Insurance Questions

As a courtesy to our customers, CMR will bill the patients insurance company for jaw motion rehab systems. Billing for these products is difficult and our extensive experience improves the chances equipment will be covered.

In billing the patients insurance, we make every effort to have the equipment and therapy covered, including requesting pre-authorizations, pre-determinations and 1st level appeals. We also provide support in further appeals both through the insurance company and state insurance agencies.

For this process, we generally require a prescription, patient insurance information, doctors notes, and a letter of medical necessity for jaw motion rehab products.

Comfort and recovery products are not covered by insurance; for these you can order here or we will bill the patient directly and they can request reimbursement for the items.

Additional Information:
  • We cannot guarantee that the patient's insurance company will pay any portion of the patients bill.
  • All claims must be submitted with a prescription from the treating physician.
  • We will pre-authorize or pre-determine the patients coverage when possible.
  • We make every attempt to pre-authorize the products/services that we provide, however, we will only appeal a pre-authorization denial, except when the denial is for non-covered benefit or TMJ exclusions.
  • If the patients claim gets denied as investigational or experimental, we will file a first level appeal on the patients behalf, and will assist in further appeals.
  • Any representation made by a CMR, Inc. agent about a patient's insurance coverage is based on information provided by your insurance company and, again, should not be considered a guarantee of payment.
  • Claims can only be determined eligible/ineligible at the time it is processed, and may be denied even after a pre-authorization or pre-determination is issued.
  • You may be required to submit additional information requested from your insurance company.
  • Be aware that any payment sent to you from your insurance company for services rendered to you by CMR, Inc. must be forwarded to us calling or mailing in the payment for that amount.
  • You may be responsible for any amount that is not covered by your insurance company, especially including any co-pays or deductible. We do follow the guidelines set forth by your state’s insurance personal injury protection (PIP) that only allows us to bill the insurance company if your injury is determined to be related to the accident.
Does private insurance cover CranioMandibular Rehab's products?
Private insurance (including workers comp, company funded, union plans, non- and for-profit insurance plans and HMO's) covers some CMR products. Each company, and often each individual plan, has various rules, policies and procedures for determining whether a product will be covered. Generally, the recovery products are not covered, and the motion products are on based on the diagnosis information.

Does Medicare cover CranioMandibular Rehab's Products?
Medicare covers the jaw motion rehab systems, including the OraStretch press and TheraBite System. Medicare only covers CPM for the knee, and does not cover any recovery products. Does Medicaid cover CMR Products? CMR is not registered with any state Medicaid providers, and cannot bill Medicaid for products. In general, Medicaid does not cover any motion or recovery products.  See more information on Medicare coverage on our Medicare page

What can I do to help get coverage for a product?
Your participation in the pre-authorization, pre-determination and billing process can significantly increase your chance of having the equipment covered. In addition, after CMR performs a 1st level appeal, we will help you file a 2nd level appeal and you can always file a complaint with your state's insurance regulator for a ruling to compel coverage.

What billing services does CMR provide?
CMR performs all the services to bill for our equipment up to a 1st level appeal, including pre-authorization, pre-determination, billing for providing the equipment, and a 1st level appeal (as each is necessary or required by an insurance carrier.) CMR has extensive experience performing complex appeals for DME, and can also provide billing services for other DME vendors, doctors offices, and patients.

If my appeals have failed, what other options do I have to get the equipment paid for?
Generally, after a first level appeal, you have the option to file a second level appeal to the insurance company. You can lobby your company's HR administration for assistance with the insurance company. You can also often file a complaint with the state insurance regulator for a hearing to compel the insurer for coverage.

Medicaid
Medicaid is individually controlled by each state. CranioRehab is registered with Medicaid as a provider in Colorado.  We may be registered as a provider in others states; please contact us to determine if we can bill to Medicaid in your state.  If we are not registered, we may be able to to a one-time authorization, otherwise we cannot bill Medicaid directly for provided equipment.  We can work with you and your doctor to get equipment provided to you, but we cannot guarantee coverage.