Very recently I have seen multiple practices in different states receiving retrospective Anthem refund requests for previously paid custom orthotics (L3000), including claims from 2024 and 2025.
Interestingly, the diagnosis codes are not consistent, but the refund notices contain the exact same explanation: “This plan does not cover this care or service.”
I suggest that you do not automatically issue a refund. Instead, review the patient's benefit plan in effect on the date of service and consider disputing the request.
Respond in a timely manner and ask Anthem to identify the specific benefit-plan provision that excluded L3000 on the date of service and the specific basis for classifying the original claim as a provider billing error.
I will continue to monitor these requests to determine whether they represent a broader retrospective Anthem payment-integrity review. Stay tuned. . .
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