PATIENT & PHYSICIAN FAQ
Associated Medical offers products that help patients recover more quickly and safely following surgery. People who are interested in treating pain with less medication or in a more natural approach to recovery, please join our mailing list. We publish a monthly newsletter with interviews, product reviews, and various health-related topics. Patients and physicians, please contact us for best-in-class products in: Pain and inflammation management, bracing, CPM, wound-management, and general durable medical equipment.

PATIENT QUESTIONS

What is the VascuTherm?
How do I request your services?
Are your products covered by my insurance carrier?
How does the process work?
How do I use the machine?
I get an error message when operating my machine?
What is the process for returning equipment?
I have questions regarding a bill I received?
What is your patient hardship program?

INSURANCE QUESTIONS - VASCUTHERM

Is this equipment covered by major medical carriers?
Is it covered by Medicare?
Is there a copay or deductible?
Are you in-network with my carrier?
If my carrier declines use, am I responsible?
Who gets the payment or reimbursement?
How is payment handled for HMO, EPO, POS, or PPO Plans?
What happens if I have no DME benefits?
If I get the check, how do I send payment to you?
Where do I send payment?
Miscellaneous Questions

PHYSICIAN & PROVIDER QUESTIONS - VASCUTHERM

Why is the VascuTherm medically necessary?
What are the clinical benefits?
What are the safety benefits?
What are the financial benefits?
What is the cost?
Which carriers authorize & how do you handle denials?
Can my clinic profit from this technology?
Why choose Associated Medical?
How do I order?
In orthopedics, which patients benefit most?
How long do patients use the VascuTherm?
How do you integrate into the orthopedic workflow?
Can I request the VascuTherm inhospital or at my surgicenter?
What’s your turn-around time?  
What regions do you service?
How do you ensure compliance & support the patient?
Are you in-network or out-of-network?
What’s your VTE prophylaxis program?


PATIENT QUESTIONS

What does Associated Medical Offer to Patients? We offer orthopedic and post-surgical home-care services via state-of-the-art technologies designed to improve outcomes.

What is the VascuTherm?
The VascuTherm is an intermittent pneumatic compression (IPC) device that provides solid-state cold or heat through 20 joint-specific single-patient-use garments/wraps.  The machine is custom-designed for orthopedic applications.  It’s 15 Ibs, portable, delivered to the patient’s home pre-surgery, and extremely easy to use.  The joint-specific wrap enables compression and pain relief at the surgical site and surrounding tissue.  The VascuTherm eliminates ice, most management issues, and adds active compression for management of inflammation, edema, and lymphedema.  The device also provides calf or plantar foot IPC VTE prophylaxis similar to standard inhospital devices.  The device enables at-home DVT prophylaxis in conjunction with localized inflammation/pain treatment.  Patients use the device immediately following surgery and up to 30 days thereafter.

Are Your Products Covered by My Insurance Carrier?
Generally, yes, our services are covered by most insurance carriers, including workers compensation, Medicare, and Medicaid. We will always prequalify your coverage in advance. If you are uninsured or under-insured for the cost of our services, we will strive to present this information to you in advance. Usually, we are able to work out private terms to ensure that you will receive the care prescribed and requested by your physician/surgeon.

How Do I Request Your Services?
Our services are requested by healthcare providers. You will need to contact your surgeon with our website, literature, and contact information.

How Does The Process Work?
We contact you in advance of your surgery and subsequently meet you after your surgery often at an out-patient surgical facility or at your home. We train you and a caregiver (spouse, parent, etc) on use of the machine and wearing of the wrap(s). We pick up or you return the equipment to us at the duration of the treatment as per your provider's prescription.

How Do I Use The Machine?
Refer to the patient tab above. Click the downloadable PDF machine operating instructions that is appropriate for your particular care. Call us for assistance as needed.

How Long Do I Use The Machine?
Refer to your physician's script for your daily treatment and duration of treatment. Typical total time of use may range from 1 to 3 weeks.

