Funding a ZYGO communication device through Medicare, state medical assistance programs or private insurance may seem like an overwhelming task. The funding information in this section of our website is designed to walk you through the funding process, and provide you with the information and forms you need for this process.

 

The paperwork generated from this process should be bundled together and sent to your funding resource, whether it is directly to ZYGO-USA, to our local authorized dealer in your area, or to a durable medical equipment provider who can submit a claim. It is ZYGO, the dealer, or DME who then submits the claim on your behalf to the appropriate funding source.

To be eligible to receive equipment through insurance, your equipment provider must receive these items prior to delivering equipment to the client. This applies to Medical Assistance funded purchases, rentals, and repairs (must provide month and year of purchase.)

Speech evaluations must come from a licensed Speech Language Pathologist, preferably one who is familiar with augmentative and alternative communication devices and other assistive technologies. The recommendation must be for a specific list of equipment and a justification for the medical necessity of each piece.

The prescription must be for the specific equipment called out in the speech language pathologist's recommendation. It must be dated prior to equipment delivery, must include the doctor's UPIN, diagnosis, length of need, and an itemized list of specific equipment.

Signed originals need to be submitted to the vendor company (ZYGO, our local authorized dealer, or a durable medical equipment provider willing to submit the claim) in order for the vendor company to submit the claim on your behalf. The entire packet of items listed in the Claims Requirements section should be sent by the Speech Language Pathologist.

 

If you are just beginning to consider speech generating devices, the process begins with a comprehensive evaluation from a licensed speech language pathologist. You may get help finding an SLP in your area from the American Speech Language Hearing Association (ASHA), your state Speech Language Hearing Association, or from local ZYGO representatives and dealers who can offer names and phone numbers of speech language pathologists they have worked with in the past.

A speech generating device or accessory in Medicare HCPC code categories E2500, E2502, E2504, E2506, E2508, E2510, E2511, E2512, or E2599 is covered when all of the following criteria (1-7) are met:

1. Prior to the delivery of the SGD, the patient has had a formal evaluation of their cognitive and communication abilities by a credentialed speech-language pathologist (CCC-SLP). The formal, written evaluation must include, at a MINIMUM, the following elements:
   
   • - Current communication impairment, including the type, severity, language skills, cognitive ability, and anticipated course of the impairment;
   • - An assessment of whether the individual’s daily communication needs could be met using other natural modes of communication;
   • - A description of the functional communication goals expected to be achieved and treatment options;
   • - Rationale for selection of a specific device and any accessories;
   • - Demonstration that the patient possesses a treatment plan that includes a training schedule for the selected device;
   • - The cognitive and physical abilities to effectively use the selected device and any accessories to communicate;
   • - For a subsequent upgrade to a previously issued SGD, information regarding the functional benefit to the patient of the upgrade compared to the initially provided SGD;
2. The patient’s medical condition is one resulting in a severe expressive speech impairment; and,
3. The patient’s speaking needs cannot be met using natural communication methods; and,
4. Other forms of treatment have been considered and ruled out; and,
5. The patient’s speech impairment will benefit from the device ordered; and,
6. A copy of the SLP’s written evaluation and recommendation have been forwarded to the patient’s treating physician prior to ordering the device; and,
7. The SLP performing the patient evaluation may not be an employee of or have a financial relationship with the supplier of the SGD.

If one or more of the SGD coverage criteria 1-7 is not met, the SGD will be denied as not medically necessary.

Send the entire packet to ZYGO-USA Directly

ZYGO-USA
48834 Kato Road, #101-A
Fremont, CA 94538-7368

U.S./Canada: (800) 234 - 6006
tel: (510) 493-0997
fax: (510) 770-4930
zygo@zygo-usa.com

medicare
Medicare may cover augmentative and alternative communication devices. The patient is usually responsible for a 20% deductible which might be covered by a secondary funding source. ZYGO is not an accredited Medicare provider, however we do have an arrangement with Ablenet, Inc. Funding Services to provide funding support for Speech Generating Devices sold by ZYGO. Our funding department can help you gather the materials you will need to submit the claim to receive a communication system.

medicaid
Refer Medicaid funding requests, as well as those Medicare/Medicaid requests to the local dealer or Durable Medical Equipment provider who processes Medicaid claims in your state. ZYGO has an arrangement with Ablenet, Inc. Funding Services to provide funding support for Speech Generating Devices sold by ZYGO. Our funding department can help you gather the materials you will need to submit the claim to receive a communication system. Ask if we can work with your State.

private insurance
ZYGO's funding staff provides assistance to clients who need help navigating the complex healthcare insurance system. Augmentative communication is a covered benefit of many health plans.

