Aboite Podiatry Associates

Initial Business Response /* (1000, 5, 2017/09/19) */
The patient presented at his initial appointment with specific foot complaints. After discussion of treatment options, he agreed that he wanted to be casted in the office for custom orthotics to alleviate his symptoms. Our office staff reviewed...

the procedures and fees associated with custom orthotic casting with the patient that day. The patient requested time to contact his insurance for further review of coverage. Our office provided him with the list of CPT and HCPCs that would be billed to his insurance for custom orthotic casting.
On 4-18-17 our billing office received a phone call from the patient with a Cigna representative on the other line as a 3 way call. Our billing office reviewed the patient's diagnosis with the patient's insurance representative verifying verbally that the patient met the criteria in the insurance plan's Medical Review Coverage Policy for Lower Limb Orthosis and Shoes: Cigna 0150. While on the phone call, the billing office representative stated multiple times that the patient met medical necessity for insurance coverage of custom foot orthotics, however the copayment for the office visit and the non-covered shipping and handling fee of [redacted] would be billed directly to the patient. The Cigna representative agreed that S&H would not be covered by insurance and would be patient responsibility. The call with the Cigna representative on 4-18-17 was recorded by Cigna as per their policies.
On the day of the orthotic mold casting, April 20, 2017, the patient was given the office waiver for custom orthotics and was asked to read and sign the form prior to beginning the process of creating the molds. The form lists all of the CPT and HCPCs, including the shipping and handling charge noted as not billed to insurance, patient responsibility, [redacted] Shipping and handling is charged to the patient to cover the custom mold being shipped to the outside lab for creation of custom orthotics. The lab that makes the custom orthotics also charges our office for shipping and handling to send the orthotics to our office. This was explained to the patient when he inquired about the charge at the time of casting, as well as on the phone calls prior to and post casting.
All of our patients are requested to schedule a follow-up / dispensal appointment with their first pair of custom orthotics so that the doctor can check for appropriate fit, trim the orthotics to align with the patient's preferred foot wear, review proper break in protocol, and discuss any situation in which the patient should immediately contact the office for further care. Custom orthotics require a prescription from a Doctor of Podiatric Medicine and follow up care is needed in nearly all cases to verify that the treatment is beneficial to the patient's complaints and symptoms and make additional adjustments when necessary. The referenced payments from Cigna that the patient mentions not only cover the custom orthotics, but also custom molds, original consultation, nail and callus care, and follow up visit.
Our office received a call from another Cigna representative on 8-7-17 stating that the patient filed a complaint that he was unaware of the shipping and handling charge. Our billing office requested the Cigna representative to reference the recorded conversation on 4-18-17 in which the patient was notified multiple times of the charge. The Cigna representative was also notified of the waiver that the patient read and signed on 4-20-17. The Cigna representative agreed that the patient had been notified properly prior to performing any the services. The Cigna representative ended the call that day stating she would notify the patient that Cigna does not disagree with our office billing the patient for this charge.
After the discussion with the Cigna representative and in response to an email from the patient requesting that we stop sending him a bill, our billing office called the patient on his home phone. The billing office manager asked the patient if he recalled the 3-way call with Cigna, our office, and himself on 4-18-17. The patient became irate and yelled that he remembered the call and does not care what he was told on the call or what paper he read and signed. All of the phone calls and discussions with the patient were documented as they occurred.
The patient had been notified of the amount that would be billed to him a week prior to the appointment for casting of custom orthotics. He was reminded on a recorded phone call with a representative from his insurance days prior to having the services performed. He was asked to read the waiver and given time to read and sign it prior to beginning the services. The patient's insurance has reviewed the multiple discussions and signed waiver; Cigna has agreed with our office. We took all appropriate steps to notify and work with the patient.
Initial Consumer Rebuttal /* (3000, 7, 2017/09/20) */
(The consumer indicated he/she DID NOT accept the response from the business.)
they have never told me about [redacted] shipping charges.
they have already over charged for orthotics. They even do not look custom. I might have to get checked by some other firm.
Obviously they made me sign a paper for hidden charges and they already knew that they will charge me this [redacted]
right from beginning I said I do not want any out of pocket expense and they said whatever is not paid by insurance they write it off.