AADL? What does that mean?

AADL? What does that mean?

By Ryan Cochrane on December 17, 2020 in Health & Care, Health Treatments, Post Surgery

Alberta Aids for daily living

Many Albertans are not aware of the extra coverage that the Alberta government offers. We are very fortunate to have over and above funding for certain medical devices. One of the most common government bodies is Alberta Aids to Daily Living (AADL) 

Alberta Aids to Daily Living, more commonly known as AADL, is used to help fund medical equipment and supplies to Albertans who qualify. This helps individuals live more independent lives. Listed below are 6 of the most common questions, I will try to answer about AADL:

1. Who is Eligible?
2. How to Use AADL Benefits?
3. What is Covered?
4. Cost Share
5. Approved Vendors
6. Forms

Who is Eligible?

  • Must be an Alberta resident with a valid Alberta Health Care Number
  • Must require assistance for 6 months or more with chronic, long-term, or terminal illness or disability
  • You can not have comparable coverage through any other funder

HOW TO USE AADL BENEFITS?

  • You must be seen by a health care professional and be provided with a prescription for the device
  • The health care professional should give you three approved facilities to go to
  • Choose which approved vendor you wish to use and make an appointment to be assessed for the device or benefit needed.
  • The approved vendor will submit your claim directly and will only bill you for your patient portion if there is one.

What is covered?

COST SHARE

  • AADL will cover 75% of device or supply
  • Patients under the age of 65 years of age will cover 25% of the cost up to $500
  • Patients who are receiving custom footwear are responsible for 25% of the cost no matter their age
  • Patients with lower income can qualify for Cost-share Exemption

APPROVED VENDORS

  • As stated above you must go to an approved vendor to be eligible for coverage. 

FORMS

If you are uncertain whether you qualify, please take your health care card to an approved vendor and they can look it up in the AADL system. It’s always best practice to ask a lot of questions so that you can be certain you are receiving the best service possible.

Private insurance: Will they cover the cost of my device?

Private insurance: Will they cover the cost of my device?

By Ryan Cochrane on July 22, 2020 in Health & Care

What is Private Insurance?

Alright you beautiful people, let’s talk Private insurance. Now I know BORING, but we receive hundreds of questions on the subject, so I will try to provide insight into what we have learned over the years. 

For most people, private insurance means a payment comes off my paycheque, and the next time I go to the dentist it only costs me $20 instead of $100. The majority of places can direct bill for you, whereas, in our field, this is not always the case. Unfortunately, the larger private insurance companies decided that clinics like ours would no longer be allowed to direct bill as there are too many products to regulate. Over the last few years, we have discovered the ins and outs for most insurance companies (until they change their rules again). We can help you navigate your insurance, even though we are unable to directly bill them.

Most of the information providing to us is VERY general. We can advise you on what questions to ask your insurance company before proceeding with a device. This way you can be assured you are covered. Private Insurance companies very rarely allow us to talk to them directly to get the information needed regarding our patients, so you must call them to clarify your coverage.

Common Devices that are Covered: What information do they need?

  1. Foot Orthotics 
  • Usually, a new pair is covered every 1-2 years, ranging coverage between $200-$400. 
  • 2-page “PAID” invoice
  • A prescription from your family physician
  • Biomechanical assessment
  • GAIT analysis

     2. Compression socks

  • Medical-grade compression is only covered, which means the pressure gradient has to be over 20 mmHg. 
  • For most Blue Cross plans the pressure gradient has to be over 30 mmHg (except Registered Nurses)
  • The number of pairs covered per year varies greatly between all the companies

    3. Custom & Non-Custom Bracing, & Prosthetics

  • Most companies will pay a maximum of $500.00 at 80%.
  • Must have a prescription with a diagnosis in order to claim it through your insurance

There of course are some insurances that only require a receipt, for example, ASEBP (Alberta Teacher’s Benefit). We do not know all the ins and outs so if all else fails give your insurance company a call. 

Direct Billing

Most insurance companies require you, the patient, to pay for the device and then submit it to your insurance yourself. The only insurances at this present date that allow us to direct bill are:

  1. ARTA (retired teachers plan)
  2. Green Shield
  3. Veterans Affairs
  4. Chambers of Commerce

Websites of Common Insurance Companies

We understand that it is challenging to navigate through your insurance and can be downright discouraging. We are here to answer any of your questions to help you get your money back as easy as possible.

This is a lot of information and not exactly something you wanted to read, but if you have any questions, please do not hesitate to call the clinic.  We are here to help no matter what it is regarding.

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