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Ruby is a 59-year-old woman who has been referred for evaluation at the hand therapy clinic following a right Colles’ fracture. Ruby’s health insurance is run by a Health Maintenance Organization (HMO). What will the OT have to do before she can initiate treatment with Ruby?
A. Inform Ruby that she will have to pay privately for OT services since HMOs do not cover occupational therapy.
B. Contact Ruby’s case manager from the HMO to gain prior approval for services.
C. Bill for services as usual because HMOs always cover occupational therapy services.
D. Write a prescription to Ruby’s physician for 6 sessions as that is the limit covered by HMOs.

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Posted by (Questions: 108, Answers: 97)
Asked on September 11, 2017 7:31 am
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B

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Posted by (Questions: 0, Answers: 8)
Answered on October 5, 2017 5:38 pm
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B

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Posted by (Questions: 0, Answers: 9)
Answered on September 21, 2017 3:25 pm
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Answer: B. Contact Ruby’s case manager from the HMO to gain prior approval for services. HMOs use case managers to review and approve payment for all medical services provided, including occupational therapy services. The OT must show the case manager that OT services are medically necessary and reasonable or the case manager may not approve payment.

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Posted by (Questions: 108, Answers: 97)
Answered on September 11, 2017 7:32 am
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