oandp.com

This is to share w/ all providers for Orthotics and Prosthetics an experience
we had when tyring to obtain an authorization to treat a patient for a new prosthetic limb.
The patient was referred to us w/ a documented referral to come to our practice from
Universal Health Care Insurance. We then in turn went thru the necessary and proper channels
to obtain another authorization to make the leg. This is, mind you, after we have already
evaluated, casted, and ordered parts for the patient, and she' s walking
around on a test socket.. While waiting for the leg to be made and the
authorization to come in..the patient called us and stated that Universal
Health Care called her up and tried telling her they wanted her to go to
another provider of which Universal took upon themselve to seek a second
opinion and lower quote.

The authorization department, took our codes and forwarded them to Hanger
asking for a second quote, and this was done without the second
company ever seeing the patient. They did not evaluate the patient. Had no
idea what products would this patient most benefit from, etc, etc.
We are contracted with Universal and they basically were trying to steer the
patient out of our practice, even though the referring physician's office specifically
requested our company to make the leg. We followed the patient in the hospital,
we casted, and fit w/ an immediate post operative prosthesis, and Universal took it upon
themselves to make the patient go to another facility...Now here's the real
shocker...The patient was a Medicaid replacement policy w/ Universal..and
the quote that went out was the Florida Fee Schedule for Medicaid
recepients...and Hanger still undercut that quote. How low can you go?
After much to do and many conversations w/ the Executive Offices, I am
happy to say..I was able to save our patient from being taken away from us!
No insurance company has a right to take our revenue out of our
practice's...nor dictate to a pateint where they should be going for
treatment when the treating provider is in a contracted relationship w/ that insurance
company.
This is a notice to all...to beware of the behind the scene's authorization
request's from Universal Health Care Insurance Company, located here in
St.Petersburg Florida.

Nancy Mckay, Director of Reimbursement