FW: Again with One Limb Per Lifetime in NY

FW: Again with One Limb Per Lifetime in NY

Herb Shalant

12/15/2015

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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