Advice About "Mangled Care Organization" Contracts
One of the recurring tasks in my consulting practice is to help facilities prepare effective letters of justification or to appeal inappropriate denials of prescribed care. These problems are rampant in health care in general and are not unique to prosthetic and orthotic rehabilitation in the United States. I subscribe to a variety of newsletters and e-zines that deal with this area of practice.
I recently received an e-zine that included an article titled "Managed Care: Why Should You Sign That Mangled Care Contract?" This short piece contained a number of practical tips that apply to prosthetic or orthotic practices just as much as they do to medical offices. For example, one recommendation is to fax a list of the ten procedures you perform most frequently [e.g., typical examples of transtibial and transfemoral prostheses] to the Managed Care company and demand a fax back listing the total reimbursement they allow, prior to signing any contracts. Another suggestion is that you strike out and initial any stipulations that prohibit the patient from paying for non-covered services.
To read the entire newsletter, click to www.appealsolutions.com/tal/managed-care-contracts.htm. Readers from outside the USA may be interested just to learn about the restrictions that are commonly included in low quality health insurance contracts in this country.
