New Claiming Criteria: Prosthetics, Braces and Supports

April 2, 2013
The following was sent by Pacific Blue Cross to members on February 19, 2013.

Prosthetics, braces and supports enable British Columbians facing injury or disability to thrive at home and in the workplace.

Growth of claims for these devices has grown at double digit rates in recent years with broader acceptance of items such as wrist supports. As a result, the insurance industry is increasingly called upon to request more information to support the medical necessity and frequency of these claims.

Beginning March 1, 2013, we will ask all Pacific Blue Cross plan members to include a practitioner’s note with their claims, to support the medical need for these devices.

Members will have a grace period of one year from March 1, 2013, during which they can submit a first claim without a practitioner’s note. Explanation of Benefits statements will include a message advising that future claims will require one.

By March 1, 2014, we will require a practitioner’s note with all claims for prosthetics, braces and supports.

Accepted practitioners include licensed chiropractors, physiotherapists and physicians.

This is not a change to your contract, but simply a change in extended health claims processes. We will also note this change on our CARESnet member information portal.