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What would you guys do in this situation?

Posted by Nancy N on 5/31/01 at 19:57 (049509)

Hi, everybody. I'll try to make this short, since it is a source of major annoyance to me and I don't want to put you through all of it!

Anyway. In January 2000, I got my first pair of custom orthotics from my pod. These were the ice-scrapers that I paid $280 for. I could never wear them for more than a week without being worse off than before, but that's a side issue. I paid for them out of my pocket because I thought, at the time, that my insurance would not cover them. The $280 was a discounted rate because I was paying for them myself.

In July of 2000, I was talking to my insurance company any found out that, in fact, the orthotics should have been covered completely. I called the doctor's office, explained the situation, and picked up a bill I could send in for an insurance claim to get my money back. The amount on the bill was the $280. At this point, my pod had left the group and I hadn't been back to their office in quite a while.

August 2000--I get a check for $110 and change from the insurance company. I call them up to find out what the deal is, and they tell me that I need to get the rest back from the doctor's office. And so the nightmare begins--I call the doctor's office, and of course I get nowhere. They tell me that they can't do anything because the amount on the claim was the discounted rate, and not what they'd have billed the insurance company for (which would have been $350). I send certified mail to their billing company, etc, and get nowhere.

Finally, early this year, they send in a new claim for the full amount, which of course has really confused things. Last month, I get a check from the insurance company for another $37, and I'm still baffled. I decide to wait a few weeks to see if I hear anything from the doctor's office. I should mention here that the woman I am dealing with is surly, rude, and downright mean-spirited and succeeds in ticking me off in a really BIG way. She even accuses me of deliberately trying to cheat them out of the money they'd have received from the insurance company, even though THEY were the ones who gave me the bill in the first place!

Never heard anything, so I called the insurance company yesterday to find out what I should be expecting from the doctor's office. They tell me that the $147 I've received is their contracted rate with the doctor's office, and that I need to get the balance of my $280 back from the doctor. (Why they are dealing with me instead of the doctor is beyond me--maybe because I sent in the original claim??)

So.... I call this awful, surly woman again this morning and tell her what the insurance folks told me. It takes her a minute to remember me, but then her nasty old self comes back out, and she tells me that she spent DAYS working on this because I screwed it up the first time and that the insurance company told her that they'd take it from there, that she shouldn't do anything else, and that the $147 must be all I'm going to get back from them (even though I shouldn't have paid anything in the first place!). Then, to top it all off, she tells me that she's spent too much time on it already and she's not spending any more on it because it's just not worth it, whereupon I informed her that it's worth a lot of money to me (I can think of some things to do with $133!!). She repeated (ad nauseum) that it just wasn't worth it to her and that the only way she'd do anything else for me was if she received a letter from the insurance company saying telling her what she had to do. She would not even agree to get in touch with the people she'd dealt with at the insurance company. I told her that I would do that if she would tell me who I needed to talk to, though I think I may just call their Provider Relations number tomorrow and make a stink.

So, given all this, and the rise in my blood pressure every time I deal with these people, here's my question. This battle-axe told me she would swear to the doctor in the practice that she had told me she wasn't doing anything more for me, if I felt like complaining to him. I am seriously contemplating sending him a letter about her--he is a respected podiatrist around here and most people with foot problems seem to know who he is. Since my initial run-in with this woman earlier this year, I have told people not to go there because of the trouble I've had, and I am thinking that perhaps he should know that his staff is awful enough for patients to be warning people away from their office.

But at the same time, I am not sure if it is worth it to me to go through the aggravation of doing this or not. It may be more hassle than it's worth, but I also don't want anyone else to have to go through this kind of anguish.

What do you think? If you were in my shoes, what would you do? If you were the doctor, would you want to know?

I really appreciate your thoughts on this one. Thanks in advance.

Re: What would you guys do in this situation?

Cynthia D on 5/31/01 at 21:56 (049515)

Hey Nancy, sorry you had to go through that episode! I was thinking forget the whole episode that it's not worth the aggravation because you had in your mind initially written off the cost of your 'ice scrapers'. But in reading on, my blood got heated up, too. Maybe just writing (or printing this) up for the podiatrist would be all you should do. Letting him know he is being represented in a surly way would surely help others. Perhaps he may just tell her to give you your money back, too! After that, I wouldn't waste any more energy on it and just concentrate on the good things in your life now (like planning on getting to London). Sometimes just writing things out helps to get it out of your system so you can move on. Good luck.