There are three steps involved in this procedure.

Step 1:
Find your health plan provider in your state. ZYGO also processes private insurances as well.

If the client does not have health insurance, there are public agencies that may offer assistance such as Department of Vocational Rehabilitation, Easter Seals Society, the United Way, and other organizations dedicated to helping people with a specific disability such as ALS Association, and the Muscular Dystrophy Association. Non-profit or civic organizations such as the Rotary Club, Knights of Columbus, etc. may also provide assistance.

Step 2:
Eligibility to receive equipment through insurance is dependent upon the completion and submission of several items including: Client Profile, copy of all insurance cards (front and back), Assignment of Benefits, co-pay and deductible (if there is no secondary insurance provider), Consent Form, Speech Therapist's Comprehensive evaluation , and a Physician’s Prescription.

Step 3:
For further information or assistance regarding funding a communication system, please call our Medical Accounts Manager at (800) 234-6006 or e-mail info@zygo-usa.com with your specific questions.

Q. How long does the funding process take?
A. This depends on the funding source and the completeness of the documentation. As a general rule, it takes 30-60 days for the funding process to be completed and an order shipped.

Q. What type of documentation is required?
A. Most funding sources require a prescription and a speech evaluation or letter of medical necessity. You must also provide us with the following information necessary to process an insurance claim.

• - Completed Client Profile
• - Copy of all insurance cards (front and back)
• - Assignment of Benefits signed by client
• - Consent Form, signed by client
• - Co-pay and deductible if there is no secondary insurance
• - Speech Therapist's Comprehensive evaluation (dated prior to prescription)
• - Physician's prescription (prescribing an itemized list of equipment)

Q. Where do I send the paperwork?
A. Mail the complete packet of documentation to ZYGO-USA, Funding Department:

ZYGO-USA
Funding Department
48834 Kato Road, Suite 101-AA
Fremont, CA 94538-7368 U.S.A.
(800) 234-6006

Q. Can I fax the documentation?
A. Yes, but you must also mail the original documentation. We can receive faxes prior to receipt of final paperwork to allow our funding department to go over the documentation and contact you if we see any problems that may need to be corrected. However, we do require that you mail the original paperwork to us even if a copy has been faxed. Most funding sources require us to maintain the original, signed paperwork in your file.

Q. Who can assist me in the funding process?
A. Anyone in our Funding Department can answer questions you may have regarding funding. You may also get a better understanding of the process from our Funding Program page on our website. Please contact us at toll-free (800)234-6006, direct at (510) 493-0997, or by e-mail at info@zygo-usa.com.

Q. How are insurance claims processed?
A. All paperwork for Medical Assistance should be submitted directly to ZYGO-USA. We submit the claim for equipment to Ablenet, Inc. Funding Services or your insurance company for you.

Q. Can I submit to my insurance policy myself?
A. In some situations, yes. However, we recommend that you contact your insurance agency first to ensure the greatest likelihood of receiving reimbursement. In some cases they will cover devices but only pay to the vendor.

Q. I have an older device. How long do I need to wait before I can get a new device?
A. Most funding sources are in agreement that a speech device should last for at least five years. It may be possible to get another device before that time if your communication needs have changed or if the device is damaged beyond repair.

Q. What funding sources might help pay for speech generating devices?
A. There are many funding sources available. Private insurance, Medicaid, Medicare, Vocational Rehabilitation, Department of Developmental Disability, Veterans’ Administration, state telecommunications programs, school systems, clinics, hospitals, non-profit organizations like the ALS Association or Muscular Dystrophy Association, and foundations have all funded augmentative communication devices. Local charity functions have also been quite generous in raising funds for its citizens in need.

