Nationwide Insurance - Chiropractic
Members who have experienced denials of hot packs, treatment of infants and re-evaluations: take note. Nationwide does not have blanket claim policies to deny these services. If an adjuster tells you there is a corporate policy to deny care for infants under 2 years old, it is incorrect. If the adjuster insists on this position, please ask him or her to refer the case to Nationwide's medical review staff for assessment.
Hot packs are normally covered for 30 days; however, if there is a compelling reason why the patient cannot manage hot packs at home, send this information to the adjuster and ask for a medical review determination.
Adjusters who deny patient re-exams may have done so incorrectly. The medical review staff at Nationwide indicates that they prefer to see periodic re-assessments so the patient benefits from a change in care or a referral if the current treatment is not improving the patient's health status. Be sure to include information in the clinical record about the results of the re-exam, patient improvement or regress, and your treatment plan.
Posted on Friday, April 25, 2008 at 1:44 PM
Posted in Insurance (RSS), Insurance DC (RSS)