I Get an Error Message When Operating My Machine?
Call us to discuss. Otherwise, perform the following checks. Turn unit to OFF position. Remove and reconnect power cord - check that power cord is properly connected to a 120V outlet. Remove and reconnect all port connectors by pushing down on metal release or twisting for DVT ports. Ensure that there is no kink in the cord/hoses. Unscrew reservoir knob on top of unit, check that there is at least 50% volume of fluid. If volume of fluid is low, add distilled water via the fluid bottle provided with the unit. Ensure that all 3 ports of the therapy wrap are securely connected to the hose. You will hear audible clicks when a proper connection is made. Place the wrap around your body as appropriate. Turn unit to ON position. Observe display and call us if error message persists. Further, ensure that there is at least 6 inches of airflow around the machine and that the unit is dry. Look at the mesh filter around the machine to ensure that airflow is not blocked. Machines may not operate if left in cold environments; allow machine to come to normal temperature for operation.

What Is The Procedure For Returning Equipment?
Please call or email support@assocmed.com to arrange a pickup. If you have been provided with a return airway bill, please call the carrier as per our instructions. Leave the unit in a safe location the morning of the scheduled pickup.

I Have Questions Regarding a Bill I Have Received?
Please direct billing questions to billing@assocmed.com. Our billing staff will be glad to assist you.

What Is Your Patient Hardship Program?
Associated Medical's equipment and services have a positive impact on patient outcomes. If your physician prescribes our services, we will do everything in our power to ensure that you receive treatment for the duration as requested by your provider. However, there are fixed and real costs relating to our operation including equipment, disposables, travel and staff time.

If you are uninsured, under-insured, or unable to pay for our services, contact us at billing@assocmed.com. We are willing to work with you for alternate payment arrangements

INSURANCE QUESTIONS - VASCUTHERM

Is this equipment covered by major medical carriers?
YES, the equipment is covered by nearly all major medical carriers, including Anthem, Aetna, BCBS, Cigna, Connecticare, Community Health (HUSKY), Oxford, United, TRICARE, most others and workers’ compensation payers.  The carrier may authorize use at either the in-network or out-of-network benefit level.  If approved at in-network, you will be responsible for the in-network deductible and copay as applicable.  If approved at out-of-network, you are only responsible for what the carrier reimburses you or pays us.  On the occasion that your carrier declines your specific usage, you will NOT be held responsible for the charges incurred though many patients make a donation.  You may continue using the equipment as we appeal your case.  Generally, the reasons for decline are not strong. The carrier has a legal obligation to provide access to medically necessary care.  If declined, it is our responsibility to appeal and to win.  If we lose the appeal, you will not be held responsible for any financial obligations but may donate by your choice.

Is it covered by Medicare?
Most devices are covered by Medicare; some are still outstanding.  If Medicare is your primary insurer, you are encouraged to use the equipment as your doctor ordered.  We bill Medicare and your secondary as required.  If both Medicare and your secondary declines, you will not be charged.   While the codes are payable by Medicare, Medicare may approve or decline use based on a variety of factors.  You don’t need to fear an outstanding bill if Medicare declines; you will not be charged.

Is there a copay or deductible?
For all in-network benefit level approvals, you will be responsible for your in-network copay and deductible in most cases.  Exceptions to this are when your copay is particularly large and/or beyond your ability to afford.  If you cannot afford your in-network copay, we will work with you.  For all out-of-network benefit level approvals and declines, you will not be held responsible for your out-of-network copay or deductible.  You may get a billing correspondence from us, but we will not force payment on copays or deductibles when services are authorized at the out-of-network benefit level.  If you are unable to meet your financial obligations under your insurance contract, we may be able to offer a discount based on documentation of financial need.  We will always work with you, not against you, by offering a convenient payment plan.

Are you in-network with my carrier?
In-network is also called ‘par’ and out-of-network ‘non-par.’  We are in-network with some carriers and out-of-network with others.  Carriers are complicated.  Some networks are ‘closed.’  We are either in-network or we obtain in-network pricing with nearly all carriers because our equipment is not available by other local companies.  When we are not in-network, we automatically request what is called a ‘GAP exception’ or a ‘network inadequacy’ to ensure that we obtain in-network pricing.  That means that your coverage will go through at the network benefit level in most cases even if we are not contracted.  If your carrier tells you that we are not in-network and therefore our services will not be covered, you may tell the carrier that there is generally no in-network vendor and you are requesting an immediate expedited appeal.  You should advise the agent that you are authorizing Associated Medical to appeal use of the prescribed service on your behalf.  Don’t be alarmed by the response of a lower level agent, who may be wrong in what they tell you.  You have a legal right to care.  Call us and we will work to resolve the issue for you, with no further responsibility on your part.

