Here are some important suggestions that have proven beneficial for many Sunny Hills clients.

First, clients need to determine the O&P coverage their insurance plan offers. There can be several alternatives for a custom device in each case, and the level of service each MCO will cover can differ significantly from plan to plan.

Next, even though an MCO may "direct" clients to a specific O&P provider, investigate to see if you actually have a choice. "Many managed care companies contract with more than one O&P provider and should let you choose the firm you want to use from their list," explains Sunny Hills co-owner Randy McFarland, CPO. "Ask for a complete list of approved providers and do some research before you decide which you will be using. There is a difference between providers."

Medicare recipients: Be very careful if you are thinking about assigning your Medicare benefits over to a Health Maintenance Organization (HMO) or an independent managed care company. "You may find, down the road, that you have severely limited your choices for O&P services," McFarland says.

All clients need to ask a lot of questions and get a lot of information from their O&P provider, health care professionals and MCO. The process of understanding device alternatives, setting rehabilitation goals and making financial arrangements needs to be interactive in order to achieve optimum results. Written documentation from your physician, therapists and O&P provider will prove invaluable as MCO clerks need to be able to justify their decisions to their supervisors.

Preauthorization is highly advised (mandatory with many managed care plans) so there won't be surprises in terms of reimbursement/payment from the insurance company.

"O&P providers should be able to explain alternatives and together with the client and physician make a decision as to which device is most appropriate," states McFarland. "We consider desired lifestyle and the function each client needs from their device. Then, we look for the most cost-effective solution and make our recommendation to the insurance company. We find it's beneficial to everyone when we get involved to this degree."

If you feel you are not receiving the level of care or satisfaction you deserve from your O&P provider, speak up.

"Managed care companies truly want clients' feedback about the quality of care their contracted providers are giving. If you don't communicate with them, they'll have to assume you are satisfied," McFarland says.

"While there may be more or less expensive alternatives, we will recommend the most cost-effective prosthesis or orthosis that allows the client to reach his or her rehabilitation goals and live their desired lifestyle," continues McFarland.

In each client's case, a combined commitment from all parties involved will help ensure a win-win-win outcome -- for the client, O&P provider and managed care organization. Sunny Hills feels incumbent to continually take an active role in this partnership.

"Regardless of what "challenges" come your way, don't look at them as "obstacles"... look at them as giving you a new set of "options" and then be "proactive" in your approach. You don't always have to accept what is presented to you. You can contact your government officials to convey your concerns about healthcare or any topic. The following link lets you E-mail messages directly to government officials and lets you access the government at all levels via the Internet.