Our partner Brittany Turner recently prevailed on appeal, overturning a judge’s decision requiring our client to pay for a medical device a treating doctor billed for but did not properly request. In this case, the insurance carrier authorized right shoulder surgery and postoperative physical therapy. After that, however, our client received a bill for a pneumatic compression device and a half leg segmental gradient pressure pneumatic appliance. The bill for these devices totaled $1101.00. At a hearing, the judge directed our client to pay $1000.00 of the charge on the rationale that authorization need not be sought for treatment costing $1000.00 or less.
Brittany appealed, contending that the bill for the devices should not be paid by the carrier because both requests required an application through the board’s prior authorization request (PAR) approval system and the treating doctor had failed to make a proper application. Although the board on appeal reminded the carrier that the objection to the devices should have been made against the medical report of the treating doctor who prescribed the devices and not to the bill submitted by the supplier, the board then credited Brittany’s argument that a PAR authorization request was required prior to prescribing durable medical equipment such as that requested in this case. As a consequence of the doctor’s omission, the Board Panel reversed the judge’s decision in its entirety and relieved our client of all obligation to pay for the devices.
Brittany’s careful review of the appropriate regulations and persistence on appeal demonstrates our firm’s care in assessing our clients’ objections to medical treatment and billing. This was just PAR for the course for Brittany.
