Guest guest Posted February 1, 2006 Report Share Posted February 1, 2006 I had a similar issue. I got a letter of necessity from the Ortho. A copy of the script and sent those in with refusal letter and the reconsidered and reimbursed me. DM needing prayers wrote: I think someone else mentioned the same problem some time ago. I don't remember what the outcome was. My insurance is telling me it is considered out of network and " may " cover 60% of the cost. I have yet to be reimbursed - the file is still pending processing. Carol wrote: I am seeking reimbursement for the 's from United Healthcare PPO, my insurance. They will cover the AFO part but not the bar. Seems kind of kooky since, as we all know, the shoes don't work without the bar. Is this common? Any suggestions? Thanks in advance, Carol and , bcf, 10-27-05 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 1, 2006 Report Share Posted February 1, 2006 I went through many rounds with UHC. It all depends upon how it is billed to them. They need to bill the shoes and bar together as one CPT code. If it wasn't billed that way, then call UHC and ask for a supervisor - get a NAME and PHONE NUMBER of that person as well. Once I explained the situation, they accepted it. But they said that unless the shoes and bar are billed together for subsequent claims, I would have to keep calling in each and every time. Hope this helps. daughter Addison, 7/3/04, bcf 14/7 > > I am seeking reimbursement for the 's from United Healthcare > PPO, my insurance. They will cover the AFO part but not the bar. > Seems kind of kooky since, as we all know, the shoes don't work > without the bar. Is this common? Any suggestions? Thanks in advance, > > Carol and , bcf, 10-27-05 > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 2, 2006 Report Share Posted February 2, 2006 Hi, Carol, We have United Healthcare EPO & interestingly enough, in order to get them to pay for the shoes, we have to order a new bar every time!! Sounds like they don't have a consistent policy. The orthotics dept. has always dealt with them directly, so I'm afraid I don't have any firsthand advice to pass along. Sorry to not be more help, Kim Lily, 3/28/05, lcf, P/M FAB, 16/7 Tessa, 7/17/02 Carol wrote: I am seeking reimbursement for the 's from United Healthcare PPO, my insurance. They will cover the AFO part but not the bar. Seems kind of kooky since, as we all know, the shoes don't work without the bar. Is this common? Any suggestions? Thanks in advance, Carol and , bcf, 10-27-05 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 2, 2006 Report Share Posted February 2, 2006 Carol, The bar should be covered by UHC, that's who I have and they do cover it for me, 100%. I think it must be coded as Medical Equipment, our provider used code L3150. Mom to Jenna (4/7/01) & Sammy (9/25/04, RCF, Dobbs' brace, 14hrs/day) > > I am seeking reimbursement for the 's from United Healthcare > PPO, my insurance. They will cover the AFO part but not the bar. > Seems kind of kooky since, as we all know, the shoes don't work > without the bar. Is this common? Any suggestions? Thanks in advance, > > Carol and , bcf, 10-27-05 > Quote Link to comment Share on other sites More sharing options...
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