Re: FW: Again with One Limb Per Lifetime in NY

Re: FW: Again with One Limb Per Lifetime in NY

Stephen Rinko

12/17/2015

Dear Colleagues,

I would like to know if anyone has fitted bilateral BK prostheses to a Medicare patient that has a motorized wheelchair that was paid for by Medicare? Will Medicare pay for the prostheses?

I would appreciate your responses.

Merry Christmas and a Happy New Year !!

Stephen Rinko, CPO#627

-----Original Message-----
From: Orthotics and Prosthetics List [mailto:<Email Address Redacted>] On Behalf Of Herb Shalant
Sent: Tuesday, December 15, 2015 5:58 PM
To: <Email Address Redacted>
Subject: [OANDP-L] FW: Again with One Limb Per Lifetime in NY

 

Colleagues,

 

Again with the Affordable Care Act limitation in NY and Blue Cross!!!

 

I thought we won this battle.

 

But today I am being told after multiple re-examinations of a claim to Blue Cross that because they paid partially for stump socks for a below-knee amputee, and they consider that payment as part of their prosthetic benefit, she has maxed out her lifetime prosthetic coverage under the One Limb per Lifetime limitation.

 

In other words, because she received socks she can't get a prosthesis ever under their plan!!!

 

AM I ALONE???

 

Is any other facility having similar denials?

 

I'd like to present this to our State and Congressional representatives, but this will only be anecdotal if I can't get your help to show this as a systemic problem.

 

Please share this with your billing personnel and let me know if I am not alone.

 

Together we can make a difference.

 

Herb Shalant, C.P.O.

White Plains, NY

 

 

 

 



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