The key to success (this time)
The key to success (this time)
Gina:
The Buzz words are "Durable Medical Equipment" and "Supplies".
They have to be clear on the fact that you are getting supplies, not the Protime machine itself.
The Procedure codes that worked in the past are:
X6503, X6503NU and E1399.
From my discussion recently with a Nurse in the EBCBS Medical Management Department, they will readily cover SUPPLIES. Covering the machine itself is another story.
My appeal letter cited the fact that previous claims for supplies were honored and that the most recent claim was arbitrarily denied. The letter was sent via Certified Mail to their Appeals Department with copies to the NY State Insurance Board and to the NY State Department of Heatlh. I think I got their attention because the rejection was rescinded on the very day they signed for my letter. I guess it pays to rattle the cages.