Off the Shelf - Non Custom Devices
I like to watch for patterns, trends and developments, especially relating to insurance. With that being said, the past several months, while verifying insurance, it has become more evident, thru "VERBAL" communications with insurance reps, that most major insurance companies are no longer paying for "Off the Shelf", non custom medical devices. Suppose we have Medicare to thank for that for excluding elastic type devices in April 2009.
Today, a friend of mine called and was telling me the same thing, and that one rep advised her to ALWAYS pre-authorize Custom Devices, even when the CSR tells you that NO AUTH is required, which led my mind to wander back when I teach Claims & Billing Courses when I would always tell folks...just ask for the pre-auth number anyway and thank them. Hang up and call the pre-auth dept.
As a matter of fact, I verified insurance for a prosthetic patient recently, was told all of the LCodes required prior authorization, I submitted for prior auth and just received a letter from the insurance company indicating that NONE of those LCodes needed prior authorization!
Makes one wonder if the insurance companies, and/or their employees know what they are talking about? Furthermore, they expect providers to verify and authorize...when we follow these procedures, at times it is still a risk.
Ugh...insurance companies!