What Happens After Your Doctor Orders a Brace?

If your doctor has recently prescribed a knee brace, back brace, or other orthopedic support, you may be wondering:

“What happens next?”

At National Medical Solutions, we believe patients deserve clarity. Here’s a step-by-step look at what happens behind the scenes after your physician sends us your order.

Step 1: We Receive Your Prescription

When your doctor determines a brace is medically necessary, they send us:

• A signed prescription

• Supporting medical documentation

• Clinical notes explaining your condition

• Any required testing results

Documentation is critical. Insurance companies require proof of medical necessity before they approve coverage. We will give you a call within 24 business hours of getting your order to let you know next steps.

Step 2: Insurance Benefit Verification

Before we schedule your fitting, our billing team verifies your benefits.

We check:

• Your deductible

• Your coinsurance percentage

• Your out-of-pocket maximum

• Whether prior authorization is required

• Whether the brace is covered under your specific plan

Many patients are surprised to learn that braces typically fall under coinsurance, not a flat copay. That means your deductible may apply first.

Our goal is to provide you with a clear financial breakdown before moving forward.

Step 3: Prior Authorization (If Required)

Some insurance companies require approval before we can dispense your brace.

If authorization is required:

• We submit your documentation to insurance

• We respond to any follow-up requests

• We track approval status daily

Authorization timelines vary by insurance company, but we actively work to minimize delays.

Step 4: Scheduling Your Fitting

Once benefits are verified and authorization (if needed) is approved, we schedule your fitting appointment.

During your appointment:

• We ensure proper sizing and alignment

• We educate you on proper use and care

• We answer any questions about wear schedule

• We review insurance responsibilities

A properly fitted brace is critical to healing and stability.

Step 5: Billing & Claims Submission

After your brace is dispensed:

• We submit your claim to insurance

• Insurance processes the claim

• You may receive an Explanation of Benefits (EOB)

An EOB is not a bill — it simply explains how your insurance processed the claim.

If you owe a balance (such as coinsurance or deductible), we’ll send a clear statement and can discuss payment options if needed.

Why Documentation Matters So Much

Insurance companies require detailed medical notes that demonstrate instability, pain, or functional limitation.

Common required documentation may include:

• Ligament instability testing (Lachman, Drawer tests)

• Varus or Valgus instability findings

• Prior conservative treatment attempts

• Clear physician signatures and dates

If documentation is incomplete, insurance may delay or deny approval. That’s why our team carefully reviews every order before submission.

Our Commitment to You

At National Medical Solutions, our goal is simple:

✔ Reduce delays✔ Communicate clearly✔ Ensure proper fitting✔ Advocate with insurance on your behalf

We work closely with physicians, hospitals, and insurance companies to ensure patients in Idaho receive timely, medically necessary equipment without unnecessary frustration.

Have Questions About Your Order?

If you’ve been prescribed a brace and have questions about next steps, coverage, or timing, our team is happy to help.

📞 Call us at 208-377-1881📍 Visit us at 8601 W Emerald St Ste 110, Boise, ID 83704

We’re here to make the process simple and stress-free.