UNITED HEALTHCARE DENYING ALL ABOVE K2
Mike Rieth, LPO
Description
Collection
Title:
UNITED HEALTHCARE DENYING ALL ABOVE K2
Creator:
Mike Rieth, LPO
Date:
10/18/2013
Text:
Hello Alllllllllll...
Here I go again! United just denied a bilateral K3 BKA. They will not authorize an L5979 for the patient, therefore request denied!
I'm livid! This brings now a total of 5 patients they have denied. I've check around and they only way I can bring attention to what they are doing as a provider, I will have to file fraud charges against them.
I'm am going to tell the patients to call Medicare and let Medicare know what they are doing. It's probably a matter of time, they will be cancelling our contract. If this happens, I'm going straight to the News, the OIG, AHCA, The American Medical Association, The CMS folks and I will start a blog and UTube account. It's just out of hand. I spoke to a Dr. Robert Shaw out of Tampa this week, a Medical Director and I asked him if it was his experience to downgrade patients even with a specific written order from the Physician that ordered the K3 products for the patient. He say's, your not a CPO, I said, it's pretty clear what your doing and I asked him what LCD's he was referring to while making his decisions, he says L11464...I stated that's not the one we use..and he very sternly say's..'THEY ARE ALLLLL THE SAME This conversations is OVER he says..denies the auth request.
Everything he came at me with, I had a rebuttle, he got flustered, I could tell. Sooooooo...Mke says..tell him we will down grade our patient to a K2, but we want it on record that it is at his request and that United is going against written doctor's orders and the recommendations of the CPO. Left that on his voice mail....then the next am, we get a message on my v.m. saying that...and I saved it...lol..and Dr. Shaw says...I didn't telllllll you what to put on the patient. Yikes! So let me get this straight...you deny our request for auth using a L5979..tell us we should be using a L5972 or L5978...and then tell me the next day you didn't sayyyyyyyy this...he's trying to get himself off the hook I can tell...Unbelievable what is happening with United.
My suggestions is..and I don't really know if this is gooing to work or not....get an independant review of the patients needs. Document the heck out of what this patient does on a daily basis. Like,, swimming, boating, tennis, dancing, excercising, going to the gym, sailing,
running...etc...it has to be well documented...we'll see what happen's next week..
Have a good weekend all!
Nancy
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Here I go again! United just denied a bilateral K3 BKA. They will not authorize an L5979 for the patient, therefore request denied!
I'm livid! This brings now a total of 5 patients they have denied. I've check around and they only way I can bring attention to what they are doing as a provider, I will have to file fraud charges against them.
I'm am going to tell the patients to call Medicare and let Medicare know what they are doing. It's probably a matter of time, they will be cancelling our contract. If this happens, I'm going straight to the News, the OIG, AHCA, The American Medical Association, The CMS folks and I will start a blog and UTube account. It's just out of hand. I spoke to a Dr. Robert Shaw out of Tampa this week, a Medical Director and I asked him if it was his experience to downgrade patients even with a specific written order from the Physician that ordered the K3 products for the patient. He say's, your not a CPO, I said, it's pretty clear what your doing and I asked him what LCD's he was referring to while making his decisions, he says L11464...I stated that's not the one we use..and he very sternly say's..'THEY ARE ALLLLL THE SAME This conversations is OVER he says..denies the auth request.
Everything he came at me with, I had a rebuttle, he got flustered, I could tell. Sooooooo...Mke says..tell him we will down grade our patient to a K2, but we want it on record that it is at his request and that United is going against written doctor's orders and the recommendations of the CPO. Left that on his voice mail....then the next am, we get a message on my v.m. saying that...and I saved it...lol..and Dr. Shaw says...I didn't telllllll you what to put on the patient. Yikes! So let me get this straight...you deny our request for auth using a L5979..tell us we should be using a L5972 or L5978...and then tell me the next day you didn't sayyyyyyyy this...he's trying to get himself off the hook I can tell...Unbelievable what is happening with United.
My suggestions is..and I don't really know if this is gooing to work or not....get an independant review of the patients needs. Document the heck out of what this patient does on a daily basis. Like,, swimming, boating, tennis, dancing, excercising, going to the gym, sailing,
running...etc...it has to be well documented...we'll see what happen's next week..
Have a good weekend all!
Nancy
********************
To unsubscribe, send a message to: <Email Address Redacted> with
the words UNSUB OANDP-L in the body of the
message.
If you have a problem unsubscribing,or have other
questions, send e-mail to the moderator
Paul E. Prusakowski,CPO at <Email Address Redacted>
OANDP-L is a forum for the discussion of topics
related to Orthotics and Prosthetics.
Public commercial postings are forbidden. Responses to inquiries
should not be sent to the entire oandp-l list. Professional credentials
or affiliations should be used in all communications.
Citation
Mike Rieth, LPO, “UNITED HEALTHCARE DENYING ALL ABOVE K2,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 1, 2024, https://library.drfop.org/items/show/235739.
