Tips & Tricks For Insurance Claims For Clubfoot Treatment
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Tips & Tricks for Insurance Claims for Clubfoot Treatment

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Insurance claims can be tricky, frustrating, and time-consuming, and are even more difficult if you aren't an expert on medical billing codes and practices. Fortunately, there are many clubfoot parents who have been through all types of fights and scenarios with their insurance providers. Here are some tips on getting your claim approved and receiving the proper benefit amounts:

STAY ORGANIZED - This cannot be stressed enough! Set up a folder or envelope to keep all invoices/receipts in. Get a dollar-store little notepad to keep note of dates, times, and names of people you speak with and what you talk about.

Do as much through e-mail or other forms of written communication as you can. This helps with documenting who said what and when. Having an answer in writing is the best way to get the correct answer because insurance providers don't want to put out anything in writing that they cannot honor later. They won't win in a suit.

Review your invoices for accuracy. Make sure the proper medical codes are used for both the diagnosis and the treatment or medical device provided. If something doesn't look right, call the provider first. They will explain what the charge is for and you can distinguish whether or not it's legitimate. The typical diagnosis code for clubfoot (congenital) - talipes equinovarus is 754.51 (source: ICD-9-CM). If you see a different diagnosis code, double-check with the provider because mistakes can happen. You can find this code and others in the standard billing codes listed in the ICD. If you order the Ponseti bar and Mitchell shoes directly from the manufacturer, MD Ortopaedics, there is a reference on their website listing each of their products and the respective billing codes. You can use this to check with your insurance provider before ordering.

Know your benefits. Review your insurance provider's benefits packet for your specific plan. Specifically, you'll want to look for a clause that talks about the exclusion of foot deformities or problems. This generally applies to things like plantar fasciitis, bunions, etc. and not clubfoot (because clubfoot is a congenital birth defect, not an acquired foot disorder). This is why the diagnosis code on everything for your clubfoot treatment needs to be correct. The insurance company won't know it's required for treatment of a birth defect if it's not coded correctly. Speak with your insurance company about this ahead of time to see what is deemed necessary under your plan's benefits. For example, my insurance provider still considers the boots and bar a "durable medical device," so it has specific benefits that are different from my prescription drug benefits. Most importantly, understand that each plan is completely independent and different from someone else's and the plans also differ under the same company's umbrella. BlueCross BlueShield, for example, has THOUSANDS of plans with THOUSANDS of variations on benefits. Just because someone else has BCBS insurance and everything was covered 100% with no out of pocket expense does not mean your BCBS plan will do the same.

For more tips on clubfoot treatment, community discussions, and other clubfoot parenting resources, please visit Clubfoot Closet.


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