Who bills, who services the patient, and what Synapse Health does with the order in the situations that come up most often.
Synapse Health is the supplier of record for the patients it manages, so the answer to “who bills for this?” depends on the patient’s plan and on what is on the order. This article covers the two situations that generate the most questions: a patient whose coverage changes, and an order that contains a non-covered item.
For how payment reaches you once an order is complete, see How to get paid.
When a patient’s insurance or plan changes
These three scenarios cover an existing Synapse Health patient whose coverage or ordering situation changes.
| Billing scenario | What happens |
|---|---|
| Existing Synapse Health patient switches to a fee-for-service (FFS) UnitedHealthcare plan | Synapse Health continues as the DME provider of record and bills the FFS plan. The subcontracted DME provider continues to service the rental and any resupply related to that rental, under Synapse Health. A new order for something unrelated to that rental — a wheelchair, for example — falls outside it, and the DME provider can fulfill and bill that order directly. |
| Patient mid-rental with a non-UnitedHealthcare payor converts to a capitated UnitedHealthcare plan | Synapse Health resumes the patient at their most current rental month, regardless of prior payor (Aetna, BCBS, etc.). The patient isn’t billed twice for the same rental month, and you’re paid for every month you service. |
| Existing Synapse Health patient becomes new to Medicare, or moves to a non-contracted payor | The patient transitions back to their previous DME provider. Synapse Health initiates the transition and coordinates it with the DME provider — do not start this on your own. |
| Patient mid-rental on a capitated plan when their DME provider leaves the Synapse Health network | Synapse Health restarts the rental with a new in-network provider. The incoming provider is paid from the first rental month rather than picking up a partial rental. Synapse Health coordinates the transition — do not start this on your own. |
| Existing Synapse Health patient enters a skilled nursing facility (SNF) or hospice care mid-rental | Billing pauses and resumes when and if the patient returns to equipment. |
When an order includes a non-covered item
Two things decide the outcome: whether the order carries a covered item at all, and whether the non-covered item is clinically required or a patient-preference upgrade.
| Order scenario | What happens |
|---|---|
| The order contains a single item that falls outside the patient’s or payer’s benefit scope | Synapse Health cancels the order. The supplier handles it directly with the patient. |
| The order contains a covered item and an excluded item | Synapse Health accepts and processes the order and pays the subcontractor for both the covered and the excluded items. |
| The patient wants an upgrade to premium equipment that insurance does not cover | Synapse Health supplies items that are both Medicare-covered and within Synapse Health’s scope for that plan. Some Medicare benefits — orthotics and prosthetics, complex rehabilitation, parenteral nutrition, vision and hearing, and others — sit outside that scope, so Medicare coverage alone does not mean Synapse Health will process the order. If the patient opts for an upgrade or cross-sell item that is not covered, they pay out of pocket and cannot apply their DME benefit. The request is referred to the subcontractor through Fulfill as a fully patient-pay referral order.
This is a referral order, not a subcontract order. The no-patient-billing and no-point-of-sale-collection rules apply to orders you fulfill under Synapse Health. On a referral order you are the provider of record and bill the patient directly under your own standard process. Synapse Health does not pay you for it. |
If your situation is not listed here
Contact DME provider support before you submit or reject the order. Guessing on a scenario that is not covered above is the most common cause of a rejected claim.
DME provider support
Email dmeprovidersupport@synapsehealth.com
Phone 1.888.33.MYDME (1.888.336.9363)
Related
- Timely filing and payment reconciliation deadlines — the 60-day filing rule and the 30-day payment dispute window
- How to get paid — completing orders, monthly statements, reporting discrepancies
- Network policy updates effective June 1, 2026 — FAQs
- Search in-scope UnitedHealthcare plans