Lodi Podiatry Group

Review: Did not authorize charges.

Dr.Stroh felt orthotics may help my wifes problem,said he would confirm our insurance coverage for no out of pocket expense to us.United Health Care confirmed no charge to us(9/25/13 [redacted] 877-842-3210 [redacted]).Upon authorization orthotics were molded.United Health Care denied claim saying [redacted] was wrong and they would not pay.[redacted] of Dr.Stroh"s office filed a complaint,(as did my wife and her employer),but the carrier would not pay.Dr. Stroh is billing us for $455.00 but told me they will take $385.00.My wife only agreed to try the orthotics if there was no charge to us,plus they do not work.I feel this is matter for the Dr. and the insurance carrier to deal with,as we never would have agreed with the charge.Desired Settlement: Remove this charge from our account

Business

Response:

This is in response to the complaint by [redacted] and [redacted], regarding the

Date of Service 09/30/2013. We feel that everything that transpired from the

beginning of the process to the denial of the appeal to UnitedHealthcare

insurance that we sent on behalf of the patient [redacted], was done in good

faith. We are attaching the original information that was used to inform the

patient of the options, based on what we had been informed by the

representative from the insurance company. As stated on the sheet the

representative gave the exclusion, needs to be molded, she did not include the

exclusion, only covered if diabetic. The appeal letter that was sent on the

patient' s behalf is also attached. The appeal was sent on 10/9/2013 and we

received the denial on 10/24/2013. We called 877-842-3210 on ll/8/2013 to the

insurance company again. Spoke to Ange! and she stated she is sending the claim

back under the notations that the claim had automatically adjudicated but the

service was:

1. PRESCRIBED BY A DR

2.THEY ARE CUSTOM MADE

3. THERE WAS MEDICAL PURPOSED (MEDICALLY NESSARY)

THEY SHOULD PAY THE CLM- CL REF# [redacted]

We believed that due to the unfortunate circumstances of the erroneous

information that we were originally provided by the representative of uHC

insurance, we were and Bra willing to work with the [redacted]' to make

arrangements to pay for the product they received. When [redacted] picked up the

orthotics she did not voice any complaints at that time. When [redacted] initially came

tO our office she was given forms to read and sign. We printed out the page that

specifically states that she would be financially responsible for all charges

whether or not paid by insurance. Let us finish this up with this statement: Due to

the inability to view the details of each patients policy, it is the responsibility of

the policy holder to know what and what is not covered and the effort that we

make on the patients behalf is always done in good faith and we can only go by

the information the insurance representative gives us.

Thank you,

Medical Billing Specfalist

209-334 6677-Fax

Business

Response:

This is in response to the complaint by [redacted] and [redacted], regarding the

Date of Service 09/30/2013. We feel that everything that transpired from the

beginning of the process to the denial of the appeal to UnitedHealthcare

insurance that we sent on behalf of the patient [redacted], was done in good

faith. We are attaching the original information that was used to inform the

patient of the options, based on what we had been informed by the

representative from the insurance company. As stated on the sheet the

representative gave the exclusion, needs to be molded, she did not include the

exclusion, only covered if diabetic. The appeal letter that was sent on the

patient' s behalf is also attached. The appeal was sent on 10/9/2013 and we

received the denial on 10/24/2013. We called 877-842-3210 on ll/8/2013 to the

insurance company again. Spoke to Ange! and she stated she is sending the claim

back under the notations that the claim had automatically adjudicated but the

service was:

1. PRESCRIBED BY A DR

2.THEY ARE CUSTOM MADE

3. THERE WAS MEDICAL PURPOSED (MEDICALLY NESSARY)

THEY SHOULD PAY THE CLM- CL REF# [redacted]

We believed that due to the unfortunate circumstances of the erroneous

information that we were originally provided by the representative of uHC

insurance, we were and Bra willing to work with the [redacted]' to make

arrangements to pay for the product they received. When [redacted] picked up the

orthotics she did not voice any complaints at that time. When [redacted] initially came

tO our office she was given forms to read and sign. We printed out the page that

specifically states that she would be financially responsible for all charges

whether or not paid by insurance. Let us finish this up with this statement: Due to

the inability to view the details of each patients policy, it is the responsibility of

the policy holder to know what and what is not covered and the effort that we

make on the patients behalf is always done in good faith and we can only go by

the information the insurance representative gives us.

