Discussion3 Comments

  1. Lois Clauss, PMAC

    We are changing our policy on how we handle orthotic coverage with patients. Previously we checked with all insurance companies (except the standards we knew never covered) prior to orthotic casting with patients. It has been a discussion topic that many physician offices do not even check, they automatically tell patients they are non covered and collect for the services. I was interested in knowing if you then submitted all orthotics to insurance companies to see if they were covered and how you handled the ones who actually required a pre authorization number in order to receive coverage (in our state this is required for certain insurance companies). Thank you in advance for your feed back.

    • Hi Lois,

      Our office only checks coverage on a few policy’s that we know cover it. There is only one that requires a prior authorization. Will fill the form out, fax it in. When we receive the authorization we call the patient to schedule the casting appointment. All the other insurances (non-Covered) we offer a letter of medical necessity to the patient and a receipt and let them know it’s patient responsibility.

      We collect the full amount due on day of casting, for all not covered. We collected any deductible and co-payments that would apply for the covered policies. We do have one that its covered however, the rate of pay is really low (79 for a set). So we tell the patient we don’t accept assignment on them.

      I don’t think you should ever tell a patient that its not a covered benefit if it is! You should say we don’t accept assignment on orthotic payments. This will elevate a patient getting upset with you when they really are covered and they can get reimbursed by the insurance company.

      This however it just what we do in our office.

      Cheryl A Bailey, PMAC
      ASPMA Journal Editor

    • Hello.

      In our office, if the physician feels as if orthotics are a benefit to the patient they would leave the room to tell the staff. One of us would call the insurance company real quick to see if its a covered benefit then note it in their electronic chart for future reference. We also ask about the deductible so the patient is aware of the cost if any and how much he needs to reach his or her deductible. Its a courtesy we do for our patients. Sometimes if its too busy, we will inform the patient that we cant call at this time but we give them the information to call their insurance.

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