This document explains possible patient costs for off-the-shelf orthopedic braces and related supplies obtained from SilverSoul. Read it before submitting a website inquiry and before deciding whether to order an item. Your actual responsibility depends on the item, your coverage, applicable billing protections, and the information provided for your specific order.
SilverSoul applies the payment terms in this document only to an order approved by your primary care doctor. We must receive and verify the doctor’s valid written order for the requested item before supplying it, submitting an insurance claim, or billing or collecting payment from you. If the doctor declines the order or approval is not received, we do not supply the item and nothing is billed by SilverSoul to you or your insurer for that order. There is no SilverSoul charge for the inquiry, eligibility review, or request for the doctor’s approval.
Doctor approval alone does not create a payment obligation or guarantee insurance coverage. You must also choose to proceed after receiving the cost information and any required notices. Billing must meet the applicable delivery, documentation, payer, and legal requirements described in this document.
Acknowledging this document confirms that you have received and read this information. It does not place an order, authorize a charge or recurring payment, assign insurance benefits, waive an appeal or billing protection, or make you responsible for every claim denial. Any required order consent, payment authorization, assignment, or noncoverage notice is handled separately.
Before you decide to proceed, we will explain the item and quantity, its price, the expected insurance contribution and your estimated share, and any known coverage restrictions. A cash purchase requires an agreed price before the item is supplied. Ask us to explain anything you do not understand. You may decline an item before agreeing to the order.
We must confirm the authorizations needed to supply the item in your state and bill your payer before accepting the order on that basis. This document does not represent that SilverSoul is currently Medicare-enrolled, accredited, in network, or authorized to serve every state or payer.
Give us accurate insurance and other coverage information, and tell us about changes or a similar item received previously. We check eligibility and relevant coverage requirements, but an eligibility response, prescription, prior authorization, or Same or Similar equipment-history check does not by itself guarantee payment.
After your primary care doctor approves the order and you choose to proceed, you may owe a deductible, copayment, coinsurance, or a properly disclosed charge for a noncovered item only when the amount is legally collectible from you. A deductible is the amount you pay before specified benefits begin; a copayment is a fixed amount; coinsurance is a percentage. Plan terms, secondary coverage, and legal protections can reduce or eliminate your share.
Medicare Part B covers medically necessary arm, leg, back, and neck braces when ordered by a doctor or other authorized health care provider and when Medicare requirements are met. For a covered item, the usual patient share is 20% of the Medicare-approved amount after the applicable Part B deductible. Secondary insurance or assistance may change what you actually owe.
Before a Medicare order proceeds, we must confirm supplier enrollment and explain whether assignment will be accepted for the claim. Assignment means accepting the Medicare-approved amount as full payment for the covered item, subject to lawful deductible and coinsurance amounts. No particular payment is guaranteed by this document.
When Medicare rules require an Advance Beneficiary Notice of Noncoverage, called an ABN, we must provide the current official CMS-R-131 notice before supplying the item. It must identify the item, the specific reason Medicare may not pay, an estimated cost, and your options. We must give you time to ask questions and make an informed choice, and provide a completed copy.
This document and the website checkbox are not an ABN. They cannot replace a required notice or transfer liability for all denials. An ABN does not guarantee payment. Where applicable, you may choose to receive the item with a Medicare claim submitted so that you receive a coverage decision and can exercise appeal rights, or choose another option shown on the notice.
If you are enrolled in the Qualified Medicare Beneficiary program, called QMB, you have no legal obligation to pay Medicare Part A or Part B deductibles, copayments, or coinsurance for Medicare-covered items and services. This protection applies in Original Medicare and Medicare Advantage. SilverSoul must not collect those amounts from you even if Medicaid does not pay them. Tell us if you receive a bill for protected cost sharing so we can correct it.
Medicare Advantage, Medicaid, and commercial plans have their own network, authorization, coverage, and payment rules. The Original Medicare ABN is not the Medicare Advantage coverage-determination process. A Medicare Advantage member may request a plan coverage decision, called an organization determination, before receiving an item. Required plan notices and appeal procedures must be followed. Medicaid and plan protections against billing patients remain applicable.
A cash price does not mean that you must give up insurance rights or that a Medicare or Medicaid billing restriction can be bypassed. Any decision to proceed without insurance must satisfy the rules that apply to your coverage and the item.
If you are uninsured, or have private health insurance and choose not to use it, you generally have a right to a written good faith estimate when you request one or schedule an item or service at least three business days in advance. We will provide any estimate required by the applicable rules within the required time. The estimate describes expected charges; it is not a purchase agreement.
If a bill from a provider is at least $400 more than that provider’s good faith estimate, an eligible uninsured or self-pay patient may use the federal patient-provider dispute process. The request generally must be made within 120 calendar days of receiving the initial bill. Keep your estimate and bill. Information is available at cms.gov/medical-bill-rights. People enrolled in Medicare, Medicaid, or other federal health care programs generally use their program’s protections instead of this good faith estimate process.
We will explain any amount billed to you and the payment terms for your order. Insurance explanations of benefits and Medicare Summary Notices are not themselves bills from SilverSoul. Before collecting a patient balance, we must review the payer decision, required notices, secondary coverage, and protections that apply. An insurer’s denial does not automatically make the balance your responsibility.
We will not bill you for an amount that law or a binding payer agreement makes our responsibility. This document does not authorize automatic debits, late fees, collection costs, or additional charges. Any separate payment arrangement must be disclosed and lawful. If you have difficulty paying, contact our billing team to discuss your account.
Contact us if a bill appears wrong, an item was not received, or a payment was duplicated. We will review the account, explain the outcome, correct errors, and return amounts that must be refunded under applicable requirements. Ask about the item’s return and warranty terms before ordering; those terms do not remove rights provided by law.
You may request an itemized explanation, dispute a bill, contact your insurer, and use applicable complaint and appeal procedures without retaliation. Contacting SilverSoul does not extend a payer or legal filing deadline. We will explain how to obtain the appropriate notice or contact information.
Contact SilverSoul
SilverSoul Medical Supplies LLC
312-792-2822 info@silversoulcare.com
1100 Lake Street, Suite LL30B, Oak Park, IL 60301
silversoulcare.com
