Re: Workers comp NY
Marty Mandelbaum
Description
Collection
Title:
Re: Workers comp NY
Creator:
Marty Mandelbaum
Date:
12/5/2015
Text:
Responses to: I have a patient that has WC insurance which pays on the
Medicaid fee schedule. He needs a L5685 Prosthetic sleeve which costs me
aprox $82 not counting shipping and the Medicaid rate for this is $32.10,
any advice on other options?
Let me explain that this is a new client, I have not made anything for him
in the past, he just wants 2 sleeves, yes, I may make him a prosthesis in
the future.
I think some of us take the wrong attitude of thinking that we will make
it up on other items and that is why we have the continuing problem with
obsolete fee schedules that don't account for our yearly cost increases and
account for our professionalism. Yes, WC will give you 1 and a half times
cost of invoice if you go through the process. Why don't they just supply
the product themselves? They would still have to have an employee decide
what product, order and ship at more than the 1 and a half times costs they
provide us for low cost items.
I don't want to evaluate, start a chart, go through authorization, etc
for$30.
Our fee schedules are obsolete and don't account for our professionalism
and we as a field are to blame because we accept these terms. If enough of
us turn down these ridiculous reimbursements, patients will complain and
carriers will have to re evaluate.
I rejected another WC (medicaid fees) case for a trans radial cable
controlled prosthesis that would pay a few hundred over our Hosmer invoice.
We don't even get a decent markup that a general store would make for the
components let alone labor, fabrication materials, etc.
1 -
Absorb the loss in a socket replacement.
Tell patient that you can not help him.
Provide a less expensive Neoprene Durasleeve instead of a more expensive
gel sleeve. You might come out even with this.
Tell him to ask his relatives/friend to buy him sleeves for
Christmas/Hanukkah and charge them your U&C.
Leave the O&P field.
2- Have the pt pay your price and have him reimbursed what he paid. So
if you bill $160. He pays that and he turns it in. They pay him back
$160. Your not in business to lose money. That's what we've done.
3- Check your state W/C manual. There may be a provision that the carrier
has to reimburse the patient at the amount paid by the patient. Some states
have that provision. BTW there are less expensive sleeves on the market.
You are not bound to provide World Cass product/service at below cost
reimbursement.
4- Average out the total cost of care vs. reimbursement over the life of
his relationship with you and it might come out ahead?
Or try sending them an invoice with an additional L5999 code describing the
cost of the item over and above what they are paying. Maybe they have a
deal to pay cost +10% or something like that for consumables?!? Might have
to read the contract!
5 - Something's you just have to do to help your patient. I'm sure you
made some money when you provided his prosthesis.
6- Well if you want to make deals with the Devils, don't complain about it.
What are you worth, what does it cost you to have a facility, pay you
employees. Until people stand up and say We'er not gonna take it like a
old song.
This will not end until you respect yourself and your profession and stop
your own carnage.
Medicaid fee schedule. He needs a L5685 Prosthetic sleeve which costs me
aprox $82 not counting shipping and the Medicaid rate for this is $32.10,
any advice on other options?
Let me explain that this is a new client, I have not made anything for him
in the past, he just wants 2 sleeves, yes, I may make him a prosthesis in
the future.
I think some of us take the wrong attitude of thinking that we will make
it up on other items and that is why we have the continuing problem with
obsolete fee schedules that don't account for our yearly cost increases and
account for our professionalism. Yes, WC will give you 1 and a half times
cost of invoice if you go through the process. Why don't they just supply
the product themselves? They would still have to have an employee decide
what product, order and ship at more than the 1 and a half times costs they
provide us for low cost items.
I don't want to evaluate, start a chart, go through authorization, etc
for$30.
Our fee schedules are obsolete and don't account for our professionalism
and we as a field are to blame because we accept these terms. If enough of
us turn down these ridiculous reimbursements, patients will complain and
carriers will have to re evaluate.
I rejected another WC (medicaid fees) case for a trans radial cable
controlled prosthesis that would pay a few hundred over our Hosmer invoice.
We don't even get a decent markup that a general store would make for the
components let alone labor, fabrication materials, etc.
1 -
Absorb the loss in a socket replacement.
Tell patient that you can not help him.
Provide a less expensive Neoprene Durasleeve instead of a more expensive
gel sleeve. You might come out even with this.
Tell him to ask his relatives/friend to buy him sleeves for
Christmas/Hanukkah and charge them your U&C.
Leave the O&P field.
2- Have the pt pay your price and have him reimbursed what he paid. So
if you bill $160. He pays that and he turns it in. They pay him back
$160. Your not in business to lose money. That's what we've done.
3- Check your state W/C manual. There may be a provision that the carrier
has to reimburse the patient at the amount paid by the patient. Some states
have that provision. BTW there are less expensive sleeves on the market.
You are not bound to provide World Cass product/service at below cost
reimbursement.
4- Average out the total cost of care vs. reimbursement over the life of
his relationship with you and it might come out ahead?
Or try sending them an invoice with an additional L5999 code describing the
cost of the item over and above what they are paying. Maybe they have a
deal to pay cost +10% or something like that for consumables?!? Might have
to read the contract!
5 - Something's you just have to do to help your patient. I'm sure you
made some money when you provided his prosthesis.
6- Well if you want to make deals with the Devils, don't complain about it.
What are you worth, what does it cost you to have a facility, pay you
employees. Until people stand up and say We'er not gonna take it like a
old song.
This will not end until you respect yourself and your profession and stop
your own carnage.
Citation
Marty Mandelbaum, “Re: Workers comp NY,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 2, 2024, https://library.drfop.org/items/show/237925.
