AADL – Vendor information

AADL vendor application

• AADL Vendor Application
• Send the complete application to AADL

Change of vendor

Clients may change vendors at any time, for any reason. Alberta Blue Cross will keep a record of a client’s vendor through claims made.

Medical and surgical

Pricing for medical and 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 AADL generic description for that particular product.

Client products at or below the benchmark price

All AADL vendors must offer a minimum of one product to clients at or below the benchmark price, sale price or shelf price, whichever one is lower.

Follow manufacturers' expiry dates for medical/surgical products

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 For example, if a vendor provides a client with outdated flanges for their stoma and an adverse reaction occurs, the vendor could be held liable.

No automatic deliveries to the client

A client or legal guardian needs to call the vendor every two months at minimum to order more supplies.

Quantities

2-month AADL medical and surgical supply

AADL’s benefit year starts July 1; if a client receives a two-month supply for July and August on July 1, they are eligible to receive their next two-month supply no earlier than September.

AADL’s maximum quantities are based on best practice and research. These quantities are reviewed every two years. If the client requests more supplies, they need to have a reassessment done by a health-care professional.

The health-care professional may suggest trying an alternate product or, if applicable, review client technique when using the product. When a client experiences a change in their condition, they may eligible for an increase in quantities of supplies funded for a short term via the quantity and frequency review (QFR) process.

If the client declines a reassessment or does not wish to follow their authorizer’s clinical directions, they are entirely financially responsible for any quantities above the authorized two-month amount (medical/surgical only).

Additional supplies for clients leaving the country

If a client is leaving the country and would like additional medical or surgical supplies, they must complete the  AADL Request for Advanced Quantities of Medical Surgical Supplies.

The form must be received by AADL at least one month before their departure date. This allows for processing and to ensure that the vendor can provide adequate supplies for the client’s trip.

If approved, Alberta Blue Cross will contact the client’s preferred store and grant permission to provide the client with a greater than two-month supply.

Diabetes management

Clients cannot be authorized for syringes for diabetes management. Direct clients to their private insurer.

Compression stockings

Funding for compression garments

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 and CEAP classification 4 or 5 (with hemosiderin staining) or chronic lymphedema.

Provide compression garments to clients

AADL recommends vendors provide clients with one pair of compression garments initially rather than a client’s maximum quantity 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 three garments are provided at once, the client will be responsible for the cost of purchasing any additional garments that may be required if the originally authorized compression garment does not meet the client’s clinical needs.

Requests for all 3 compression garments at once

For clients who want all 3 compression garments at once, AADL recommends vendors have the client sign a document acknowledging that the vendor recommended the client should take one pair initially.

This protects the vendor if, for example, the client comes back and states the compression garments are the wrong length or wrong pressure. The signed document will act as proof that the  client understood the recommendation to only take one pair, and the client must pay for any new pairs.

Trying on compression stockings

A client might refuse to try to don and doff their compression stockings independently during the fitting. AADL recommend that the refusal is documented in some form along with the client’s signature.

Refusing to be re-measured

A returning client might refuse to be re-measured. Document this and have the client sign it stating that they declined re-measuring. This will protect the vendor if any concerns or problems arise.

Client product type upgrades

Clients requesting to upgrade to a garment that they are not eligible for are responsible to pay any associated upgrade costs. This upgrade may pertain to an item that cost above benchmark or may refer to a client who wants pantyhose when authorized for a below knee stocking, etc. The vendor submits a claim using the compression garment code that the client is authorized for, and the client is responsible for any cost sharing and additional charges, such as the upgrade cost to pantyhose. AADL recommends documenting the client agreed to pay the upgrade costs. In the event of a disagreement, AADL will side with the client in the absence of document evidence of their agreement.

Breast prosthesis

Eligibility for breast prosthesis clients

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

Refusing to go through AADL for funding

Vendors should explain to clients that AADL will not reimburse them for breast prosthesis. This means that if their insurance carrier denies their claim, the client will be fully responsible for the cost of the breast prosthesis.

Swimmer prostheses and mastectomy bras

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

Incontinence supplies

Pull-up style of diaper under the AADL diaper code

Vendors may provide clients with a pull-up style of diaper, provided it meets AADL’s absorbency standards.

Children's swimmer diapers not covered by AADL

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

Children's wet-feel diapers not covered by AADL

AADL does not provide funding for toilet training-related products for children. 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.

Diaper supply

As per a vendor’s contractual obligation with AADL, vendors cannot provide products into future months, nor can vendors submit a claim for future products. Vendors are only permitted to supply a client with their two-month maximum authorized amount for the current two month period.

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

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

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

Dispense only one type of diaper

Vendors may only dispense only one type of diaper as per the AADL category number listed on the client’s form.

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

Vendors are only permitted to provide products that meet AADL’s generic description and absorbency standards. Get the list of incontinence supplies approved by AADL.

Authorization expiration

Product(s) authorizations that have expired or near expiration

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

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 should contact their old authorizer or call Health Link at 811 to find an authorizer in their area.

Hearing aid

Eligibility of seniors for hearing aid funding through AADL

A senior is eligible for hearing aid funding through AADL at the beginning of the next month after turning 65. Proof of age is required to register/verify senior status. The client can complete either the Proof of Age Declaration for Alberta Health Care Insurance Plan or the Alberta Seniors Benefit Financial Assistance Application.

AISH clients are cost-share exempt

All AISH and Income Support clients should be cost-share exempt. However, if they have not received benefits through AADL before, they will appear as cost-share on the Alberta Blue Cross online health portal.

Mobility and large equipment

Option on manufacturer’s spec sheets

You can include options on the manufacturer's specification sheet for the wheelchair. However, they may not be funded by AADL. If the client agrees to pay for the option, AADL may include it on the order.

Visit the manufacturer website for more information on wheelchair parts and specifications.

Contact

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