Providers & FEP Coverage

Providers & FEP Coverage

I am cross posting this because I believe a couple of PMs I received make this important. Thanks for the Private Messages.

For all Federal Employee Program (FEP) participants, be very careful with pump providers and their billing everything to FEP. Do not let providers tell you something is not on "contract" because the provider must do a paper claim and gets low reimbursement.

I am a new pumper and had this brought to my attention by my doctor's CDE after the provider's nurse checked me off on my new pump. My provider says they do not bill FEP for battery & cartridge caps because they are not on the Federal (USA) contract. My doctor's CDE shared another patient had this problem about billing, paid out-of-pocket, sought reimbursement, and was informed by FEP the pump vendor should be billing the caps, getting the claim processed, and then billing the difference.

I called the vendor & my FEP office, confirmed the story so when I order my replacement caps in two more months, I will know the truth. It appears the problem is caps (battery & cartridge) do not have Medicare billing codes which are used by all insurance companies to code goods and services. This means the caps are billed under a catch-all code, get rejected, and then the vendor must send in a paper claim which takes too much time and effort to get their paltry allowable charge.

Instead, they try to get the patient to pay full retail. The patient then submits the claim to FEP, gets asked why a participating provider is not billing the caps, and then told to have the provider refund the retail price and bill the caps. The provider has trained their representatives well according to all I have asked.

BOTTOM LINE: If you are an FEP participant, BE CAREFUL!