F/U on credibility attacks
Sean Cresap
Description
Collection
Title:
F/U on credibility attacks
Creator:
Sean Cresap
Date:
10/12/2013
Text:
Happy Saturday, all,
I just wanted to thank everyone who read and responded to my query regarding the occurrence of the consultant for the insurance company knocking on the door of my patient's home to confirm the need for prosthetic services.
I had an overwhelming response, and included in those emails were some very colorful and heartfelt opinions. The bottom line is that it sounds like this type of thing is becoming more common than any of us would like to think. I suspect that most of us might welcome a second set of eyes to confirm our findings, but the sneaky visit to the home of our patients by a questionably qualified person is less than desirable or ideal.
In my case, I misspoke in my first letter to you all, in that I erroneously said I had already gained approval for the new prosthesis. My OA had submitted the request, and this is what triggered the investigation. So the consultant came by the patient house, spent 10 minutes talking and looking at the old prosthesis, gave her blessing to the proposed service, and ran off. Oddly, when asked for detailed credentials, she said she forgot her cards at home... Hmmm. No badge, no card.
Anyway, I obviously have some research to do on my end, but I just wanted to bring some closure to this for any interested parties.
Have a great weekend...
Sean D Cresap, CPO
----------------------------------
My original email, for those who missed it...
Colleagues,
I recently evaluated a patient who needed a new socket for her transtibial prosthesis due to weight gain of twenty pounds, cracked socket, etc. We had to get authorization from her insurance, Washington state Molina, to provide the service. Once we obtained approval we began the fitting process.
I just received a call from the patient, and apparently she is going to have a home visit from a dme provider who is contracted as a consultant with Molina to determine if she really needs a new socket .
I am not worried about what this person will find, but I am worried about the offensive nature of this concept, as it is yet another undermining of the experience and integrity of our field.
Does anyone know of this happening elsewhere? I had just not ever seen or heard of this before. Doesn't it seem more cost effective to call and request notes or pictures?
Anyway, thanks for reading my little rant. I hope you all have peace this weekend!
Sean D. Cresap, CPO
Wenatchee, WA
I just wanted to thank everyone who read and responded to my query regarding the occurrence of the consultant for the insurance company knocking on the door of my patient's home to confirm the need for prosthetic services.
I had an overwhelming response, and included in those emails were some very colorful and heartfelt opinions. The bottom line is that it sounds like this type of thing is becoming more common than any of us would like to think. I suspect that most of us might welcome a second set of eyes to confirm our findings, but the sneaky visit to the home of our patients by a questionably qualified person is less than desirable or ideal.
In my case, I misspoke in my first letter to you all, in that I erroneously said I had already gained approval for the new prosthesis. My OA had submitted the request, and this is what triggered the investigation. So the consultant came by the patient house, spent 10 minutes talking and looking at the old prosthesis, gave her blessing to the proposed service, and ran off. Oddly, when asked for detailed credentials, she said she forgot her cards at home... Hmmm. No badge, no card.
Anyway, I obviously have some research to do on my end, but I just wanted to bring some closure to this for any interested parties.
Have a great weekend...
Sean D Cresap, CPO
----------------------------------
My original email, for those who missed it...
Colleagues,
I recently evaluated a patient who needed a new socket for her transtibial prosthesis due to weight gain of twenty pounds, cracked socket, etc. We had to get authorization from her insurance, Washington state Molina, to provide the service. Once we obtained approval we began the fitting process.
I just received a call from the patient, and apparently she is going to have a home visit from a dme provider who is contracted as a consultant with Molina to determine if she really needs a new socket .
I am not worried about what this person will find, but I am worried about the offensive nature of this concept, as it is yet another undermining of the experience and integrity of our field.
Does anyone know of this happening elsewhere? I had just not ever seen or heard of this before. Doesn't it seem more cost effective to call and request notes or pictures?
Anyway, thanks for reading my little rant. I hope you all have peace this weekend!
Sean D. Cresap, CPO
Wenatchee, WA
Citation
Sean Cresap, “F/U on credibility attacks,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 27, 2024, https://library.drfop.org/items/show/235669.