Q. How do I determine which funding source to approach?
A. Start with the list of funding sources above. Look for the most obvious source for your current situation. For example, your medical insurance is interested in satisfying your medically related needs, school funding is obviously education based, whereas vocational rehabilitation focuses on providing equipment that allows you to return to or retain your job.

Q. If I have a combination of health plans (private insurance, HMO, Medicare, Medicaid), which should I approach first?
A. As a rule, if you have Medicare, it is likely the primary insurance provider. State Medicaid, private insurance, and HMO/PPO plans are usually secondary to Medicare. Contact you primary care physician, as he or she will likely know about your insurance plans.

Q. How is "medical necessity" justified?
A. Medicare and Medicaid have specific criteria that must be addressed in the speech evaluation report that is generated by your Speech Language Pathologist. Most health plans require a letter of medical necessity that clearly indicates how the absence of the communication device could pose a substantial risk to the patient's health or safety. If possible, specific examples should be given that the communication device is the patient’s only way of indicating that he or she is not feeling well, speaking with a medical professional, or contacting 9-1-1 for emergency assistance.

Q. What happens if a claim is denied?
A. If any funding source denies the claim, you can appeal the denial. Claims denied on the first try are frequently funded after an appeal. Contact our Funding Department for assistance in the appeal process or for the name of the Protection and Advocacy center in your area.

Q. Will I be required to pay a portion of the cost of a device approved through insurance?
A. Many insurance policies require a co-payment from the policyholder for the purchase of the device. The amount of the co-payment depends on the health plan and the policy. Often times the co-payment is paid by a secondary policy, such as Medicare/Medicaid. Medicaid payments are considered payments in full and the recipient is generally not responsible for any co-payment. Medicare deductibles are generally 20% of the product price, and must be paid to ZYGO prior to shipment.

Allowable
The amount of money for which your insurance company will allow a claim to be processed. The client's co-insurance is usually based on their allowable amount. For example, if the allowable amount is $5,000.00, and the client's co-pay is 10%, the amount the client will owe is $500.00.

Assignment of Benefits (AOB)
Form signed by the policy holder that allows the insurance company to pay ZYGO-USA or its dealers directly. Without an AOB, the policy holder may receive the insurance payment instead of the provider.

Certificate of Medical Necessity (CMN)
This is usually a state-specific form which is signed by the physician or speech therapist.

Claim
Billing submitted to the insurance company after the equipment has been delivered.

Client Advocate
Person who is representing the client during the funding process. This person is usually a speech therapist or case manager.

CPT Code
The Current Procedural Terminology code describes the type of services that are being supplied. This is generally the same as a HCPC Code.

Custodial Care Facility
Facility that provides room, board, and assistance with daily living activities, such as feeding and dressing. This care is generally on a long term basis and does not entail the continuing attention of trained medical personnel.

Deductible
That amount that the client must pay annually before benefits will be paid by the insurance company.

Durable Medical Equipment (DME)
Systems made to withstand repeated use that are used for the treatment of an injury or disease. Speech Generating Devices have been classified as Durable Medical Equipment.

Explanation of Benefits (EOB)
The statement from the insurance company showing the services and amounts that were paid by the policy. This is also known as a remittance.

Exclusions
Services for which the insurance company will not pay.

Funding Questionnaire (FQ)
A questionnaire that is usually completed by a family member or other contact person which includes important information such as the client's address, physician, insurance information, and a list of the equipment that they wish to order.

HCPC
Code that is used to describe the services rendered. For example, the Optimist MMX has a Medicare HCPC code of E2510.

Hospice
Supportive care given to a terminally ill client and their family. The focus of this care is to enable the client to remain in the familiar surroundings of their home for as long as they can. Hospice care may be either inpatient or outpatient.

ICD-9 Code
International Classification of Diseases. Insurance code that describes a client's medical condition or diagnosis.

Insurance Letter of Requirement (ILR)
This letter is sent to your insurance company by your funding coordinator and explains the details that should be included in a private insurance authorization. An approval form is also included with this letter. Insurance companies may complete the approval form instead of creating a letter.

Invoice
Itemized statement explaining what items or services have been delivered.

Letter of Medical Necessity (LMN)
A letter explaining the medical need for AAC services. This letter can be written by a physician, speech therapist, or occupational therapist. These letters usually give the client's diagnosis and a brief explanation of why services are necessary.

