Dear Colleagues,
I am certain now that I am not alone with regards my concerns that our
profession needs help to regain the respect from not only the insurance
companies, the house of representatives, our peers and more importantly, our
associations. I received 38 replies and I cant list all because I only have
300 lines…..however the majority of the posts indicate disappointment with
the current state of our profession. The majority also indicate that our
associations have become bureaucratic institutions that do not support the
members agendas, but are driven by their own agendas. However there is
confidence to some extend in NAAOP. One out of 38 was positive about how far
our profession has come in time…..hmmm – I qualified in Germany and South
Africa and I was called an Orthopaedic Technician….and I was simply a limb
maker – but I got paid for what I did without any denials! Now my education
is a post grad masters, I have the title, Prosthetist…..I am not part of
any division of medicine, I am DME and I get denied payment for what I do??
The comment on my question of whether we need a lobbyist? – First of all
an ombudsman or lobbyist just parties like congress. They said we only
introduce bills, not create or modify them. And they are correct, only
think tanks write bills or modify them, then they hand them to a congress
person and they “introduce†the bill. If you see this, then you understand
why it is like throwing money into the middle of the ocean, and that is
where prosthetic lobby money goes, you see the results. One comment said we
all need to licenced…..again I mention that it is so watered down by the
time it is implemented that I question the efficacy? One comment indicates
that the low quality of orthotic and prosthetic care is directly related to
the low bids for insurance contracts. One comment is that it will take a
class action lawsuit against the insurance companies to break their power
over us. One statement is that I alienated the big companies and that we all
need to come together as a profession. One said get the patients involved
because they are ultimitely the member. One mentioned that my post was more
than 2 sentences and that most will never finish reading it……One comment
is that insurance denials after pre-approval is illegal. One comment is that
insurance companies are running out of money – then how come the CEO’s of
the big insurance companies are earning between $8M and $41M in BONUSSES!…
by denying their members critical care? This was a great comment – My point
in all this? Expect pushback at every turn, especially when you are going to
be making changes. The only people who really want the change is the
insurance company (trust me…). Since the providers higher up in the food
chain don’t want to be transparent, their only option is to stonewall every
provider. This was confirmed to me by an Anthem VP with “ our only way to
control their runaway billing practices is to slow them down with
paperwork…â€
Like myself, we are all very aware of the issues that we face as a
profession, but have no idea as to how to remedy it and what the next step
is to regain our respected position in the medical as well as congressional
arena. I feel that we are caught between a rock and a hard place because we
are a professional from an education point of view, but are still deemed
Durable Medical Equipment from a clinical position.
We all agree that there is no love lost between the small clinics, corporate
America and the bureaucracy that its all about who can eliminate who. We
show very little support for one another and that is our down fall because
we are divided and insurance companies take advantage of this situation….
they are winning at our loss of respect for one another. One suggestion was
to form a franchise platform for independents which will build a community
independents and then forward the agenda of these independents…..can that
work? Here are a handful of responses and hopefully I have stayed within my
300 lines…..Thanks again everyone, John Hattingh
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-John, I have exactly the same take, and maybe even further frustration. Our
profession is inept concerning the challenges we face. I am doing something
about it, I am building an independent “franchise†platform, which includes
the website platform (which I hope you are happy with), Prosthetist Finder
(referral tool), the free prosthetic specific EHR we are rolling out in the
next month and finally Revenue Cycle Management (RCM-billing and
collections), with a guaranteed payment. Through these very economical
offerings and support, OPS is building a community of independents allowing
them to be practitioners instead of what we have become. At some point in
the near future we will leverage that community to forward the agenda of the
independents (I.e. Staff attorney(s), physicians, PTs, volume discounts,
group insurance plans…). Call me sometime if you want to discuss it.
Sincerely,Jason T. Kahle, MSMS, CPO, FAAOP
-I hear you and agree. I was under the impression that when ABC gave away
our credentials to BOC we were on the path to unification, to bolster and
unify our field. I have seen nothing resulting from this that created a
stronger position for our profession. ABC sold us out to BOC for nothing,
but to reduce the value/quality of an ABC certification. I’ve met the BOC
to ABCer’s. They make sure you know they have the ABC credential. I’m sure
this was a Hanger endorsed move. I had just received my ABC CO when this
occurred and continue to feel betrayed. Stephen Hamilton, CPO
-Every O&P company would first need to agree and all be a part of a decision
to act. Don’t know if that would happen. I often think about how crazy it is
that we accept such low reimbursements but if we ALL didn’t accept them it
may change. But again, the key word is ALL. We were contracted with Homelink
for years. Then they lowered reimbursement. With them being connected with
OPGA, one would think they would “be on our sideâ€. But no. Such a shame. We
chose to no longer be contracted with them. I now keep getting emails from
them to become a par provider. I’m guessing other O&P provides may have
jumped ship too?? But I don’t think they raised reimbursement yet, so…And
all of the appeals are crazy! And you’re correct, the denials make no sense
at all.Sandra J.Yeater, CFO
-Hello John, I respect you and I’d like to help. There is a solution to one
of your issues. For the bills that are denied, delayed, denied, and delayed
after a pre-approval has been given, that is illegal. It is a violation of
insurance laws in most states (I learned a lot when I studied for my
insurance license). I’ll have to look it up for you and get back to you on
the verbiage you want to use when combatting it. It’s a game and it is time
you win it. I recommend that you always get your pre-auth as a fax or email
so you have printed, retainable proof. Always get your pre-auth for EXACTLY
the codes you intend to use. Other than the planning session where you list
the codes you’ll need, don’t start work til you get the pre-auth. If you
find, once you start a case (and don’t start til you have the pre-auth) you
need additional codes, apply for an amended Pre-auth and wait until you
receive it before you resume work on the case. Yes, this goes against your
grain. Yes, this makes the patient mad. Yes, this is good. A mad patient
can call the 800# on the back of the insurance card and get a lot further a
lot faster than you
-You want to conglomerate the practitioners of O&P? Admirable! Yet in the
same swift statement you alienated the “big companies†AND its couple
thousand employees to join you in this seemingly noble endeavor of advancing
the field. If you want to encourage change every voice will have to be heard
as ONE. We are not a large enough field for exclusions between the “big and
small companies†regardless of your personal disapproval of business
strategy…After all, we the clinicians (not the company we work for) are
practicing in the same field we have the same hopes of fair reimbursement
from payers, mutual respect within the medical field, and most importantly
providing valuable life changing services to our patients. We are in this
position today because unlike doctors or physical therapist we have not been
willing to work in unison towards these common goals. Nor have we invested
our money, time, and talents to the absolutely essential research required
to support the claims we make to insurance companies about improving quality
of life, mobility, and independence. With this said I believe it’s critical
that we be optimistic about where our field stands today. In the past few
years we have ensued more rapid positive change than we have had in any span
of history in our field. Yes, we have a far ways to go but at least the
train is moving. I couldn’t agree with you more, we the clinicians need to
take matters into our own hands. A good starting point maybe the
cooperation of our professional groups (The academy, AOPA, etc..) as well as
integrating university O&P programs, NCOPE, Accrediting bodies (ABC &BOC),
O&P manufactures, as well as patient groups such as the amputee coalition,
to come together and agree on a consensus for positive change. Imagine such
a meeting where all of these clinicians, companies, and organizations come
together to define a common goal, And actually commit their time and energy
to reach that destination.
