insurance billers-appeal suggestions
Jessica Longoria
Description
Collection
Title:
insurance billers-appeal suggestions
Creator:
Jessica Longoria
Date:
9/5/2014
Text:
Does anyone have tips/suggestions on fighting an insurance claim denial for
not a covered service when authorization was provided?
Amerigroup Medicaid reviewed our medical documentation and provided us with
an authorization for the prosthesis. The claim is denied because it is
not a covered benefit. I understand authorization is NOT a gurantee of
payment. But, do you have ANY suggestions/ideas on how I should fight the
claim?
I also understand Medicaid (at least in Texas) does NOT cover prosthetics
for patients over 21 years of age. However, this particular patient was
enrolled (for many years) in a special Medicaid program which does allow
for coverage for prosthetics for those of 21 years of age. They have paid
for all of his prosthetic services in the past since he was enrolled with
this special program. It appears Amerigroup Medicaid dropped him from this
special program prior to delivery and we were unaware. He is still
enrolled with Amerigroup.
Thank you for any help you offer.
Jessica Longoria, CP, CMF
*Jessica Falknor Longoria*
*Centers for Mobility/A Touch of Pink*
*7777 Southwest Freeway 107*
*Houston, TX 77074*
*713-773-0969*
*www.CentersForMobility.com < <URL Redacted>>*
not a covered service when authorization was provided?
Amerigroup Medicaid reviewed our medical documentation and provided us with
an authorization for the prosthesis. The claim is denied because it is
not a covered benefit. I understand authorization is NOT a gurantee of
payment. But, do you have ANY suggestions/ideas on how I should fight the
claim?
I also understand Medicaid (at least in Texas) does NOT cover prosthetics
for patients over 21 years of age. However, this particular patient was
enrolled (for many years) in a special Medicaid program which does allow
for coverage for prosthetics for those of 21 years of age. They have paid
for all of his prosthetic services in the past since he was enrolled with
this special program. It appears Amerigroup Medicaid dropped him from this
special program prior to delivery and we were unaware. He is still
enrolled with Amerigroup.
Thank you for any help you offer.
Jessica Longoria, CP, CMF
*Jessica Falknor Longoria*
*Centers for Mobility/A Touch of Pink*
*7777 Southwest Freeway 107*
*Houston, TX 77074*
*713-773-0969*
*www.CentersForMobility.com < <URL Redacted>>*
Citation
Jessica Longoria, “insurance billers-appeal suggestions,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 2, 2024, https://library.drfop.org/items/show/236745.