Thanks for all your support these past few days!

Re: What would you guys do in this situation?

Ddr. Zuckerman on 6/01/01 at 00:13 (049534)

Tell the guy what is on your mind. Very strange why the insurance company doesn't handle this. It is their job not yours!!

Re: What would you guys do in this situation?

Dr. Zuckerman on 6/01/01 at 00:15 (049535)

I will also bet you that the orginal bill is wrong and the payment is per foot. They forgot to put two units in the unit part of the HCFA form. or the insurance Co. didn't look to see that it is per foot. Very common for the insurance company to do this.

Re: What would you guys do in this situation?

Laurie R on 6/01/01 at 00:20 (049536)

Hi Nancy, I have to agree with Dr.Z... PLEASE don't let this go. Down the road you may even be helping a lot of people ..Write the letter,better yet call and talk to the Pod... I would have no problem geting someone like her in trouble if she disrespected me like she did you... She needs to be put in her place.... I bet she is the type of person that is sweet as can be to the doctors but when they are not around she thinks she is the boss..Right?? I know this is upsetting but maybe she has treated people like this is the pass and they did not do anything about it and that is why she is doing it to you. Thi sis something you paid for ,you deserve 'Your' money back.Nancy the way I look at it is ,it does not matter if is 1.00 or 1.000 it is your money....

Let us know what you decide to do ..Laurie R

Re: What would you guys do in this situation?

karenc on 6/01/01 at 09:24 (049561)

Of course you would never sue someone over $133 BUT, if you have any attorney friends that would give you 15 minutes, often times a NICE, short note on an attorney's letterhead, simply explaining that SURELY there is some misunderstanding, will help (not an 'I'm going to sue you' letter - they know you won't). I HATE to even suggest this, but I am an attorney (in Texas - don't know where you are), and the bottom line is that often times, neither insurance companies nor doctor's, etc. find it worth their time until it reaches that point. then they say, ok, now I'll deal with it.

And again, $133 is $133. and you got ripped off and treated badly. Don't spend the rest of your life righting the wrong, but following up a bit more doesn't make you the bad guy. Good luck. By the way, I just got my $250 orthotics (not covered by insurance but reimbursed on my flexplan). Anyway, I've only had them a week and my feet hurt the same if not worse. I'm so frustrated and don't know if I keep wearing them, get new ones, scrap them, etc.

Re: What would you guys do in this situation?

JudyS on 6/01/01 at 10:12 (049568)

So Karen, would you write a letter for me to my neighbor who is running a combination junk yard and auto repair business about 20 feet from my bedroom window and back deck? :)
Karen, did you give those new orthotics some 'breaking in' time? That's usually about an hour a day for a few days then increasing time over a few weeks. Like everything else with PF, even using orthotics requires an endless amount of patience!

Re: What would you guys do in this situation?

Valerie S on 6/01/01 at 10:51 (049582)

Hi Judy and Nancy...

Nancy:
I vote you write a letter to your doctor, or talk to him, whatever way is easier for you to express yourself. He is running a business, and deserves to know what your experiences have been. I am a little peeved by a nurse at my pod's office, and have considered the same... but she's just incompetent. At least she's nice. I really CAN'T STAND poor service! Really!

Judy:
My uncle has the same problem, and he put up some pine trees between his house and the neighbors... or privacy hedges -- get the tall ones! hee hee. You never know... they might also be stockpiling ammo in the basement, so you might want to be a little more subtle about confronting them! hee hee.

Take it easy... Val.

Re: Oine trees - and hassles

Julie on 6/01/01 at 11:11 (049589)

But Judy, be careful with Leylandii. They grow enormously high very quickly and are very hard to keep under control. As we know to our cost (the high cost of paying someone to chop them back for us every year). But they have protected us from our somewhat unpleasant neighbours for the last 15 years, so we're not complaining.

Nancy, give the doctor the facts and then put this thing behind you.

Re: Oine trees - and hassles

Julie on 6/01/01 at 11:12 (049590)

Sorry. A touch of the Wendys. I meant pine trees not oine trees.

Re: Oine trees - and hassles

Valerie S on 6/01/01 at 11:22 (049592)

hee hee... I was thinking, oine trees... what are those? Must be a British thing... hee hee. You're too funny. amazing how a little typo can make you laugh so ... thanks, Julie.

Re: Oine trees - and hassles

Julie on 6/01/01 at 12:15 (049596)

Glad I gave you a laugh, Val.

Re: Thanks, everyone.

