Friday, June 14, 2024

RX for bilateral G2’s with AFO attachments

Charles Barocas,C.O.

I have just been asked my opinion on 2 patient/orthotist problems. The

patient was given an RX for bilateral

G2’s with AFO attachments. The orthotist (who is the HMO designated O&P in

the area) received approval from the HMO insurance provider at a particular

price. Then the orthotist called the patient and told her that the HMO

would not pay for the cast molds of the legs so she would have to pay or he

would not make he brace.

The HMO feels the casting process is part of the L code pricing. The

questions asked of me is

1. Is this a customary practice to charge for casting after the

authorization is given?

2. Is this against the rules of ABC?

3. Should this Orthotist be reported to the HMO(probably done already), the

ABC, & the Florida O&P


The second problem is an orthotist who received an Rx to do a certain custom

OA brace. He then called the Doctors office and asked to switch the brace

to another brand. The Doctors secy thought this would not be a problem. The

secy now says she was blind sided by the orthotist who made it sound like

this was a normal procedure. The orthotist switched the brace to a cheaper,

off the shelf, ACL brace. He didn’t even use an OA brace. What should we

do in this case?

Charles Barocas, C.O.,

[email protected]


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