Compression Hose Fraud Widespread in Benefit Plans
Our paramedical claims manager had a very enlightening discussion with a chiropractor about a insurance fraud scams around compression hose.
Compression Hose Fraud is Widespread in Benefit Plans
Drug stores are “working out a deal” with some customers who have insurance coverage regarding the compression hose.
The member is informed to get a prescription from the chiropractor for compression hose. Then they submit this prescription to the pharmacist who submits it to the insurance company. So for example, if the compression hose coverage is $400.00, drug store and/or pharmacist submits for the full amount to insurance company and receives the reimbursement.
Following the drug store/pharmacist does not provide the compression hose but rather gives the member a store credit of X dollar amount.
According to this chiropractor, he has discussed this with his peers and have found that this is a widespread scam. This chiropractor has been working for 40 years.
Our claims manager has checked into stockings, spoken to pharmacists and chiropractors about any differences in store bought hose vs. hose ordered by chiropodist/podiatrist/chiropractor. So far, she has concluded that there is no difference. “Basically, it’s a rip off to pay more than the $15.00 to approx. $20.00 cost,” she advises.
The only validity she has found so far is that it is necessary for a patient to get assessed whether or not they require the compression hose from the specialist and if so, what density.
Once they know that, they should be purchasing it off the rack.
What Beneplan Recommends You Do
- Reduce coverage for compression hose; or,
- Have compression hose benefits subject to pre-approval through Beneplan