Nancy N on 6/01/01 at 17:09 (049626)

Here's my update on this problem. I called my insurance company back today, figuring if I wait for this woman to tell me who she talked to, I could be old and grey. I have to say that I have never ever had a problem with the people who answer at United Healthcare--they have, every single one of them, been fantastically helpful. The woman I spoke to today told me that they don't have a standard letter they can send out, but she tried to call the doctor's office instead and conference me in, but she was on hold so long that she had to give up and would try again later, and let me know what happened. (I told her how this woman had treated me before and we both agreed that she may not have wanted to answer the phone when she heard it was someone from UHC!)

I asked her why the money was sent to me and not the doctor. She says that, unless there is any payment outstanding, they sent the money to the patient because the patient has already paid. She also told me that this is in the contract the provider signs with UHC and that it is a violation of that contract for the doctor's office to withhold my money.

So... I am hoping that she will manage to get in touch with this woman and work everything out. There's a part of me that is tempted to make a real nuisance of myself and tell this woman that the one guaranteed way to make me go away is to return my money (and it's all I can do not to tell her I want 3% interest on it, too--they've had my money for 18 months now). But I am hoping that the insurance company can put the fear of God into her and take care of it all without me having to do anything else.

I am going to write a letter to the doctor(s) in this group to let them know what this woman is like. It could be a long writing weekend!

Oh--thanks for the legal suggestion, Karen. The only lawyer I know is retired, so I don't know if she would be able to help, but she might know someone who could. I'll wait and see what happens with the insurance company before I go that route, though.

Thanks again for your input. I really appreciate it.

Re: on neighbors and new pf devices

karenc on 6/04/01 at 09:55 (049829)

First of all, good for you that you're making progess. I had United before and they were nice, too. It's just a sad state of affairs that lawyer letters are ever even necessary.

Anway, can't remember who in line it was (Judy, was it you?) regarding the neighbor, and I don't know where you live, but have this elderly woman living alone next to us, who occassionally would take in sort of transient types for yard work, etc. to help them along. At some point, this woman started living with her and next thing we knew was running a tow truck company from her home. We live in a modest neighborhood w/ relatively small houses (well under 2000 sf - maybe more like 1500), so the yards and lots and all are small). Anyway, everyday, maybe at 5 am., 6 am, 7 am, or at 11 pm, all during the day, there were bright yellow 'Toe Jam' tow truck(s) running loudly outside her house (and therefore ours), w/ the guys waiting for their next job. I've actually seen these trucks (now, all the time) and it's quite legit, it's just that she was operating it from this woman's house. Anyway, it got resolved b/c we have this other elderly woman (dare I say a battle axe?) who has for 20 years sort of been the organizer for any neighborhood issues and is big buddies w/ all the folks at the city. so, I went through her first and there was some zoning restriction and they found it - end of story (though it actually took several months), the tow truck business is gone, but it was really difficult. Sorry, I got off on a tangent, but I know others who have had zero luck getting old cars and stuff out of front yards. but often times w/ 'businesses' being run out of the home, depending upon what it is, there are zoning restrictions, necessary permits, etc. - key is to find someone at the city who is sympathetic and knows the ins and outs (easier said than done), then get them on the neighbor rather than you. We had folks selling drugs next to us at one point and I was too scared to call the cops for fear of retribution and finally they moved - so now we have a great neighbor who's clean but w/ dogs that bark all night. Who knows.... good luck and sorry for the long post.

Oh, yea - pf - forgot - as for the orthotics, I did try to break them in and they are better now, but not great. I thought maybe I needed new running shoes to put them in, b/c they look all beat up, but even the shoe salesman said I probably had a few more months on them and didn't need a new pair now. Maybe I just want to throw my cash away, b/c I just keep thinking my feet should feel all soft on the ground w/ the new orthotics and they're not. However, one poor guy working there got pf during the Olympic trials a few years ago - how sad for him - but he bought this $15 thing out of a magazine that basically works like taping (only it's one piece and you just take it on and off, so less time, etc.) - he said it really got him on the road to recovery - have any of you all tried it? I got the numer and am going to order it today. I'll keep you posted.

Re: What would you guys do in this situation?

