03/31/2017    Joel Lang, DPM

Denial of Foot Orthotics Despite Doing Everything (Jeff Bean, DPM)

So often, I read of podiatrists having multiple
problems getting their insurance claims paid.
They jump through hoops, spend time on phone
calls with minimum wage insurance clerks and
negotiate fees with patients who are unexpectedly
denied. My advice is not the “ball” in a ping-
pong game between the patient and their insurance
carrier. It is the weakest position you can be
in.

In my practice, I required that orthotics be paid
in full at the time of casting. After submitting
the claim and the insurance paid for the service,
the patient was promptly refunded the amount of
the insurance payment. This was all stated in a
signed release at the time of casting. I realize
that might not be possible in all cases today,
but I have an alternative suggestion.

The Insurance Commissioner in the state in which
you practice is there to enforce coverage upon
insurance companies for which they are
contractually bound. Take advantage of this free
advocacy service. They have a battery of lawyers
who are experts on insurance coverage. When an
insurance company receives a request from that
office to respond to a complaint, they will
definitely respond and their lawyers will not
accept a phony response. When I was in practice,
I actually had a pre-programmed computerized
letter that would allow me to generate a “formal
complaint” with a few key strokes.

When insurance companies know you will complain
to the Insurance Commissioner when not treated
fairly, they will take all your claims more
seriously. When the Insurance Commissioner
receives multiple complaints about a specific
insurance carrier, they will independently
initiate their own investigation. Insurance
companies know that.

Don’t work harder – work smarter. Use your state
Insurance Commissioner.

Joel Lang, DPM (retired), Cheverly, MD

There are no more messages in this thread.