UNITED HEALTHCARE
Mike Rieth, LPO
Description
Collection
Title:
UNITED HEALTHCARE
Creator:
Mike Rieth, LPO
Date:
10/3/2013
Text:
Hello Friends.....are you ready for this? I, hope your sitting down?
United Healthcare is now denying alllllllllllllllll our K3 or above requests for authorizations,
for new prosthetics .If you are contracted with them, it does not matter. And, even if the
codes are on the fee schedule, they will deny the request for authorization anyway.
They are denying L5979, L5978, L5976, all feet that are over $500. If you want authorization
to provide the above particular feet, you will have to appeal, or have a peer to peer interview with the
Medical Director, and this means the ordering physician will have to be involved in this peer to peer,
even thoooooo we all know that doctor's don't have the slighted clue on which feet to put on a
prosthesis whether it be a K0 to K4..they barely know what functional level is, let alone which
foot is proper, without us schooling them. Also..if you go the appeals route, they are wanting
to know what the measurements of the stump are. What it was and what it is now.
Also, are you still with me? If you go the appeals route, they want to know what the patient
does all day and how he/she gets around the house on a daily basis, thus, they want a home
assesment filled out. Now, we are wondering, whooooooooooo does this? No clue...(yet)
we haven't exactly appealed anything yet.
This came across my desk this morning and I'm about over all of this run around and I am thinking
of a way to get this out to the public and the powers that be, to stop all this craziness. At least it's
making me that.
Now here's the kicker,..The above patient, I'm speaking about, is walking around on a 10 year old
exoskeletal leg with a Seattle foot that is crumbling and the forefoot is held on with duct tape. I, even
sent them pictures of this archaic leg. And,guess what? They told our patient that the appeal will
take 30 days and to be careful walking around!
True story folk's! God help us all!
Nancy M
Director of Reimbursement
.
United Healthcare is now denying alllllllllllllllll our K3 or above requests for authorizations,
for new prosthetics .If you are contracted with them, it does not matter. And, even if the
codes are on the fee schedule, they will deny the request for authorization anyway.
They are denying L5979, L5978, L5976, all feet that are over $500. If you want authorization
to provide the above particular feet, you will have to appeal, or have a peer to peer interview with the
Medical Director, and this means the ordering physician will have to be involved in this peer to peer,
even thoooooo we all know that doctor's don't have the slighted clue on which feet to put on a
prosthesis whether it be a K0 to K4..they barely know what functional level is, let alone which
foot is proper, without us schooling them. Also..if you go the appeals route, they are wanting
to know what the measurements of the stump are. What it was and what it is now.
Also, are you still with me? If you go the appeals route, they want to know what the patient
does all day and how he/she gets around the house on a daily basis, thus, they want a home
assesment filled out. Now, we are wondering, whooooooooooo does this? No clue...(yet)
we haven't exactly appealed anything yet.
This came across my desk this morning and I'm about over all of this run around and I am thinking
of a way to get this out to the public and the powers that be, to stop all this craziness. At least it's
making me that.
Now here's the kicker,..The above patient, I'm speaking about, is walking around on a 10 year old
exoskeletal leg with a Seattle foot that is crumbling and the forefoot is held on with duct tape. I, even
sent them pictures of this archaic leg. And,guess what? They told our patient that the appeal will
take 30 days and to be careful walking around!
True story folk's! God help us all!
Nancy M
Director of Reimbursement
.
Citation
Mike Rieth, LPO, “UNITED HEALTHCARE,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 2, 2024, https://library.drfop.org/items/show/235731.
