Medical / surgical information for AADL vendors

1. Pricing for the medical/surgical products

The pricing for medical surgical benefits is based on the benchmarking principle. Each price is based on a specific manufacturer product‘s retail price for the smallest quantity that the vendor has to buy. Each vendor signs their agreement which states that they will provide clients with choice of product at shelf price, sale price, or benchmark price whichever one is lower. This gives the client choice of product and the vendor choice of different brands provided that they meet Alberta Aids to Daily Living's (AADL) generic description for that particular product.

2. Client products at or below the benchmark price

As an AADL vendor you must offer clients products at or below benchmark price, sale price or shelf price whichever one is lower.

3. Follow manufacturers' expiry dates for medical/surgical products

Expiry dates are on items for the supplier and consumer’s safety. For example, if you provide the client with outdated flanges for their stoma and an adverse reaction occurs, as the supplier, you could be held liable.

4. No automatic deliveries to the client

A client or legal guardian needs to call the vendor every 2 months if they require more supplies.

Quantities

5. Only a 2-month AADL medical/surgical supply

AADL’s benefit year starts July 1, if the client gets their 2-month supply on July 1 for July and August and they come back the beginning of August wanting their 2-month supply for September/October, it cannot be supplied until September.
AADL’s maximum quantities are based on best practice and research. These quantities are reviewed on an annual basis. If the client requests more supplies, they need to have a reassessment done by a healthcare professional.

The healthcare professional may suggest trying an alternate product or if applicable, review client technique when using the product. Once the client has been reassessed and all other strategies have been reviewed, the Quantity and Frequency Review (QFR) process can be used provided the authorizer clinically supports the client’s request. If the client declines a reassessment or does not wish to follow their authorizer’s clinical directions, they are 100% financially responsible for any quantities above the authorized two-month amount (medical/surgical only).

6. Requesting additional supplies for clients leaving the country

  1. Provide a copy of the AADL Request for Advanced Quantities of Medical Surgical Supplies PDF icon or direct the client to download the form from the AADL website.
  2. The client mails the form to AADL. The form must be mailed to AADL at least one month prior to their departure date to allow for processing and to ensure that the vendor can provide adequate supplies for the client’s trip.
  3. If approval is obtained, AADL will contact your store and grant permission to provide the client with a greater than two-month supply.

7. Clients cannot be authorized for syringes for diabetic management

Please direct your clients to the Alberta Health diabetic supplies information page or their private insurer.

Compression stockings

8. Clients no longer eligible to receive funding for compression stockings

The AADL program provides funding for support stockings for specific medical conditions based on a medical assessment of need. To be eligible for coverage of compression garments through AADL, a client must have signs and symptoms of Chronic Venous Insufficiency CEAP 4 or 5 (with hemosiderin staining) or Chronic Lymphedema.

9. Providing compression garments to clients

AADL has observed that vendors are providing initial clients with all 3 pairs of compression at once. It is strongly advised that clients ONLY receive one pair initially to determine: compliance, adequacy of compression (especially important when a lower leg ulcer has just closed), and the length of garment meets the client’s needs.

If all 3 pairs are provided at once, the client will be responsible for the cost of any stockings that may be required if the original compression authorized does not meet the client’s clinical needs.

10. Clients who want all three compression garments at once

It is recommended that you have the client sign the AADL’s fitter’s form acknowledging that you recommended that they should take one pair initially. This protects you if, for example, the client comes back and states they are the wrong length or wrong pressure. You have proof that it was recommended that the client only takes one pair, and the client must pay for any new pairs.

11. Client who refuse to try to don and doff their compression stockings independently during the fitting

Again, it is recommended that you document this on the AADL’s fitter’s form and you have the client sign it.

12. Returning clients who refuse to be re-measured

Document this on the AADL’s fitter’s form and have the client sign it stating that they declined re-measuring. This will protect you if any concerns or problems arise.

13. Clients wanting pantyhose but only authorized for below-the-knee compression stockings

The client can pay the additional charges for the pantyhose length. You would bill AADL the compression code that the client is authorized for and then the client would be responsible for any cost sharing and the additional charges, such as the up-grade cost to pantyhose. It is also recommended that this is documented on the fitter’s form.

Breast Prosthesis

14. Eligibility for breast prosthesis clients

As per the AADL Regulation PDF icon, clients must access all other resources including private insurance. If the client does not have private insurance or any other source of funding, they may be eligible for AADL benefits.

15. Refusing to go through AADL for funding

You should explain that AADL will not reimburse. This means that if their insurance carrier denies their claim, the client will be 100% responsible for the cost of the breast prosthesis.

16. Swimmer prostheses/mastectomy bras not covered

AADL does not cover swimmer prostheses/mastectomy bras. The client may want to check with their private insurer for coverage for these items.

Incontinence supplies

17. Pull-up style of diaper under the AADL diaper code

You can provide a client with a pull-up style of diaper, provided it meets AADL’s absorbency standards.

18. Children's swimmer diapers not covered by AADL

AADL does not provide benefits for convenience and/or lifestyle.

19. Children's "wet feel" diapers not covered by AADL

AADL does not assist products when a child is  toilet training. AADL’s program is for clients with daily (24 hour) moderate to severe urinary and/or bowel incontinence who, are not expected to gain continence.

20. Diaper supply

As per your contractual obligation with AADL, you cannot provide products into future months nor can you bill AADL. Vendors are only permitted to supply a client with their 2-month maximum authorized amount for the current two month period.

If a client is insistent on obtaining more than two month’s supply, advise the client of the following:

  • The client can purchase the extra supplies on their own for that 2-month period (they will not be reimbursed by AADL).
  • The client can contact their AADL authorizer for a reassessment.

Note: An assessor will determine if there is a clinical need for an increase in the product or if a change of product in needed.

21. Dispense only one type of diaper

You are only permitted to dispense only one type of diaper as per the AADL category number listed on the clients form.

22. Clients authorized for M200 and M243 but only wants M243

M243 is a booster line, designed to be worn inside a full brief, diaper or M240 for extra absorbency. If your client is only using the M243, please alert the client's authorizer and AADL's program manager immediately. Your client will need to be reassessed.

23. No substitution of incontinence products under the client's authorization code

You are only permitted to provide products that meet AADL’s generic description and absorbency standards.

Change of vendor

24. Client process to change vendor

The client should complete and submit the change of vendor form PDF icon .

Vendor changes are not accepted over the phone. The client may also go to the old vendor or their new vendor to complete the change form. The completed change form must be sent by mail to the AADL program.

Note: A client will be required to obtain these supplies from their old vendor until the next change occurs. Vendor changes for incontinence supplies occurs January 1, March 1, May 1, July 1, September 1, and November 1.

Authorization expiration

25. Product(s) authorizations that have expired or near expiration

The client will require a reassessment. Advise them to contact their old authorizer or call the Health Link at 811 to find an authorizer in their area.

26. No product until clients are reassessed

The client will be responsible for any costs if they let their authorization expire. In circumstances where there is a wait list for an assessment/authorization, the client may contact the AADL program and discuss an extension of their current authorization.