Dear list,
We are having an internal discussion related to custom cranial remolding
helmets.
How are you currently dealing with situations where you are contracted with
an insurance company that pays less than what it costs to fabricate one of
these devices, let alone take into consideration the intensive time, follow
up, adjustments , etc that are involved?
In the past we have had a cash only policy for helmets- specifically because
most of the insurance companies didn’t pay for them. Recently some
insurance plans have been starting to pay for the helmet codes, but the
allowable is so low that it makes no sense to even see the patient. Since
we are contracted with the insurance company, even if the patient is willing
to pay cash the problem occurs when they submit for reimbursement to the
insurance company and the insurance company pays the small dollar value back
to us and informs us that we are not allowed to bill the patient anything
over the allowable. Then we are operating at a significant loss.
How are you dealing with these issues if you continue to provide these
services?
What are your policies regarding payment for helmets?
Thanks a lot,
Paul E Prusakowski, CPO, FAAOP
Gainesville Prosthetics
