Question: denials for above K2
Rick Milen
Description
Collection
Title:
Question: denials for above K2
Creator:
Rick Milen
Date:
2/24/2009
Text:
Dear List,
We have recently been battling w/an area insurance carrier concerning payment for any component or feature of a prosthesis that is rated for above functional level K2. It absolutely does not matter what the patient's functional level is because their policy (reworked Oct. 2008) states something to the effect that the device must only ensure the most basic ADLs &/or household ambulation. Voccation does not matter. Recreation absolutely does not matter.
This company has historically covered medically justified K3 functional prosthetic devices with this same wording within their policy. No more. OK, it IS their policy and it IS a person's right to obtain other insurance to meet their prosthetic needs, but....
Has anyone ever had L5649: isch containment/narrow ML socket design
denied for advanced componentry/ not medically necessary ???!
What is this world coming to? Just venting; not whinning. We're in the appeals process.
Rick Milen, CPO, PTA
NEXSTEP, Inc.
Prosthetic Specialists
West Lawn, PA
We have recently been battling w/an area insurance carrier concerning payment for any component or feature of a prosthesis that is rated for above functional level K2. It absolutely does not matter what the patient's functional level is because their policy (reworked Oct. 2008) states something to the effect that the device must only ensure the most basic ADLs &/or household ambulation. Voccation does not matter. Recreation absolutely does not matter.
This company has historically covered medically justified K3 functional prosthetic devices with this same wording within their policy. No more. OK, it IS their policy and it IS a person's right to obtain other insurance to meet their prosthetic needs, but....
Has anyone ever had L5649: isch containment/narrow ML socket design
denied for advanced componentry/ not medically necessary ???!
What is this world coming to? Just venting; not whinning. We're in the appeals process.
Rick Milen, CPO, PTA
NEXSTEP, Inc.
Prosthetic Specialists
West Lawn, PA
Citation
Rick Milen, “Question: denials for above K2,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 22, 2024, https://library.drfop.org/items/show/230078.