If my carrier declines use, am I responsible?
No.  However, if we lose the appeal and obtain zero reimbursement, we ask that you consider paying us at a self-pay rate.  This is not required, but it’s courteous for you to consider reimbursing us some amount.  State and federal laws (ERISA, PPACA, CUIPA) do require that your carrier provide you with access to medically necessary care at either the in-network or out-of-network level.  Your carrier may decline use of this equipment as being ‘not medically necessary.’  Medical necessity is defined by the combination of standard-of-care practices, peer-reviewed publications, the opinions of physicians, and recommendations of professional societies.  If your carrier ultimately refuses, you will not be obligated to out-of-pocket expense except in so far as you choose to pay at the self-pay rate.

Who gets the payment or reimbursement?
Most carriers send payment directly to our office.  The carrier, however, may send the check directly to you.  Many patients with Anthem or BCBS will get payment sent directly to them (not to us).  If you get a check from the carrier, it may reference codes E0650, E0675 or E1399, note the dates of use, and may list Associated Medical.  If you get the check, that is payment to us for services provided to you.  Payment was remit to you as the carrier expected that we already billed you for that amount.  Again, in the event you receive the reimbursement, that is intended as reimbursement for the services we provide to you.

How is payment handled for HMO, EPO, POS, or PPO Plans?
HMO & EPO: These plans by definition have no out-of-network benefits.  If we are not in-network with your carrier, we will request an in-network exception.  If the carrier declines this exception, we will appeal.  If we lose the appeal, you will not be responsible.  POS & PPO: Both have in- and out-of-network benefits.  If payment processes through your in-network benefits, you are responsible for applicable copay and deductible.  If payment processes through your out-of-network benefits, you are not responsible for copay or deductible (under nearly all circumstances).  If you cannot afford your in-network copay or deductible, we will work with you as stated above.

What happens if I have no DME benefits?
If your plan has no allowable benefit for durable medical equipment (DME), we will appeal your usage with the carrier citing applicable law which guarantees you access to care.  If we are unsuccessful in securing you coverage and lose the appeal, you should consider compensating us at the self-pay rate.  While we will not refuse service to you per the physicians’ orders, we ask that you recognize our very real staff and equipment costs.  You should expect to provide some compensation based on your financial ability.

If I get the check, how do I send payment to you?
This generally applies when our claim processes through your out-of-network benefits.  When claims are processed in-network, you will get an EOB but we will get the check directly. 

• If you receive a check from the insurance carrier, it was sent to you as compensation for our services.  We require that you notify us by phone within 14 days of receipt of the check as to when you will be sending in payment to us.  When we receive the exact amount of the check plus a copy of the explanation of benefits (EOB) within 30 days of issuance, we will consider your obligation complete.
• Most patients simply endorse the check over to us:  Sign your name and write ‘Pay to the order of Associated Medical, Inc.’  We require a copy of the form that came with the check, the EOB, to understand how your carrier processed our claim.
• If we are informed that you receive another check or reimbursement from the carrier which relates to services provided by us to you, the same above applies: you are required to remit that payment to us.
• Please be certain you understand that a reimbursement provided to you is intended to be paid to us for services provided to you.  If you refuse to release payment in the above 30 day window, we reserve the right to bill you for the full outstanding amount that we have billed your carrier.
• We bill the carrier market rates, and the carrier pays you a percentage (discount) per its determination and your specific plan.  The carrier may list an additional amount as your obligation (beyond the amount paid to you in the check).  You will not be responsible for any amount beyond what the carrier reimburses or pays you if you fulfill payment to us within 30 days of your receipt of the check.

The above policies apply in all circumstances when you receive direct compensation for our services. Be aware that we are still required to bill for in-network copays and deductibles when applicable.

