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Home
About
About FPMA
Florida Podiatric Medical Society (FPMS)
Florida Podiatry Political Committee (FPPC)
Florida Foot & Ankle Fellowship Society (FFAFS)
FPMA Corporate Affinity Partners
FPMA Contact Info/Staff
FPMA Leadership
FPMA Committees
Join
Join FPMA
Member Benefits
Apply for Membership
Conferences
SAM 2025
FPMA Conferences
Future SAM Conference Dates
Future FPMA Summer Conference Dates
Conference Archives
Education
Education
Online Courses for FPMA Member Staffs
FPMA Young Member Seminar Series
Current Biennium Information
First Biennium Renewal for Podiatric Physicians
X-Ray Assistant Initial Licensure
X-Ray Assistant Recertification
DPM Resources
Advocacy
OPEIU Local (GUILD 45) Health Care Plans
Health Care Clinic Establishment (HCCE) Permit
Podiatric Links
FPMA Member Benefits
Public Affairs
Public Affairs
FPMA Footprints Magazine
Diabetic Foot/Shoes Outreach Project
DPM Mentors/Student Recruitment
Falls Prevention Resources
ADA Step Out Walks/Tour de Cure
Request Presentation Materials
FPMA Blast Emails
FPMA Videos
Careers
FPMA Career Center
Podiatric Education/Career Info
Considering a Career in Podiatry?
Podiatric Medical Students
Podiatric School Grads/Residents
New Podiatric Practitioners
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FPMA Insurance Complaint Form
The FPMA Insurance Complaint Form is available to FPMA members who need assistance with various insurance matters. Once you complete and submit the form, it will be provided to Dr. Mark Block, Chairman of the FPMA Committee on Insurance Affairs, who will try to assist you with the issue you reported. Please complete the information below and provide details about your situation.
*
- Required Field
First Name *
Last Name *
Email *
Employer *
APMA Member Number *
Address *
Telephone number *
Health Plan *
Plan Type *
Select all that apply
PPO
HMO
POS
Indemnity
Workers' Comp
Medicare HMO
ERISA/Self-Funded
Medicare Advantage Plan
Other
If you selected "Other" above, please enter the information below.
Type of complaint *
Select all that apply
Denial of referral
Denial of care
Denial of pre-authorization
Denial of payment after pre-authorization
Denial of CPT modifier
Incorrect application of CPT modifier
Incorrect or partial payment (per contracted fee schedule)
Coordination of benefit issue
Lost claims by payer
All products clause
Request for extensive documentation
Late payments
Continuous medical review referrals
Non-itemized explanation of benefits
Payment below contract schedule
Payment of different rates than MD/DOs
Failure to list membership in plan directory; listing of podiatrist in section apart from MD/DOs
Inappropriate modification of originally submitted CPT code
Inappropriate downcoding of originally submitted CPT code
Inappropriate bundling of services/procedures
Denial of procedure, service, or test CPT code; item/supply HCPCS code
Failure to follow general CPT guidelines/CMS guidelines
Automatic denial of code(s)
Incorrect application of CPT modifier
Incorrect re-coding of procedure/service
Other
If you selected "Other" above, please enter the information below.
Brief description of complaint, codes (original, modified, bundled), etc. *
Have you contacted *
Select all that apply
The payer in question?
Your state podiatric medical association?
Your state Department of Insurance?
The Department of Consumer Affairs?
Other?
If you selected "Other" above, please enter the information below.
If you have any additional information to report, please provide it in the section below.
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