CONCLUSION TO: [OANDP-L] FYI NY State Insurance - United Healthcare discussion
Marty Mandelbaum
Description
Collection
Title:
CONCLUSION TO: [OANDP-L] FYI NY State Insurance - United Healthcare discussion
Creator:
Marty Mandelbaum
Date:
7/1/2013
Text:
> Hi, Thanks to all of you that participate on this list serve and thanks
to Paul P. for starting it.
>
> After numerous phone calls quoting the letter from UH to the patient with
denial where it says Also, your provider can reach the physician reviewer
who made this decision.... I finally got a call back from the physician, I
discussed the K levels with her, she said she was just in serviced by
someone that a K2 is a community ambulator. I explained a K2 and K3 to her
and said I could email her at least 50 references that would back me up. I
also explained to her that there was no where in the Medicare manual where
they dmote someone's K level due to diabetes and there is no reference as
to socket design and K levels for a transtibial. She was very grateful for
my educating her and wished she knew more before denying services. She also
thought it would be more beneficial to speak to a knowledgeable prosthetist
about his/her patient rather than a peer to peer with another physician Oh,
and I also taught her how to pronounce the word PROSTHESIS!! She
immediately rescended the denial and we do not have to wait for the lengthy
appeals process.
> INMHO- That is another reason for us pursuing licensure in ALL states so
that we have a more legitimate voice in the medical community, maybe we can
be on par with the licensed cosmetologists, nail specialist and massage
therapists.
> Thanks
> Marty Mandelbaum CPO
>
to Paul P. for starting it.
>
> After numerous phone calls quoting the letter from UH to the patient with
denial where it says Also, your provider can reach the physician reviewer
who made this decision.... I finally got a call back from the physician, I
discussed the K levels with her, she said she was just in serviced by
someone that a K2 is a community ambulator. I explained a K2 and K3 to her
and said I could email her at least 50 references that would back me up. I
also explained to her that there was no where in the Medicare manual where
they dmote someone's K level due to diabetes and there is no reference as
to socket design and K levels for a transtibial. She was very grateful for
my educating her and wished she knew more before denying services. She also
thought it would be more beneficial to speak to a knowledgeable prosthetist
about his/her patient rather than a peer to peer with another physician Oh,
and I also taught her how to pronounce the word PROSTHESIS!! She
immediately rescended the denial and we do not have to wait for the lengthy
appeals process.
> INMHO- That is another reason for us pursuing licensure in ALL states so
that we have a more legitimate voice in the medical community, maybe we can
be on par with the licensed cosmetologists, nail specialist and massage
therapists.
> Thanks
> Marty Mandelbaum CPO
>
Citation
Marty Mandelbaum, “CONCLUSION TO: [OANDP-L] FYI NY State Insurance - United Healthcare discussion,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 24, 2024, https://library.drfop.org/items/show/235344.