Maximum Out of Pocket
The maximum amount a client will pay towards their deductible and co-insurance during the year.

Managed Care Organization (MCO)
Any insurance plan in which the client will need to have services approved by their plan's referring physician or medical group.

Medicaid
State-sponsored medical plan. Eligibility for these plans is traditionally based on a family's income. May also be called Title 19.

Medicare
Federally-sponsored medical plan. Clients become eligible for this program when they turn age 65 or have a qualifying disability. There are two separate programs under Medicare
Part A (hospitalization) and Part B (medical). Clients must pay a monthly fee for Part B coverage. speech generating devices are covered under Medicare Part B.

Medicare Supplement
An insurance policy that covers Medicare co-payments and other services. This policy must be purchased by the Medicare beneficiary.

Non-Participating Provider
Provider that has not contracted with a health insurance company to provide services at a reduced fee. Also referred to as an Out of Network Provider.

Original Documentation
Prescription and speech evaluation that has an original signature. The signature page on the evaluation and the doctor's prescription cannot be stamped, copied, or faxed. Medicare requires that original documentation be on file with the vendor for any product.

Payment Agreement (PA)
Form signed by a policy holder stating that they agree to cover any amounts not paid by the insurance company.

Place of Service (POS)
The location where the medical services will be provided or used. It is important that we know whether a client lives at home, in a group home, or in a nursing facility. Some funding sources will not cover clients that live in a nursing facility.

Pre-certification
See Prior Authorization.

Pre-determination
A review done by an insurance company to determine whether a service will be considered a covered benefit.

Prior Authorization
Approval issued by the insurance company before equipment is delivered. Authorizations are normally issued by nurse reviewers at the insurance company who review the doctor's orders and other documentation to ensure that a service is medically necessary.

Referral
Specific directions or instructions from a client's primary care physician. Referrals may be on paper or electronic and are usually required by HMO policies.

Release of Information (ROI)
A form that is signed by a client or their guardian and gives permission for the vendor to release medical documentation to insurance companies and other funding sources.

Remittance
A statement sent to medical providers from the insurance company to show the payment that was issued. Also called Explanation of Benefits (EOB).

Rx
Prescription. This must be signed by a medical doctor or dentist.

Sole Source Supplier
A provider who is the only source for a particular service or type of equipment.

Subscriber
The employee covered under an employer's group insurance policy. Also referred to as the policy holder.

Skilled Nursing Facility (SNF)
A facility which provides inpatient skilled nursing care and related services to patients who require medical, nursing, or rehabilitative services but do not require the level of care provided in a hospital. If a person is in this type of facility, they are not able to use Medicare as a funding source.

Stop Loss
See Maximum Out of Pocket.

UPIN
Unique Physician Identification Number. Identification number that is used to identify the physician who signed the prescription. This number is used when filing claims to insurance companies.

Usual and Customary Charges
Also referred to as Reasonable and Customary Charges. An amount determined by an insurance company that represents a routine charge for a medical service by similar medical and professional providers in the same geographical area. Allowable amounts are normally based on the Usual and Customary Charges.

AAC TechConnect
AAC TechConnect, Inc. provides clinical tools which simplify your augmentative communication (AAC) evaluations. At their web site, you can find the Device Assistant which is a search tool which helps you list AAC devices through feature-matching, and then provides you with side-by-side product comparisons.

ALSA
The ALS Association is the only national not-for-profit health organization dedicated solely to the fight against ALS. ALSA covers all the bases - research, patient and community services, public education, and advocacy - in providing help and hope to those facing the disease. The mission of The ALS Association (ALSA) is to find a cure for and improve living with amyotrophic lateral sclerosis.

AOTA
The mission of AOTA (American Occupational Therapy Association) is to advance the quality, availability, use, and support of occupational therapy through standard-setting, advocacy, education, and research on behalf of its members and the public.

ASHA
The mission of ASHA (American Speech-Language-Hearing Association) is to promote the interests of and provide the highest quality services for professionals in audiology, speech-language pathology, and speech and hearing science, and to advocate for people with communication disabilities.