Cynthia D on 5/31/01 at 21:56 (049515)

Hey Nancy, sorry you had to go through that episode! I was thinking forget the whole episode that it's not worth the aggravation because you had in your mind initially written off the cost of your 'ice scrapers'. But in reading on, my blood got heated up, too. Maybe just writing (or printing this) up for the podiatrist would be all you should do. Letting him know he is being represented in a surly way would surely help others. Perhaps he may just tell her to give you your money back, too! After that, I wouldn't waste any more energy on it and just concentrate on the good things in your life now (like planning on getting to London). Sometimes just writing things out helps to get it out of your system so you can move on. Good luck.

Thanks for all your support these past few days!

Re: What would you guys do in this situation?

Ddr. Zuckerman on 6/01/01 at 00:13 (049534)

Tell the guy what is on your mind. Very strange why the insurance company doesn't handle this. It is their job not yours!!

Re: What would you guys do in this situation?

Dr. Zuckerman on 6/01/01 at 00:15 (049535)

I will also bet you that the orginal bill is wrong and the payment is per foot. They forgot to put two units in the unit part of the HCFA form. or the insurance Co. didn't look to see that it is per foot. Very common for the insurance company to do this.

Re: What would you guys do in this situation?

Laurie R on 6/01/01 at 00:20 (049536)

Hi Nancy, I have to agree with Dr.Z... PLEASE don't let this go. Down the road you may even be helping a lot of people ..Write the letter,better yet call and talk to the Pod... I would have no problem geting someone like her in trouble if she disrespected me like she did you... She needs to be put in her place.... I bet she is the type of person that is sweet as can be to the doctors but when they are not around she thinks she is the boss..Right?? I know this is upsetting but maybe she has treated people like this is the pass and they did not do anything about it and that is why she is doing it to you. Thi sis something you paid for ,you deserve 'Your' money back.Nancy the way I look at it is ,it does not matter if is 1.00 or 1.000 it is your money....

Let us know what you decide to do ..Laurie R

Re: What would you guys do in this situation?

karenc on 6/01/01 at 09:24 (049561)

Of course you would never sue someone over $133 BUT, if you have any attorney friends that would give you 15 minutes, often times a NICE, short note on an attorney's letterhead, simply explaining that SURELY there is some misunderstanding, will help (not an 'I'm going to sue you' letter - they know you won't). I HATE to even suggest this, but I am an attorney (in Texas - don't know where you are), and the bottom line is that often times, neither insurance companies nor doctor's, etc. find it worth their time until it reaches that point. then they say, ok, now I'll deal with it.

And again, $133 is $133. and you got ripped off and treated badly. Don't spend the rest of your life righting the wrong, but following up a bit more doesn't make you the bad guy. Good luck. By the way, I just got my $250 orthotics (not covered by insurance but reimbursed on my flexplan). Anyway, I've only had them a week and my feet hurt the same if not worse. I'm so frustrated and don't know if I keep wearing them, get new ones, scrap them, etc.

Re: What would you guys do in this situation?

JudyS on 6/01/01 at 10:12 (049568)

So Karen, would you write a letter for me to my neighbor who is running a combination junk yard and auto repair business about 20 feet from my bedroom window and back deck? :)
Karen, did you give those new orthotics some 'breaking in' time? That's usually about an hour a day for a few days then increasing time over a few weeks. Like everything else with PF, even using orthotics requires an endless amount of patience!

Re: What would you guys do in this situation?

Valerie S on 6/01/01 at 10:51 (049582)

Hi Judy and Nancy...

Nancy:
I vote you write a letter to your doctor, or talk to him, whatever way is easier for you to express yourself. He is running a business, and deserves to know what your experiences have been. I am a little peeved by a nurse at my pod's office, and have considered the same... but she's just incompetent. At least she's nice. I really CAN'T STAND poor service! Really!

Judy:
My uncle has the same problem, and he put up some pine trees between his house and the neighbors... or privacy hedges -- get the tall ones! hee hee. You never know... they might also be stockpiling ammo in the basement, so you might want to be a little more subtle about confronting them! hee hee.

Take it easy... Val.

Re: Oine trees - and hassles

Julie on 6/01/01 at 11:11 (049589)

But Judy, be careful with Leylandii. They grow enormously high very quickly and are very hard to keep under control. As we know to our cost (the high cost of paying someone to chop them back for us every year). But they have protected us from our somewhat unpleasant neighbours for the last 15 years, so we're not complaining.

Nancy, give the doctor the facts and then put this thing behind you.

Re: Oine trees - and hassles

Julie on 6/01/01 at 11:12 (049590)

Sorry. A touch of the Wendys. I meant pine trees not oine trees.

