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Doctor not qualified vs. insurance question??

Posted by Paula G. on 4/09/01 at 07:28 (044053)

I have a question for everyone. we got a statement from our insurance company, which we must call to see what is going on.
I went to a visit in February to my podiatrist, and he casted my foot to get orthotics and also I got night splints from him. I told him if he would write the order for them my insurance would pay.
Anyway, we got a rejection saying he was unqualified in that area. I guess because under description for service it is written 'miscellaneous appliances'. That was what my splints are called. Good grief!
Has anyone had problems getting their insurance to pay for splints or orthotics??

Re: Doctor not qualified vs. insurance question??

Dr. Zuckerman on 4/09/01 at 09:59 (044074)

This usually means that the code that was used can't be used by this type of provider. Doesn't have any thing to do with the ability of the doctor. This is a typical HMO way of making patients go to a specific provider who they have a contract with at a lower rate of payment. We get this alot with x-ray payments. They want the patient to go to a capitated radiologist center that they already have worked out a group discount.

Re: Thanks... get through one day with no self-focusing!

Paula G. on 4/09/01 at 10:22 (044077)

Thanks. I think it was all just billed wrong. I just picked up the copy and I was wrong what I stated before, sorry. For the casting of the orthotic and getting the night splints it says under service description 'unlisted proc. casting...miscellaneous appliances.'
Sounds like a billing problem was all.
Anyway...appreciate all your answers you give. Now today I told Valerie I am going to try to get through the 24 hours with no self-focusing...Not saying to my poor hubbie how my feet hurt! Seems I say that all the time!
This problem becomes a way of life. You can think of nothing else. You don't want to go anywhere anymore where you know you have to walk...I find myself at times sitting on the bottom shelf of the aisle at stores even!!

Re: My husband deserves a medal

Valerie S on 4/09/01 at 20:05 (044133)

Hi Paula.

Regarding complaining to your husband: My husband deserves a medal for putting up with my mood swings!

I hope you don't mind my saying so, but I got a little chuckle visualizing you sitting on the bottom shelf at the grocery store. Not meaning to find humor at your expense... I can really relate, I am in such a bad way today.

Take it easy.
Val.

Re: My husband deserves a medal

Paula G. on 4/10/01 at 09:03 (044159)

That's okay...It is quite funny when I sit down like that. Usually it is when hubbie is looking at something. it is so hard to just stand. You sit where you can get a seat right? Look out old ladies!! Get off that bench, I need to sit down!!
Wanna hear of a nice exercise that helps?? Laying in the tub full of nice hot water....Lean back and I put both feet on the control knobs and flex..
Oh....that is so soothing to the back of my legs......

Re: Doctor not qualified vs. insurance question??

Dr. Zuckerman on 4/09/01 at 09:59 (044074)

This usually means that the code that was used can't be used by this type of provider. Doesn't have any thing to do with the ability of the doctor. This is a typical HMO way of making patients go to a specific provider who they have a contract with at a lower rate of payment. We get this alot with x-ray payments. They want the patient to go to a capitated radiologist center that they already have worked out a group discount.

Re: Thanks... get through one day with no self-focusing!

Paula G. on 4/09/01 at 10:22 (044077)

Thanks. I think it was all just billed wrong. I just picked up the copy and I was wrong what I stated before, sorry. For the casting of the orthotic and getting the night splints it says under service description 'unlisted proc. casting...miscellaneous appliances.'
Sounds like a billing problem was all.
Anyway...appreciate all your answers you give. Now today I told Valerie I am going to try to get through the 24 hours with no self-focusing...Not saying to my poor hubbie how my feet hurt! Seems I say that all the time!
This problem becomes a way of life. You can think of nothing else. You don't want to go anywhere anymore where you know you have to walk...I find myself at times sitting on the bottom shelf of the aisle at stores even!!

Re: My husband deserves a medal

Valerie S on 4/09/01 at 20:05 (044133)

Hi Paula.

Regarding complaining to your husband: My husband deserves a medal for putting up with my mood swings!

I hope you don't mind my saying so, but I got a little chuckle visualizing you sitting on the bottom shelf at the grocery store. Not meaning to find humor at your expense... I can really relate, I am in such a bad way today.

Take it easy.
Val.

Re: My husband deserves a medal

Paula G. on 4/10/01 at 09:03 (044159)

That's okay...It is quite funny when I sit down like that. Usually it is when hubbie is looking at something. it is so hard to just stand. You sit where you can get a seat right? Look out old ladies!! Get off that bench, I need to sit down!!
Wanna hear of a nice exercise that helps?? Laying in the tub full of nice hot water....Lean back and I put both feet on the control knobs and flex..
Oh....that is so soothing to the back of my legs......