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DEEOIC Explains Medical Benefits During Webinar

April 26, 2021

April 26, 2021

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The Division of Energy Employees Occupational Illness Compensation (DEEOIC) held a very informative webinar about medical benefits on April 21, 2021.  Doug Pennington, Deputy Director, and Lance Lanier, Chief, Branch of Medical Benefits presented.

The presentation stressed that only conditions approved by DEEOIC are eligible for benefits.  These benefits include durable medical equipment (DME), home health care (HHC), therapies, home or auto modifications.  The also stressed that DEEOIC is not a comprehensive insurance like Medicare.  This means that DEEOIC does not tell a claimant that a test is not necessary.  They do, however, make sure that the ordered test is only for the covered condition and supported by the clinical evidence.

Most procedures and even surgeries for the covered condition do not need preauthorization.  If a provider has a bill denied by DEEOIC the cause is usually using the incorrect ICD code or not providing the correct documentation.  It was suggested that if a provider is in doubt about whether a procedure is covered that they reach out to the Medical Benefits office to discuss.

There are some surgeries that require preauthorization.  Organ transplants is one.  Experimental treatments also require preauthorization.

Requests for HHC, DME, home or auto modifications and therapies such as massage and physical therapy also require preauthorization.  All will require a letter from the treating physician explaining why a service or equipment is necessary for the covered condition.  For example, a person with COPD can no longer walk a long distance and needs a wheelchair.  The home needs to be modified for a ramp. DEEOIC will pay for both the wheelchair and the ramp after the physician’s Letter of Medical Necessity is provided along with supporting documents.

Bear in mind DEEOIC will not pay for a complete remodel of the front of your house to match the ramp but they will pay for a medically required ramp to access your home.  Likewise, they will only pay for the amount of time a HHC employee provides services not the amount DEEOIC authorized.

DEEOIC’s webinars are filled with important and practical information about the program.  Until next webinar…!