Where do I send payment?

Remit the check and copy of the EOB to:
Attn: Accounts Payable
Associated Medical
196 Parkway South, Suite 304
Waterford, CT 06385

Miscellaneous Questions

• Do I need to call my carrier for the prior authorization?  No.  We handle the prior authorization.
• What if I want to call the carrier anyway?  Call our office first to get the necessary codes and key terms.
• If I am declined and you lose the appeal what happens?  We ask that you consider paying us at the self-pay rate, though you are not formally obligated to do so.
• How long does the billing process take?  Anywhere from 1 to 6 months.
• Is this equipment considered ‘medically necessary’?  Yes.  By nearly all carriers.
• Is this equipment considered ‘investigational or experimental’?  Absolutely not.  Proven false.
• What if I don’t know if I have coverage?  That’s okay.  Follow your doctor’s instructions, and we will advocate for your rights to medically necessary care at the in-network benefit level.
• What if I have absolutely no durable medical coverage?  We will advocate for you based on state insurance law.  You may be responsible for a modest self-pay rate if applicable.
• Is there a self-pay rate if I choose not to go through my benefits?  Yes.  If you choose for us not to bill your insurance, you are required to pay us at the self-pay rate for the days of use.
• Can I purchase the equipment outright?  Yes.  Contact us for pricing.
• Other?  Contact Beverly Melby at 203.204.2870, beverly@assocmed.com or Marcus Simpson at 516.526.5426, marcus@assocmed.com  for friendly customer service.

PHYSICIAN & PROVIDER QUESTIONS - VASCUTHERM

Why is the VascuTherm medically necessary?
The machine is considered medically necessary by nearly all carriers (we appeal those that deny) as rapid treatment and early prevention of inflammation accelerates recovery and reduces patient risk / comorbidities.  Inflammation and edema are natural responses to injury/surgery.  Lymphedema is proven to result from surgery and to be correlated with untreated edema.  VTE events (DVT, PE) are proven to be correlated with lack of mobilization, and risk increases based on invasiveness and length of convalescence.  Reduction in inflammation improves mobilization metrics, and IPC is proven to reduce the incidence rate of DVT.  IPC is believed to be safer overall than chemoprophylaxis per internal bleeding risk, current medical literature.  Lastly, reduction in inflammation reduces pain, which is further treated by the controlled temperature / cryotherapy.  State and federal law has increasingly favored advances in pain management as medically necessary and appropriate.  Multimodal therapies are encouraged per CMS.

What are the clinical benefits?
Physicians have reported improvements in overall patient recovery, speed of mobilization, opioid consumption, and inflammation.  Physical therapists indicate high satisfaction and gains in flexion, strength, and endurance.

• Improved outcomes - Pneumatic compression combined with controlled temperature reduces inflammation, edema and enables earlier mobilization which typically translates to faster return to normal activity and overall outcome enhancements.
• Better pain management - Opioids are not the only game in town.  A high percentage of surgeons using the VascuTherm have found fantastic results in non-opioid pain management and consumption reduction.  There are excellent benefits herein in reducing risks of addiction, diversion, respiratory suppression, chronic pain / RSD, and the onset of obstructive sleep apnea.
• Inflammation management - As inflammation restricts motion and causes pain, our primary goal is to reduce swelling and edema non-chemically.  Reduction in swelling is directly correlated with speed of recovery.
• VTE prophylaxis - IPC is increasingly used in place of chemoprophylaxis as it reduces the risk of internal bleeding / hematoma.  Our equipment and service is requested by facilities for both arthroscopy and arthroplasty to prevent DVT and PE in the home or SNF.
• Multimodal care - Leading surgeons suggest that the VascuTherm or comparable will be standard of care.  Our case history and knowledge of multimodal approaches (and compliments to pharmacologic ones) per AAOS, SCIP, and CMS suggests that this kind of technology provides a win-win for everyone: insurance coverage, faster recovery, risk reduction.

What are the safety benefits?
More info available.

