Insurance issue: Pre-authorized codes then considered incidental after prosthesis is delivered
Marty Mandelbaum
Description
Collection
Title:
Insurance issue: Pre-authorized codes then considered incidental after prosthesis is delivered
Creator:
Marty Mandelbaum
Date:
6/4/2018
Text:
Empire Blue Cross Blue shield pre-authorized the following L7400 and L7403
and then denies payment saying these codes are always considered incidental
codes. I realize that insurance companies always say authorization is not a
guarantee of payment, but that should relate to the policyholder loosing
coverage or other reason not for the insurance company to get out of paying
for something they did indeed authorize.
These codes are add-ons for socket laminations that are allowed under our
current L-code billing system.
Has anyone else had a similar incident and how did you resolve this?
Thanks
Marty Mandelbaum CPO
and then denies payment saying these codes are always considered incidental
codes. I realize that insurance companies always say authorization is not a
guarantee of payment, but that should relate to the policyholder loosing
coverage or other reason not for the insurance company to get out of paying
for something they did indeed authorize.
These codes are add-ons for socket laminations that are allowed under our
current L-code billing system.
Has anyone else had a similar incident and how did you resolve this?
Thanks
Marty Mandelbaum CPO
Citation
Marty Mandelbaum, “Insurance issue: Pre-authorized codes then considered incidental after prosthesis is delivered,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 6, 2024, https://library.drfop.org/items/show/208964.
