Medical Insurance & Financial FAQs
Capstone O&P offers a variety of options to provide you with the highest quality orthotic and/or prosthetic device to meet your needs. Don't let the financial burden of care prevent you from getting started today. We are here to help!
What insurance companies are you in network with?
Capstone Orthotics and Prosthetics is contracted with most large insurance companies, and we work with those that we are not contracted with on a out-of-network basis.
Can you see military veterans whose care is overseen by the VA Hospital?
Yes! Capstone O&P treats patients who have been referred for prosthetic or orthotic care from the VA. Before the VA Hospital will issue a purchase order to Capstone for your device, you must schedule an appointment with the Orthotics and Prosthetics Department at the VA for a consultation regarding your care. If they deem that a prosthetic or orthotic device is medically necessary, the treating physician will give you a prescription for the device you are in need of. It is your right to use that prescription to obtain care at any of the clinics licensed to work with the VA. Capstone O&P is a provider with the VA. If you are a veteran, contact us today and we will help you get the process started!
Do you accept patients needing care under a Worker's Compensation claim?
Yes! Capstone O&P is contracted with most Worker's Compensation providers and can bill many others under an exemption. Contact us today to find out how we can help you utilize your claim's benefits!
How will I know if my device is covered by my insurance?
Prior to your evaluation appointment, Capstone Orthotics and Prosthetics will verify your insurance and determine whether or not your insurance is active and in network. After your evaluation appointment, our clinician will design your device and assign the appropriate HCPCS codes to your encounter. Your benefits will then be applied to the codes and a detailed breakdown of your financial responsibility will be given to you.
What if my device is not covered or determined "not medically necessary"?
If your device is determined to be a "non-covered item" or "not medically necessary," a breakdown of a detailed estimate for services will be given to you. We encourage our patients to pursue third-party financing in this case and apply for Care Credit. Visit the link below for more information on how Care Credit can help you!
Do you accept payment from Health Savings Accounts (HSA) and Flexible Spending Accounts (FSA)?
Yes! We want you to take advantage of your employer's benefits. FSA and HSA accounts allow you to put aside pre-taxed income for health related expenses. We can accept payment from both HSA and FSA accounts regardless of whether or not your insurance covers a portion of your services.
Do you offer third-party financing?
Yes! We offer third-party financing through a Care Credit card. Once you are accepted for Care Credit, you will work directly with Care Credit regarding payments, balance pay off, and terms and conditions.
Visit the link below for more information on how Care Credit can help you!
What methods of payment do you accept?
Capstone Orthotics and Prosthetics accepts the following payment methods: cash, check, debit card, credit card, and third-party financing.
What do I do if my only insurance is Medicaid, and they do not cover prosthetics and orthotics for adults?
Medicaid does not cover any orthotic or prosthetic devices for patients over the age of 21. However, there is a STAR+PLUS Waiver Program for adults through the Texas Department of Health and Human Services. In order to receive a STAR+PLUS Waiver, you must apply and be accepted to the STAR+PLUS Medicaid Plan. When you sign up for STAR+PLUS, you must also detail your physical disabilities and orthotic and prosthetic needs and request a DME waiver. A Medicaid counselor can assist you with this process which might include additional evaluations and documentation from Medicaid and/or your doctor. Acceptance into the STAR+PLUS Waiver Program can take many months and due to their strenuous requirements, a waiver is not guaranteed. Visit the link below for more information from the Texas Department of Health and Human Service:
Medicaid Starplus PageAre there any nonprofit groups that can assist me if I do not have insurance or my prosthesis is not covered?
Yes! Please visit our Prosthetic Resources page at the top right-hand menu. Many of the resources listed are nonprofit organizations that have programs you can apply to for help in getting your device covered. Even if the prosthesis you need s a high activity sports or running leg, there are groups that can help! Contact us today and we can help you find additional funding sources for your prosthesis.