Misconduct by Medicare Advantage plan
Elizabeth Park
Description
Collection
Title:
Misconduct by Medicare Advantage plan
Creator:
Elizabeth Park
Date:
8/7/2020
Text:
Hello All!
Can any of you advise me on how to handle what I believe to be misconduct by an MA plan? Not naming names here. One of my staff called to get all of the insurance lowdown for a patient. The conversation included PA requirements which the rep said we did not need for the code provided.
Needless to say, they did require a PA and we went through multiple appeals with them and they still refused to pay. My biller seems to think that CMS has a platform for MA complaints but he was unsure. I welcome any information you might have.
Thanks so much,
Elizabeth
Elizabeth A.M. Park, Operations Manager
Sound Limbs Orthotics & Prosthetics
39 South Lisbon Road
Lewiston, ME 04240
soundlimbs.com< <URL Redacted> >
work - 207-784-4345 ext 207
fax - 207-783-9496
IMPORTANT: This communication may contain confidential information, some or all of which may be protected health information as defined by the federal Health Insurance Portability & Accountability Act (HIPAA) Privacy Rule. It is intended for the exclusive use of the individual or entity to whom it is addressed and may contain information that is proprietary, privileged, confidential and/or exempt from disclosure under applicable law. If you are not the intended recipient (or an employee or agent responsible for delivering this facsimile transmission to the intended recipient), you are hereby notified that any disclosure, dissemination, distribution or copying of this information is strictly prohibited and may be subject to legal restriction or sanction. Please notify the sender by telephone (number listed above) to arrange the return or destruction of the information and all copies.
Can any of you advise me on how to handle what I believe to be misconduct by an MA plan? Not naming names here. One of my staff called to get all of the insurance lowdown for a patient. The conversation included PA requirements which the rep said we did not need for the code provided.
Needless to say, they did require a PA and we went through multiple appeals with them and they still refused to pay. My biller seems to think that CMS has a platform for MA complaints but he was unsure. I welcome any information you might have.
Thanks so much,
Elizabeth
Elizabeth A.M. Park, Operations Manager
Sound Limbs Orthotics & Prosthetics
39 South Lisbon Road
Lewiston, ME 04240
soundlimbs.com< <URL Redacted> >
work - 207-784-4345 ext 207
fax - 207-783-9496
IMPORTANT: This communication may contain confidential information, some or all of which may be protected health information as defined by the federal Health Insurance Portability & Accountability Act (HIPAA) Privacy Rule. It is intended for the exclusive use of the individual or entity to whom it is addressed and may contain information that is proprietary, privileged, confidential and/or exempt from disclosure under applicable law. If you are not the intended recipient (or an employee or agent responsible for delivering this facsimile transmission to the intended recipient), you are hereby notified that any disclosure, dissemination, distribution or copying of this information is strictly prohibited and may be subject to legal restriction or sanction. Please notify the sender by telephone (number listed above) to arrange the return or destruction of the information and all copies.
Citation
Elizabeth Park, “Misconduct by Medicare Advantage plan,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 6, 2024, https://library.drfop.org/items/show/255119.