Thank you,

Medical Billing Specfalist

209-334 6677-Fax

Consumer

Response:

Review: [redacted]

I am rejecting this response because: [redacted] Writing:

The form signed in question by me was in the initial new patient packet. This was the first visit and I had not spoken to the Dr's about any type of treatment at this time. This is a standard form given by ALL medical professionals when setting up a new patient. I dispute this form as proof that I authorized any of the disputed charges. When orthotics was mentioned to me as a possible method of treatment I was told by the receptionist that she would call me and let me know what my co-pay would be after she contacted the insurance company. She actually was able to do this while I was still in the office, which at that time, she notified me that they would be covered 100%. I was not surprised since (unfortunately) we had met all of out of pocket maximums by this time. I told both her and the Dr that as long as they would be covered that I would be willing to try them since I was NOT willing to pay for them since it was an "experimental" treatment and they may not work anyway.

I got a call from the receptionist a week or so later (after the orthotics had already been in the process of being made) telling me that the insurance company denied their claim and that infact they were NOT covered and would now be my sole responsibilty. I told her that was not exceptable and again was told by her that it was too late in the process and they were mine. She the told me that I could " just try them out and if they worked we could work something out". I still refused to accept payment respoinsibilty, but again she told me to pick them up anyway since "being a custom product" they could not use them. I did contact my insurance company to try to work it out, but they were unwilling to absorb the costs even though they fully admited the mistake was theirs.

When I tried them on in the Dr's office, I did tell the Dr that they hurt very badly. I was unable to put any weight on my foot while wearing them. He told me at that time to "just try them anyway" and that "they can be adjusted if needed"... I feel that the entire process was handled unprofessionally and that I am expected to absorb the price for that. It is not acceptable to me.

This situation is between the insurance company and the Dr's office. I should not be held responsible for their combined errors. I would have refused to have had them made if there would've been any cost to me other than the office visits and co-pays.

Sincerely,

Consumer

Response:

Review: [redacted]

I am rejecting this response because: [redacted] Writing:

The form signed in question by me was in the initial new patient packet. This was the first visit and I had not spoken to the Dr's about any type of treatment at this time. This is a standard form given by ALL medical professionals when setting up a new patient. I dispute this form as proof that I authorized any of the disputed charges. When orthotics was mentioned to me as a possible method of treatment I was told by the receptionist that she would call me and let me know what my co-pay would be after she contacted the insurance company. She actually was able to do this while I was still in the office, which at that time, she notified me that they would be covered 100%. I was not surprised since (unfortunately) we had met all of out of pocket maximums by this time. I told both her and the Dr that as long as they would be covered that I would be willing to try them since I was NOT willing to pay for them since it was an "experimental" treatment and they may not work anyway.

I got a call from the receptionist a week or so later (after the orthotics had already been in the process of being made) telling me that the insurance company denied their claim and that infact they were NOT covered and would now be my sole responsibilty. I told her that was not exceptable and again was told by her that it was too late in the process and they were mine. She the told me that I could " just try them out and if they worked we could work something out". I still refused to accept payment respoinsibilty, but again she told me to pick them up anyway since "being a custom product" they could not use them. I did contact my insurance company to try to work it out, but they were unwilling to absorb the costs even though they fully admited the mistake was theirs.

When I tried them on in the Dr's office, I did tell the Dr that they hurt very badly. I was unable to put any weight on my foot while wearing them. He told me at that time to "just try them anyway" and that "they can be adjusted if needed"... I feel that the entire process was handled unprofessionally and that I am expected to absorb the price for that. It is not acceptable to me.

This situation is between the insurance company and the Dr's office. I should not be held responsible for their combined errors. I would have refused to have had them made if there would've been any cost to me other than the office visits and co-pays.

Sincerely,