Monday, December 5, 2022

Medicare Advantage

Elizabeth Park

Hello all!

Wondering if anyone has advice on how to handle a Medicare Advantage Ins.
Co. that has become problematic. We follow all of their guidelines and PA
requirements only to have them delay paying a claim (some over 90 days) or
partial pay a claim and deny some of the codes all of which have been prior
authorized. They require scads of paperwork in the PA process and much time
and energy is spent by our office staff trying to get answers from the
company. We have seriously considered ending our contract with them but don’t
want to disappoint our patients who have their insurance through them.

We’ve been told by various folks to file a grievance with CMS but we
haven’t been able to get through to anyone who knows how to handle something
this.

Also – do any of you know if we have an Ombudsman in Region A and if so can
you please share contact info?

Thanks in advance for your input!

Elizabeth

Elizabeth Park, Co-Owner
Sound Limbs Orthotics & Prosthetics
39 South Lisbon Road
Lewiston, ME 04240

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