Updated: Oct 16, 2020
Here's a fun topic! Something that we see with every device we provide are all these insurance requirements! With diabetic shoes and inserts, orthoses and prostheses (seriously, pretty much everything we provide patients), there is a lot of documentation needed from your doctor to obtain the reimbursement from your insurance plan.
Many, (many, many) years ago the only information that was needed from your doctor was a prescription. All they had to do was write a very basic description of what you needed on a piece of paper with their signature, "shoes & inserts," and bam they were done. In todays world with Medicare, Medicare Replacement Plans (these are Medicare plans that are managed by a private insurance company like Blue Cross Blue Shield or Ucare) Private Insurances (BCBS, Healthpartners, Medica, United etc) and Medicaid through the state, a few words on a prescription is simply not enough information to prove medical necessity.
One of the biggest stalls in receiving a device (just one of them!) is the time it takes to get the clinic notes from your medical doctor. Twice as much when we have to get those notes signed by your OTHER doctor! Getting the notes takes multiple phone calls and messages between the offices, as well as making sure the required information is written within them.
As you might guess, doctors are incredibly busy people, and see a lot of different patients so their time is extremely precious. Some doctors have very little experience in providing the information needed and require more information from us to learn what's needed. Finally getting the notes from your appointment with them and having the information is detailed enough for the insurance can be a task!
For more detailed information:
Medicare Requirements for Diabetic Shoes & Inserts
Coming Soon: KAFO Notes Requirements
Coming Soon: AFO Notes Requirements
Coming Soon: Knee Brace Notes Requirements
Coming Soon: Prostheses Notes Requirements