Re: Perspective Column, September 2014

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The following letter is in response to the Perspective column in the September 2014 issue of The O&P EDGE, "Payer Requests for Manufacturer Invoices: A Call for a Unified Response," by Susi Ebersbach, MT (ASCP), MBA.

Dear Editor,
The article about insurance companies and third-party payers asking for our product invoices prior to paying us mentioned that we need a unified response to this problem, and I have a simple one.

The problem with this whole issue is that billing staff doesn't know how to handle this type of situation. Oftentimes when these insurance companies try these tactics, if the person in the billing office does not know what he or she is doing and does not know how to assert his or her own authority, that person will get trounced by those on the other end.

Nowhere is it written that we must divulge our business practices. This type of intimidation is not allowed, nor do we have to stand for it. I believe that with proper training individuals in billing and related staff positions should know how to request to speak with a supervisor and, when the supervisor gets on the phone, how to express their displeasure-and to ask for the CEO if they must. Ask the CEO to divulge his or her business information and practices and see how far that goes.

This is not anything we should ever have to adhere to, and if insurance companies and third-party payers are doing this, it's because they are trying to beat us down. Don't stand for it-especially if the practice is an O&P patient care facility. We operate much like doctors' offices. We are not medical supply shops that operate like Walmart. If payers want to negotiate a rate prior to treatment, then so be it. All rates should be discussed before you put the product on the patient. Don't expect me to fit a Mercedes for a Ford payout.

Don't let payers get away with this by folding to their intimidation tactics. Contracted insurance companies don't ask for the invoices, and in my experience, the third-party payers that do are usually workers' compensation systems that are shopping around for cheaper products. Tell the patient what the payer is doing since the patient may get an attorney involved as an advocate, and after that, you may find that invoices are no longer being requested.

The bottom line is that people in the positions that have to deal with these types of issues have to know what they are doing and have to stand up for the O&P practice. They have to be firm and not put up with all these payers trying to take a piece of our pie. Good luck!

Nancy McKay, Director of Reimbursement
St. Petersburg Limb and Brace

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