• Mechanical over pharmacologic - The VascuTherm outperforms competitors on patient safety and risk reduction.  AAOS, CMS strongly points to combined therapies or those focusing on lower risk treatments.  Mechanical pain and inflammation management is inherently lower risk than pharmacologic interventions.  Most patients reduce medication-load, including substantial reduction in opioids.
• Tissue damage – The VascuTherm is fully programmable for time and temperature.  There is an extremely low risk of tissue damage per frostbite due to regulated temp at 43-50F.  Automation allows for the patient to wear the device continuously and have programmed start/stop times.
• Bleeding risk - For VTE (DVT/PE) prophylaxis, patients reduce the risk of bleeding, hematoma, and infection per mechanical IPC. 
• Compliance – Patients are more compliant and likely to use the device for pain, edema reduction based on ease-of-use and on/off functionality.  VTE compliance is monitored.

What are the financial benefits?
Surgeons and facilities can realize profit both directly per DMEPOS billing and indirectly per increased patient satisfaction and referrals.

• Revenue - Surgicenters and surgeons are able to bill per DMEPOS for the disposable wrap placed on the patient in the OR/PACU.  Revenue per patient ranges from $50-150.
• Time - Surgeons and staff realize additional time by fielding fewer phone calls from patients for meds, ER/ED visits, and complications.  Patients are less likely to be rehospitalized, reinjured.
• Cost savings - Insurance pays for this technology as it improves outcomes.  Your patients may actually save money based on the coverage and reduction in out-of-pocket cost for low-tech legacy devices.  Facilities, hospitals realize cost savings by likely reduction in ER/ED visits, rehospitalization for VTE events, and downstream cost per prolonged convalescence and opioid addiction.
• Cutting edge care - Patients love this equipment.  Well over 90% of patients report high satisfaction and recommend us.  A high percentage of patients are opioid averse; you provide them a strong alternative.  Satisfied patients demand less time and generate more referrals.

What is the cost?
See above for patient cost, which is minimal and/or the network copay. Physicians carry no cost. Physical therapy centers and other related facilities purchase the equipment.  Hospitals and surgicenters rent, purchase, or are provided the equipment on a contractual basis.  Providers may realize a revenue stream by billing for the patient disposables, which is expected to replace revenue from other products.

Which carriers authorize & how do you handle denials?
Codes for pneumatic compression are authorized by all major medical carriers, who may challenge medical necessity in some cases.  We are either in-network or achieve network exceptions for United Healthcare, Aetna, Cigna, Community Health Network / Medicaid / Husky, TRICARE, Diversified, all Workers’ Comp payers (ALL), Anthem in some cases. We appeal all denials.  We are still working on in-network for Anthem and BCBS Federal, which allow out-of-network.  We believe that federal and state law will facilitate net/par authorization for Anthem (and other carriers also denying net/par authorization).  When we receive a denial and/or lose the appeal, the patient is not expected to be responsible.  This policy is essential and is confirmed with each patient.

Can my clinic profit from this technology?
Yes, by developing a DMEPOS model certain revenues can be shared. Please contact us for discussion. We support your billing staff to collect revenue and obtain approvals.  Our staff handles all delivery, retrieval, sterilization, and tracking of patients and equipment.

Why choose Associated Medical?
Referring surgeons observe that we demonstrate a high level of care for their patients.  We truly enjoy helping patients take fewer meds; with good products we get a lot of positive encouragement.   As the president of Associated Medical, I’m optimistic that we will hold an honest, transparent, and altruistic position as we grow.  As a company, we’re focused on sustainable, quality service and holding a patient-centric approach.  Whereas many companies focus on the bottom line, we spend more energy on ensuring patient satisfaction and good support as this has driven our growth.  Most providers quickly identify our commitment and true interest in orthopedics and recovery.  -Marcus Simpson

How do I order?
2 Minutes or less.  Surgeon or PA indicates on surgical booking sheet a request for theVascuTherm.  Staff fax over a 1 page script and patient demographic.  We handle everything from there.  Email marie@assocmed.com for the script template and full info. We contact the patient, introduce the product, and arrange for at-home delivery.  We inservice the patient and caregiver in advance of surgery.  Our staff confirms with the surgicenter or hospital.  Wraps are provided to the surgicenter; therapy can be started onsite.  Patients are discharged with the wrap in place; they continue therapy at home.  We support the patient through the script, extended if needed.  We pickup or provide a UPS airway bill for return of the machine.

