How does Medicare’s Remote Therapeutic Monitoring (RTM) program work with Hero, and what should users know?
Medicare RTM is a program that leverages technology to monitor medication adherence remotely. Hero partners with medical practices that offer remote care programs, which include Hero’s smart dispenser and check-ins with licensed professionals.
Eligible Medicare members can check their eligibility through the Hero Provider Directory, and submit an application to RTM provider for evaluation and processing. Once enrolled in the program, Hero smart dispenser is automatically shipped.
Step 1: Submit Your Application
Complete the Online Eligibility Form:
Visit Hero's eligibility page (Hero Provider Directory) and fill out the required details.
Select a Remote Care Provider:
Based on your ZIP code, select a remote care provider who will handle your enrollment and billing. Remote care providers partner with a number of insurance providers, so don't worry if you don't see yours on the list.
Submit your completed application. You will either see confirmation that your insurance is not eligible or that your application has been forwarded to a provider for further processing.
Provider Evaluation:
After completing the form, your chosen provider will review your case and contact you to schedule a chat with a clinician. You'll have a short video chat with a trusted provider clinician to review your medical history and determine if Hero is right for you. If the provider does not reach out within three days, you can proactively call them using the contact information provided.
Understand Cost Considerations:
Copays, coinsurance, or deductibles may apply depending on your specific Medicare plan. Be sure to confirm these details with your provider.
Troubleshooting Non-Eligibility Scenarios:
If your insurance plan is not in-network with the selected provider, it may not be possible to qualify through the RTM program using that provider. In such cases, consider out-of-pocket options for smart dispenser subscription. Subscription pricing options include $44.99 per month on a monthly plan or prepaid plans such as $359.92 for 1 year ($29.99/month). All out-of-pocket subscriptions include a money-back guarantee and a limited warranty.
Step 2: Follow Up on Your Application
Once you have submitted your application:
Save the phone number of the chosen remote care provider (you can find it in the recent email or SMS communication from Hero).
If you do not hear back from the provider within 48 hours, it is recommended to contact them directly to inquire about the status of your application.
Roles and Responsibilities
Hero: Provides the platform to facilitate application to the RTM program but does not handle care delivery or monitoring directly.
Remote Care Providers: Conduct monitoring, including monthly check-in calls, and assess your medication adherence and overall well-being. Care providers bill Medicare if you qualify for the program.
Users: Responsible for consistent use of the Hero device and adhering to prescribed medications to remain eligible for the program. Monthly virtual check-ins with your care management team are required to maintain eligibility for the RTM programs. Failure to attend these sessions may lead to loss of eligibility.
Billing and Insurance Queries
If you have questions regarding billing or insurance, these should be directed to your remote care provider as Hero Support does not manage billing inquiries. This ensures accurate and specific assistance tailored to your insurance details.
Key Considerations and Exclusions
Users may be discharged from the program for non-compliance, such as not using the device consistently or missing monthly check-ins.
While initiating eligibility checks is free, coverage specifics depend on your Medicare plan, and there may still be copays, coinsurance and deductibles.
Private insurance:
Private insurance may or may not cover remote care programs. Check your eligibility through the Hero Provider Directory.
FSA/HSA Eligibility:
Hero is FSA/HSA eligible, meaning you can use an FSA or HSA card to pay for your subscription. Pro Tip: You can pay with a personal credit card and reimburse yourself from your HSA before interest accrues—this allows you to take advantage of tax-free payments and earn credit card rewards.
For more resources, check out our blog: Insurance & caregiver reimbursement.
What If Hero Is Not Covered by My Insurance Provider?
Hero does not directly collaborate with insurance providers (e.g., private insurers or Humana). However, you may qualify for a Hero dispenser through providers' remote care programs (deductables, coinsurance, copays may apply). Check your eligibility through the Hero Provider Directory. If your insurance does not cover remote care programs (RTM), you can also utilize existing discounts for out-of-pocket subscription, such as those available for AARP members, or consider prepaying for additional discount.
Medicaid
Medicaid is currently not accepted by remote care providers.