Fwd: Insurance issues NY
Marty Mandelbaum
Description
Collection
Title:
Fwd: Insurance issues NY
Creator:
Marty Mandelbaum
Date:
8/3/2018
Text:
It seems that most of you that have responded are all in the same boat.
What other industry is there where there is no pre commitment as to what is
being provided and what is expected payment for these particular services.
We should all be ashamed of ourselves for letting this happen.
IF EVERYONE were to refuse providing services without a written statement
saying what is and what is not covered as well as the amounts agreed to, we
would not be in this situation.
AND get rid of the b*sht statement that authorization is not a guarantee of
payment!
That's like having an addition built on your house and telling the
contractor, I am not guaranteeing payment even though we have an agreement!
Many blame our trade organization but yet we still provide the service
hoping to come out ahead. Very sad situation!
*Original message is pasted below.*
Does anyone have problems with:
-insurance companies saying no auth is required and then decide not to pay
for some of the line items?
-insurance companies not letting you know how or what they will cover for a
999 code and then find out it is less than your cost after the job is
delivered?
-Insurance companies deciding that acrylic or carbon reinforcement add ons
are not covered
-insurance companies deciding not to cover lion upgrades over nicads?
Also, if a patient wants a device that is more expensive than the Lcode
reimburses for and you are contracted with the insurance company, can you
have a signed waiver for the patient paying the difference over ins
reimbursement if the patient does not want the lesser cost device?
Thanks for your responses
Marty Mandelbaum CPO, FAAOP
What other industry is there where there is no pre commitment as to what is
being provided and what is expected payment for these particular services.
We should all be ashamed of ourselves for letting this happen.
IF EVERYONE were to refuse providing services without a written statement
saying what is and what is not covered as well as the amounts agreed to, we
would not be in this situation.
AND get rid of the b*sht statement that authorization is not a guarantee of
payment!
That's like having an addition built on your house and telling the
contractor, I am not guaranteeing payment even though we have an agreement!
Many blame our trade organization but yet we still provide the service
hoping to come out ahead. Very sad situation!
*Original message is pasted below.*
Does anyone have problems with:
-insurance companies saying no auth is required and then decide not to pay
for some of the line items?
-insurance companies not letting you know how or what they will cover for a
999 code and then find out it is less than your cost after the job is
delivered?
-Insurance companies deciding that acrylic or carbon reinforcement add ons
are not covered
-insurance companies deciding not to cover lion upgrades over nicads?
Also, if a patient wants a device that is more expensive than the Lcode
reimburses for and you are contracted with the insurance company, can you
have a signed waiver for the patient paying the difference over ins
reimbursement if the patient does not want the lesser cost device?
Thanks for your responses
Marty Mandelbaum CPO, FAAOP
Citation
Marty Mandelbaum, “Fwd: Insurance issues NY,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 5, 2024, https://library.drfop.org/items/show/209081.
