payment depends on the patient's specific plan, medical necessity requirements, documentation, authorization requirements, network status, claim processing, and other applicable payer policies.
What if my insurance denies the claim?
If a claim is denied, our billing team can review the available information and determine whether additional action may be appropriate.
Depending on the reason for the denial, this may include correcting claim information, providing additional documentation, or pursuing an appeal when appropriate.
Patients may also need to contact their insurance provider directly regarding coverage determinations, appeals, or disputes.
Still Have Questions?
We're here to help.
If you have questions about a brace, insurance coverage, billing, physician programs, or scheduling, contact Georgia Brace & Spine.
Phone: 770.619.0615
Email: info@gabrace.com
Contact us today to learn more about our orthopaedic bracing and DME services.