12/13/2022
1199 Denials for Custom Orthotics
1199 has suddenly stopped covering custom orthotics for all diagnoses previously paid, not just plantar fasciitis. denial reads: The item, service or procedure has not been proven effective and therefore, is not medically necessary" multiple claims denied same reason
We pulled a report, from our client billing database and do not see any issues with payments. The 1199SEIU website does not have any information for recent changes on orthotics reimbursement, and we have not seen any new documentation published. A few recommendations:
- Appeal with an LMN (Letter of Medical Necessity) along with notes
- Contact Provider Relations regarding their policy
- Contact the patient and ask them to contact their insurance, this is usually the best solution as Insurances tend to pay attention to their subscribers