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Insurance refuses to pay for Alan's custom shoes Archive,[link widoczny dla zalogowanych]
Last year, his insurance company (he's on a medicare HMO),[link widoczny dla zalogowanych], approved his custom molded shoes. He can't wear ANY OTHER TYPE OF SHOE EXCEPT THE CROW BOOT.
So when the foot ulcer is debrided and he can walk, he MUST WEAR THE CUSTOM MOLDED SHOES.
So this year,[link widoczny dla zalogowanych], ( a few months ago), he needed a second pair. His podiatrist wrote the prescription noting that he needed an outer wedge on this new pair of shoes because he slants over on his heels.
So he went in for the custom molding. All was done and several weeks later Alan had his new pair of shoes.
Well, we just got a letter from the insurance company saying that the Orthotic company that makes his shoes submitted a claim and the claim was denied.
Reason for denial??? NOT MEDICALLY NECESSARY. That's right, the brain dead physicians at the insurance company have come to the conclusion that based on his benefits, this is NOT A MEDICAL NECESSITY.
Not a medical necessity,[link widoczny dla zalogowanych]? The guy can't walk without these custom molded shoes,[link widoczny dla zalogowanych].
How is that NOT A MEDICAL NECESSITY??
Of course we called and they said "All you can do is appeal, get a note from your doctor (we did this last year but we didn't need to appeal last year).
These custom molded shoes are extremely pricey (as you all must realize,[link widoczny dla zalogowanych], right?)
Of course, we wrote a letter of appeal, and I just got off the phone with the podiatrist's assistant (who handles all of this), and she said "we deal with this all the time,[link widoczny dla zalogowanych], insurance companies decide that unless the shoe is fitted with a brace,[link widoczny dla zalogowanych], it's not a medical necessity".
I said 'Can we get a letter from the podiatrist,[link widoczny dla zalogowanych], maybe this will have some weight with the other physicians who ultimately came to the conclusion that Alan doesn't need custom molded shoes".
She said "no problem". So next podiatric visit, we'll go and pick up the letter.
Have any of you dealt with this (I'm sure you have),[link widoczny dla zalogowanych], and what was the outcome.
Remember, Alan is NOT a diabetic,[link widoczny dla zalogowanych], and for some reason,[link widoczny dla zalogowanych], this SEEMS TO MEAN EVERYTHING TO INSURANCE COMPANIES.
Me,[link widoczny dla zalogowanych]?? I'm a diabetic and I get new diabetic shoes every year.
But because this guy has peripheral neuropathy, foot ulcers, all these things on his feet which necessitates CROW boots,[link widoczny dla zalogowanych], custom molded stuff, etc. AND HE'S NOT A DIABETIC, we'll they'll just throw him to the dogs.
09-30-2009,[link widoczny dla zalogowanych], 05:54 PM
i wonder if it is because every trial for every type of medication or device for peripheral neuropathy is only tested on people who have PN due to diabetes. The reason of course they do the tests on diabetics is because they know the cause of their pn so that variable in testing is controlled. When you read the results however, it states that the product or drug was effective in treating some aspect of diabetic neuropathy. Those of us with other causes are left out in the cold and therefore perhaps those devices or treatments are not recognized as being effective for our type cause of PN.
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