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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

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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

>

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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

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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

>

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