Do YOU demand pre authorizaion?

Do YOU demand pre authorizaion?

Randall McFarland, CPO

Hi List members-
   I recently posted a message expressing concern about the practice of some
insurance companies in which they refuse to confirm coverage until AFTER we
submit an invoice.
Randy McFarland, CPO

Here are MORE RESPONSES


You must remember that commercial insurance companies are corporate entities
just as most P & O facilities are corporate entities. The major difference
is that their company is much larger. Our policy has always been to bill for
services at the onset of treatment. This generally means making a mold or
taking measurements, submitting an invoice for services, and informing the
patient that we must wait to continue services until we see what the
insurance will pay. Most patients appreciate that we are concerned with
reducing, or at least informing them of their risk. Some insurance companies
try to pull rank by saying that their policy is not to pay until completion
of services. This is their policy and not ours. We stick to our guns and
tell them we are unwilling to continue under those circumstances. Once we
have the patient on our side, and we do spend considerable effort doing this,
we very seldom are unsuccessful. It is a shame that the health care climate
has become the way it has, however we have been pushed into a corner and must
stand our ground against the bullies. You are correct in saying none of
this applies to Medicare or other government contracts. Those are completely
different animals.
Jim Price, MEd, CPO
Regions B and C

Billing and reimbursement has been the hottest issue on the O & P
grapevine. I would caution practices who submit a Proposed Care Plan to an
insurer in that if you receive payment inadvertently from this submit you
could be subject to possible fraudulent billing practices,particularily if
the insurer has a Medicare product in their line. As you know, regulations
that pertain to other healthcare specialties do not necessarily apply to O&
P. I would suggest if you do intend to use the Proposed Care Plan that you
add that provision to your contract with the insurer.

Just want to relate a different angle to the discussion. Several years ago I
had a client/patient that was ordered and provided a B/E myoelectric
prosthesis. After 2 weeks she returned the prosthesis and said she wanted
all monies refunded because she decided she did not want to go through
therapy and the inconvenience. But to the point I wish to bring out. After
consulting legal counsel it was pointed out that under State Law (at least
in our state) anything that is considered custom must be paid for by the
customer regardless of whether they take delivery, unless they cancel the
order in writing within 3 days of the order, they are held fully
responsible. This was said to include prosthetics as well as any product,
autos, boats, home improvements, anything custom). I would suggest everyone
check with state regulations in their area. There is one critical
requirement and that is that you must disclose and explain your cancellation
policy with the customer and have them sign an acknowledgment. Just something
to think about.