DME Supply Prior Authorization?

Why is it that a DME supplier can go through the proper channels, get a DME supply authorized by an insurance adjuster and/or case manager, get a negotiated non-reviewal price for this equipment and then have to waste a great amount of expensive time to fight for what was agreed upon in the beginning?

I’m finding out that more times than not, this authorization isn’t worth the paper it is written on. You have to appeal a payment with the claim payor that has been significantly reduced from the negotiated, non-reviewable fee. Sometimes, after being persistent and getting berated by these adjusters, who now say it’s not their problem, you will get your payment in full. By the time you figure all the time wasted on fighting for your money, I’m not sure it’s always worth it. I think prior authorization with a negotiated, non-reviewable fee should have to be honored by the payer’s of these claims.

View all Articles by: Melissa Clark, CCS-P