Re: Oine trees - and hassles

Valerie S on 6/01/01 at 11:22 (049592)

hee hee... I was thinking, oine trees... what are those? Must be a British thing... hee hee. You're too funny. amazing how a little typo can make you laugh so ... thanks, Julie.

Re: Oine trees - and hassles

Julie on 6/01/01 at 12:15 (049596)

Glad I gave you a laugh, Val.

Re: Thanks, everyone.

Nancy N on 6/01/01 at 17:09 (049626)

Here's my update on this problem. I called my insurance company back today, figuring if I wait for this woman to tell me who she talked to, I could be old and grey. I have to say that I have never ever had a problem with the people who answer at United Healthcare--they have, every single one of them, been fantastically helpful. The woman I spoke to today told me that they don't have a standard letter they can send out, but she tried to call the doctor's office instead and conference me in, but she was on hold so long that she had to give up and would try again later, and let me know what happened. (I told her how this woman had treated me before and we both agreed that she may not have wanted to answer the phone when she heard it was someone from UHC!)

I asked her why the money was sent to me and not the doctor. She says that, unless there is any payment outstanding, they sent the money to the patient because the patient has already paid. She also told me that this is in the contract the provider signs with UHC and that it is a violation of that contract for the doctor's office to withhold my money.

So... I am hoping that she will manage to get in touch with this woman and work everything out. There's a part of me that is tempted to make a real nuisance of myself and tell this woman that the one guaranteed way to make me go away is to return my money (and it's all I can do not to tell her I want 3% interest on it, too--they've had my money for 18 months now). But I am hoping that the insurance company can put the fear of God into her and take care of it all without me having to do anything else.

I am going to write a letter to the doctor(s) in this group to let them know what this woman is like. It could be a long writing weekend!

Oh--thanks for the legal suggestion, Karen. The only lawyer I know is retired, so I don't know if she would be able to help, but she might know someone who could. I'll wait and see what happens with the insurance company before I go that route, though.

Thanks again for your input. I really appreciate it.

Re: on neighbors and new pf devices

karenc on 6/04/01 at 09:55 (049829)

First of all, good for you that you're making progess. I had United before and they were nice, too. It's just a sad state of affairs that lawyer letters are ever even necessary.

Anway, can't remember who in line it was (Judy, was it you?) regarding the neighbor, and I don't know where you live, but have this elderly woman living alone next to us, who occassionally would take in sort of transient types for yard work, etc. to help them along. At some point, this woman started living with her and next thing we knew was running a tow truck company from her home. We live in a modest neighborhood w/ relatively small houses (well under 2000 sf - maybe more like 1500), so the yards and lots and all are small). Anyway, everyday, maybe at 5 am., 6 am, 7 am, or at 11 pm, all during the day, there were bright yellow 'Toe Jam' tow truck(s) running loudly outside her house (and therefore ours), w/ the guys waiting for their next job. I've actually seen these trucks (now, all the time) and it's quite legit, it's just that she was operating it from this woman's house. Anyway, it got resolved b/c we have this other elderly woman (dare I say a battle axe?) who has for 20 years sort of been the organizer for any neighborhood issues and is big buddies w/ all the folks at the city. so, I went through her first and there was some zoning restriction and they found it - end of story (though it actually took several months), the tow truck business is gone, but it was really difficult. Sorry, I got off on a tangent, but I know others who have had zero luck getting old cars and stuff out of front yards. but often times w/ 'businesses' being run out of the home, depending upon what it is, there are zoning restrictions, necessary permits, etc. - key is to find someone at the city who is sympathetic and knows the ins and outs (easier said than done), then get them on the neighbor rather than you. We had folks selling drugs next to us at one point and I was too scared to call the cops for fear of retribution and finally they moved - so now we have a great neighbor who's clean but w/ dogs that bark all night. Who knows.... good luck and sorry for the long post.

Oh, yea - pf - forgot - as for the orthotics, I did try to break them in and they are better now, but not great. I thought maybe I needed new running shoes to put them in, b/c they look all beat up, but even the shoe salesman said I probably had a few more months on them and didn't need a new pair now. Maybe I just want to throw my cash away, b/c I just keep thinking my feet should feel all soft on the ground w/ the new orthotics and they're not. However, one poor guy working there got pf during the Olympic trials a few years ago - how sad for him - but he bought this $15 thing out of a magazine that basically works like taping (only it's one piece and you just take it on and off, so less time, etc.) - he said it really got him on the road to recovery - have any of you all tried it? I got the numer and am going to order it today. I'll keep you posted.