In orthopedics, which patients benefit most?

• Sports medicine - Industry-best for pain management, speed of recovery.
• Invasive arthroscopies - ACL, RCR, SLAP as above improvements in compliance, metrics.
• Arthroscopies - Per risk factors such as obesity, age, opioid intolerance, overall improvements.
• Arthroplasties - At-home / at-rehab pneumatic compression to replace / reduce dosing of VTE chemoprophylaxis.  Reduce internal bleeding, complications per current IPC literature.
• Fractures / General - compliments pain/anti-inflammatory meds, therapy to speed recovery.

How long do patients use the VascuTherm?
The following are commonly prescribed durations of use, modified per patient risk and medical necessity..

• Meniscectomies, Minor Arthroscopies -10-14 days
• ACL, RCR, SLAP, Complex Arthroscopies - 14-30 days
• Arthroplasties, Total Joint Replacement - 14-30 days
• VTE Prophylaxis - 14-30 days or as prescribed
• Fractures / General - as prescribed

How do you ensure compliance & support the patient?

• Good pre-surgery patient education is key to compliance.  We ensure that the patient understands how to use the machine, why it’s important, and our availability for support.
• For pain/inflammation management or standard use patients, we communicate multiple times throughout the patient’s recovery.  If we have a machine failure, we fix it quickly.
• For VTE prophylaxis patients, we communicate regularly to ensure the patient is using the device.  We diligently support the rehab/nursing facility and staff to ensure compliance.  We track hours of use and report back to the physician if the patient either chooses to non-comply or doesn’t express clear understanding of the importance of using the device.
• All patients (and parents/spouses) are given complete in-person instruction as to best-practices and tips/tricks.  We deliver support materials, instructions, manual, FAQ, etc as well.
• We sign delivery and training confirmation forms  and request surveys for each patient.  Feedback forms are regularly shared with your group to confirm compliance and satisfaction.

What’s your VTE prophylaxis program?
Associated Medical is building a VTE compliance program using Bluetooth technology to track patient compliance / including regular phone calls.  Tracking data may be faxed to the physician noting times and dates when staff called the patient to confirm compliance to the script.  As IPC technologies are increasingly in use for VTE prophylaxis, we are interested in working with physicians and hospital admins on developing at-home compliance monitoring programs.

How do you integrate into the orthopedic workflow?

• At-home - Our staff instructs patient/caregiver on use of equipment prior to surgery.  Supports patient throughout recovery as needed.
• Surgicenter - Equipment in PACU/OR.  Patients begin therapy.  Wraps onsite, patients discharged with wrap in place.
• Hospital - Equipment in PACU/ASU/OR/Floor, wraps onsite.  Machines track with inpatients, stay onsite at discharge.  Complete support to nurses, admin, staff.
• Orthopedic clinic - Wraps onsite for replacement.  Staff scripts cases.
• PT clinic - Dual-patient PT machines plus wraps onsite for complete integration.
• Athletic training facility - Equipment available.

Can I request the VascuTherm inhospital or at my surgicenter?
Yes, we integrate with both.  For same day surgeries equipment allows for immediate cooling and/or pneumatic compression. For overnight shoulders or arthroplasties, it is highly effective to begin therapy in the PACU and to continue throughout inpatient stay.  We provide equipment, training, and all needed support to ensure that optimal care is available. Hospitals are generally supportive of trials of this technology.  A 30-50 patient trial with full support is generally successful in demonstrating utility.

What regions do you service?
We focus primary operations in the Northeast (NJ, NY, CT, RI, MA).  We provide national services through distribution partners and/or via direct-to-patient services. We are able to service patients and providers through all 48 continental states.

What’s your turn-around time? 

• Same-day - Called-in cases are in-serviced the same day or next day.
• General – Most often practices provide notice / fax the script when booking the surgery.
• At your command - We can jump into action within minutes when needed.

Are you in-network or out-of-network?
See Here