ATIA
The Assistive Technology Industry Association (ATIA) is a not-for-profit membership organization of manufacturers, sellers or providers of technology-based assistive devices and/or services.

Augmentative Communication, Inc. (ACI)
Augmentative Communication News (ACN) and Alternatively Speaking (AS) newsletters provide the latest information on hot topics in the field, discussion of vital issues for AAC stakeholders and news from the AAC community.

Closing The Gap
Closing The Gap, Inc. is an organization that focuses on computer technology for people with special needs through its bi-monthly newspaper, annual international conference and extensive web site.

Council for Exceptional Children (CEC)
CEC is a non-profit association whose mission is to improve educational outcomes for individuals with exceptionalities.

CSUN Center on Disabilities
The Center on Disabilities is an integral part of the California State University at Northridge mission of teaching, scholarship and active learning, furthering the vision of an inclusive society which supports the attainment of academic, professional and personal goals for persons of all abilities. The Center fulfills this mission through programs of student service, education, and research.

Disability Resources
Disability Resources, Inc. is a nonprofit 501(c)(3) organization established to promote and improve awareness, availability and accessibility of information that can help people with disabilities live, learn, love, work and play independently.

eFunding Solutions
eFunding Solutions is dedicated to helping educators locate every funding source available to them in the United States. The eFunding Solutions site is free to all educators.

Foundation Center
The Foundation Center supports and improves institutional philanthropy by promoting public understanding of the field and helping grant seekers succeed.

ISAAC
ISAAC (International Society for Augmentative and Alternative Communication) is an organization devoted to advancing the field of Augmentative and Alternative communication (AAC). The mission of ISAAC is to improve communication and the quality of life for people with severe communication impairments. The organization has chapters in 12 countries.

MDA
The Muscular Dystrophy Association is a voluntary health agency — a dedicated partnership between scientists and concerned citizens aimed at conquering neuromuscular diseases that affect more than a million Americans. MDA combats neuromuscular diseases through programs of worldwide research, comprehensive medical and community services, and far-reaching professional and public health education.

RERC
The mission of the AAC-RERC is to assist people who rely on augmentative and alternative communication to achieve their goals by advancing and promoting AAC technologies and supporting the individuals who use, manufacture, and recommend them.

RESNA
The mission of RESNA, the Rehabilitation Engineering and Assistive Technology Society of North America, is to support people with a common interest in technology and disability. Therefore, our membership is multidisciplinary and international. As an organization, we promote research and development, education, advocacy and the provision of assistive technology while at the same time supporting the individuals engaged in these activities.

UCP
United Cerebral Palsy (UCP) is the leading source of information on cerebral palsy and is a pivotal advocate for the rights of persons with any disability. As one of the largest health charities in America, the UCP mission is to advance the independence, productivity and full citizenship of people with disabilities through an affiliate network.

USSAAC
USSAAC is the United States Society for Augmentative and Alternative Communication. They are the national chapter of ISAAC, the International Society for Augmentative and Alternative Communication. It is an organization dedicated to supporting the needs of people who rely on AAC devices, as well as the professionals, manufacturers and family members making up our community. Augmentative and Alternative Communication refers to methods of communication that enhance (augment) or replace (alternative) conventional forms of expression.

VA
The Department of Veterans Affairs (VA) provides excellence in patient care, veterans' benefits and customer satisfaction. They are striving for high quality, prompt and seamless service to veterans. The VA continues to offer their dedication and commitment to help veterans get the services they have earned. About a quarter of the nation's population -- approximately 70 million people -- are potentially eligible for VA benefits and services because they are veterans, family members or survivors of veterans.

Accredited Online Colleges
Accredited Online Colleges is a site for finding accredited online colleges around the U.S. School accreditation is vital to ensuring a quality education. But, determining accreditation can feel like working your way through a maze. Accredited Online Colleges lets you search through countless accredited schools, based on a variety of criteria, to find the accredited college that best meets your needs.

Revised Fee Schedule (effective January, 2012)
The amount of money Medicare will pay towards AAC products is known as an allowable, which is spelled out in the following fee schedule.

We have added our products to this table to indicate which ZYGO products fall into which Healthcare Common Procedure Coding System (HCPCS) codes.