Justifying costs, cont.
John T. Brinkmann, CPO, FAAOP
Description
Collection
Title:
Justifying costs, cont.
Creator:
John T. Brinkmann, CPO, FAAOP
Date:
1/17/2003
Text:
Dear List Members: I just submitted the compilation of responses to my
original question about justifying costs to an insurance company that is
denying coverage for a legitimate L-Code.
Prior to asking the original question I had already provided the insurer
with a detailed explanation of the new L5301 code and locking mechanism
code, and showed price comparisons with L5300, etc. That is when I got
the second denial. I have a follow up question: If I chose to refuse to
give them detailed information, and simply restate my previous letter
(legitimate code, U&C price, etc.)and they deny the claim again, what
are the legal/ethical ramifications of billing the patient for the
unpaid amount? Should I mention that option in my next letter to the
insurer? Should I involve the patient in this process by indicating
their refusal to pay a legitimate code, and the possibility that he will
have to pay?
John Brinkmann, CPO
original question about justifying costs to an insurance company that is
denying coverage for a legitimate L-Code.
Prior to asking the original question I had already provided the insurer
with a detailed explanation of the new L5301 code and locking mechanism
code, and showed price comparisons with L5300, etc. That is when I got
the second denial. I have a follow up question: If I chose to refuse to
give them detailed information, and simply restate my previous letter
(legitimate code, U&C price, etc.)and they deny the claim again, what
are the legal/ethical ramifications of billing the patient for the
unpaid amount? Should I mention that option in my next letter to the
insurer? Should I involve the patient in this process by indicating
their refusal to pay a legitimate code, and the possibility that he will
have to pay?
John Brinkmann, CPO
Citation
John T. Brinkmann, CPO, FAAOP, “Justifying costs, cont.,” Digital Resource Foundation for Orthotics and Prosthetics, accessed December 27, 2024, https://library.drfop.org/items/show/220388.
