Doctor's bill - WWYD?
is it possible that its covered but you are still meeting your deductible?
oots said:
is it possible that its covered but you are still meeting your deductible?
Nope, unfortunately. My insurance claim says custom orthotics are not covered, period.
Sorry you have to deal with this. Call them or write a letter. Many doc's offices will work with you to spread the cost out over several payments or, perhaps put it on a credit card to do the same. They might even lower the cost to what they generally get if the orthotics are covered under insurance company schedules.
I've never known custom orthotics to be covered by insurance. I paid $400 in the mid 80's. So the price is about right. I think complaining that you were expecting a response from them about the insurance first would be appropriate. However, once they take a mold of your feet, I am not sure they are going to cut the price. Just saying this, so you are not surprised if they do not cut any of the cost.
Do you have a pre-existing condition that might make custom orthotics medically necessary? If so, the doctor may be able to generate some paperwork that would reduce or eliminate the cost for you. It is worth asking if this applies in your case.
I have to wonder if doctor's offices somehow get something every time they order a pair of orthotics for a patient. When I went to a podiatrist last summer, they were talking orthotics before I was even examined. They also said that they would confirm that my insurance covered them and then contact me before ordering them. In fact, my insurance does cover them, but I was never contacted - the orthotics were ordered. As it turns out - they made things worse and I don't wear them. I had much better luck with physical therapy. It seems like EVERYONE gets "prescribed" orthotics. So sorry about the trouble. I hope, at least, the orthotics helped.
Leealli said:
I have to wonder if doctor's offices somehow get something every time they order a pair of orthotics for a patient. When I went to a podiatrist last summer, they were talking orthotics before I was even examined. They also said that they would confirm that my insurance covered them and then contact me before ordering them. In fact, my insurance does cover them, but I was never contacted - the orthotics were ordered. As it turns out - they made things worse and I don't wear them. I had much better luck with physical therapy. It seems like EVERYONE gets "prescribed" orthotics. So sorry about the trouble. I hope, at least, the orthotics helped.
^ this. Honestly, I think some offices do this on purpose. At a minimum, I would let them know you are seriously unhappy about how this was handled.
was it a podiatrist whose name starts with an E and ends with a glow? Same thing happened to me. Never mind, I see you said SHE and this is a HE.
After one visit, when I went because my feet had been bothering me, I was told I needed $$$$ custom orthotics. They assured me they contacted my insurance and they were covered. My insurance said they would never have said that because they are not. I never picked them up. And never heard from them again. I'd also never go back.
I think my foot pain was related to child birth. I did get some orthotics eventually, from the walking store. And also a pair that mold to your feet, from the running factory. Ultimately I started wearing LESS supportive shoes, (for awhile vibram five fingers and then minimalist running shoes) and doing more yoga which helped strengthen the small muscles in my feet. Now my feet very rarely hurt unless if I wear 5 inch heels
The letter won't get passed the office administrator who is the one that screwed up. Did you try to appeal to your insurance? Insurance often rejects things hoping people won't appeal. I used to have to report my HMO to the state insurance board for every claim...even routine things like yearly physical-because they would deny claims and appeals.
My guess is the doctor's office will just say it was ultimately your responsibility.
Mine were covered 100% 15 years ago when I had 'traditional' insurance. Many do cover -maybe as durable medical equipment...but you may need a specific deformity..not just flat feet...in my case I have severe OA from my foot being crushed 30 years ago.
Once they take the mold, they can just charge you for the mold-not the orthotics if you cancel them.
dr scholls makes those semi custom orthotics that are $50....bed bath and beyond used to have them in some stores....you could use a 20% coupon...and they are good about returns if you don't like them....they aren't as good as the custom ones you get from a doc IF YOU REALLY NEED THEM...but if you just have a common flat foot issue they may be good enough.
The thing is that I already have them. When I picked them up, I actually even asked if there was a co-pay and the front desk said there must not be if there wasn't a charge on the account - I realize it's not her fault/decision but honestly I didn't think much of it otherwise. I just assumed they were covered, until I got the bill. By the way, this was back in July and I just got the bill. So I've been wearing them for months. I definitely might have opted for the Dr. Scholls or similar if I had known I was going to have to pay this much.
This may be a dumb question but how would I appeal to Aetna? I just looked up the claim info and the denial code says "Remarks: Orthopedic shoes, foot orthotics, or other devices to support the feet are excluded from coverage under your plan." Doesn't seem like there's much wiggle room there...
It does say the Aetna "member rate" would be $250, so maybe I can at least try to get the office to reduce it to that.
what does Aetna member rate mean? Heck, yeah, pursue that. I doubt you will get anywhere with the doctor's office if what MJH says is true.
PeggyC said:
what does Aetna member rate mean? Heck, yeah, pursue that. I doubt you will get anywhere with the doctor's office if what MJH says is true.
I believe that means the contracted rate they would pay the doctor IF they were covered
In my experience, the Aetna rate is the rate the patient pays as a result of being part of a network like Aetna. This generally applies if you have a HDP (high deductible plan) where you get basic preventative care but then all other medical is paid on a fee schedule that is greatly reduced by being part of the plan. So, if I see a dermatologist, his rate might be $300 a visit but the Aetna negotiated rate is $110 so that's what I pay and then the $110 counts towards my annual deductible.
I would definitely pursue that $250 Aetna rate- sounds like your best bet.
