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Insurance paying for orthotics

Discussion in 'USA' started by kellenraid, Mar 11, 2010.

  1. kellenraid

    kellenraid Member


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    The predominant insurance companies in our rural do not pay sufficient amounts for orthotics to meet my laboratory fees for a pair of orthotics. I write long justification letters to them, but I get denials. They even have suggested that I use some prefabs or OTC's; this I will not do. Oh, I tried them, but they are shoddy and address not the biomechanical reasons for the painful pathology.
    My idea was to set up a corporation under which I would be an employee. Under the aegis of that corporation, I would perform the biomechanical exams and neurtral position casting. Then send the casts to my usual lab but under the name of the corporation. Well, you see where I am going with this.
    The patients whom I have queried this told me that they would pay out-of-pocket for the devices. The insurance companies have specifically stated that this type of thing was unacceptable i.e. if I accept their insurance, being contracted as I am, then I must accept their fee schedule. And this includes their rules.
    My concern is that my "scheme" might be good for the patients, but would I be in violation of the Stark Laws against self-referral?
    I cannot believe that I am the only pod out there facing this problem. If anyone has a solution better than this or a work around, I sure would like to know.
     
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