I would not accept the statement from your doctor's office that the orthotics were covered by your insurance as being accurate, especially if the benefits for your plan specifically excludes orthotics. Is the plan information you consulted generic or does it pertain exclusively to your specific plan? If the former, it may be that the $250. rate quoted is for those plans that do cover orthotics.
If it were me, I would begin by calling the customer service number on the back of my insurance card and discussing the matter with them. This would be the best way of determining whether (a) your particular diagnosis would allow for coverage under another section of your policy; and (b) whether you should only have been charged the "member rate."
joan_crystal said:
I would not accept the statement from your doctor's office that the orthotics were covered by your insurance as being accurate, especially if the benefits for your plan specifically excludes orthotics. Is the plan information you consulted generic or does it pertain exclusively to your specific plan? If the former, it may be that the $250. rate quoted is for those plans that do cover orthotics.
If it were me, I would begin by calling the customer service number on the back of my insurance card and discussing the matter with them. This would be the best way of determining whether (a) your particular diagnosis would allow for coverage under another section of your policy; and (b) whether you should only have been charged the "member rate."
Thanks. It was definitely denied. I looked up the specific claim information wih Aetna.
this sounds like a pre-planned scam to me. They know people can't afford stuff like this without insurance. I would return them with a letter stating they led you to believe they were covered and that you only agreed under those circumstances. The problem for podiatrists is that not much of their bread and butter services are covered by insurance. Google the docs name and see if others have made the same complaints. And follow up your letter with a complaint to their regulator.
RobinM2 said:
this sounds like a pre-planned scam to me. They know people can't afford stuff like this without insurance. I would return them with a letter stating they led you to believe they were covered and that you only agreed under those circumstances. The problem for podiatrists is that not much of their bread and butter services are covered by insurance. Google the docs name and see if others have made the same complaints. And follow up your letter with a complaint to their regulator.
+1
joan_crystal said:
What explanation was given for denying the claim?
"Orthopedic shoes, foot orthotics, or other devices to support the feet are excluded from coverage under your plan."
I would call. If calling doesn't work, then I'd write. I had an issue with a podiatrist and I called. They told me to ignore the bill.
marylago said:
I would call. If calling doesn't work, then I'd write. I had an issue with a podiatrist and I called. They told me to ignore the bill.
Just curious, who did you speak to? I'm not sure who the right contact would be. There's not a billing phone number on the bill, just the office number.
I spoke to the office. I just get the feeling that podiatrists are a little shady. I don't know why...
yahooyahoo said:
Dispute the bill and file a complaint with the FTC.
I'm not sure if I really have a leg to stand on as far as a formal complaint... as a new patient I did sign the form that agrees to pay anything not covered. I just expected the courtesy of letting me know it wasn't covered - as they said they would - before they ordered an expensive item on my behalf.
TarheelsInNj said:
yahooyahoo said:
Dispute the bill and file a complaint with the FTC.
I'm not sure if I really have a leg to stand on as far as a formal complaint... as a new patient I did sign the form that agrees to pay anything not covered. I just expected the courtesy of letting me know it wasn't covered - as they said they would - before they ordered an expensive item on my behalf.
If they said/implied that they would let you know, and then failed to do so, you have a legitimate complaint and you should make that complaint. It remains to be seen what will result, as your probably don't have a "contractual" right here, but it is an ethical breach on their part in my opinion, so you should definitely let them know.
You need to look at the paperwork because you very well may have a right. You can break this down into the usual contract law fact patterns - ie. what contract covered the scenario? If you have any friends who practice in NJ, you might want to bounce this scenario off them for suggestions for how to lead them to a settlement.
sac said:
TarheelsInNj said:
yahooyahoo said:
Dispute the bill and file a complaint with the FTC.
I'm not sure if I really have a leg to stand on as far as a formal complaint... as a new patient I did sign the form that agrees to pay anything not covered. I just expected the courtesy of letting me know it wasn't covered - as they said they would - before they ordered an expensive item on my behalf.
If they said/implied that they would let you know, and then failed to do so, you have a legitimate complaint and you should make that complaint. It remains to be seen what will result, as your probably don't have a "contractual" right here, but it is an ethical breach on their part in my opinion, so you should definitely let them know.
Even if the complaint doesn't go anywhere, the podiatrist will think twice next time (hopefully).
If you 'settled up' at the doctor's office when you picked them up, it would seem that you've got a legitimate complaint against their office. I wouldn't bother with the insurance part of this as it seems you're not covered.
I'd go with
" When I picked this up, I asked if there was a charge and your representative said 'no'" I'm not paying for it. You can have them back if you want them. "
see where that leads you.
I'd love some advice for how to address this situation with my doctor.
I visited a podiatrist a few times over the summer and at one visit she recommended custom orthotics. I was fitted for them and she said they would check with my insurance before they ordered them so they wouldn't be too expensive. They apparently did not do this, but ordered them anyway, and the orthotics are not covered. So I got a bill for $500.
I understand that I sign something with the doctor that says I'll cover all costs. But I'm really frustrated they didn't at least let me know before they ordered, because I may not have even decided to get them. I assumed since I didn't hear anything, they were covered. They didn't charge me a co-pay or anything when I picked them up.
I'd like to write a letter to the doctor in hopes that they'll at least work with me on the cost. Has anyone been in this situation? What worked for you? How should I word it?