Anacortes Prosthetics & Orthotics Reviews (%countItem)
Anacortes Prosthetics & Orthotics Rating
Address: 2801 Commercial Ave Ste 5, Anacortes, Washington, United States, 98221
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Back in May of 2019 I was seeing this business for Orthopedic insoles for my shoes and an orthopedic knee brace for my right knee. I got prescriptions for both and both were for covered by insurance. At the same time of billing my *** kicked in and *** cancelled. They claimed that *** would no longer cover these Orthopedics. I then had to pay $175 for the insoles out of pocket. And in addition have been paying $50 a month to pay off the knee brace in a total amount of $550. I feel that I have been getting extorted and that Possibly Insurance already did pay them. Either way, I make a very little amount on disability per month and has been a nightmare to get this knee brace paid off. The knee brace itself is of very low quality and nowhere near the total price of $750 they claimed. My bill shows an adjustment of $192 by *** Healthcare noted as contractual. I had mailed the knee brace back to them with the letter back in June of 2019. But could not pick up my insoles until I agreed to a payment plan for the knee brace. I feel that this has been completely unfair and I do not know if they have been doing this to other patients over the years. Any assistance you could provide would be greatly appreciated.
I
write in response to the compliant submitted by Mr. ***. Anacortes Prosthetics & Orthotics (APO) provided
a knee brace and foot orthotics in 2019. He was seen per referral of a physician in May
2019. We provided services to him and delivered a knee orthosis on 5.21.2019 and
billed the
insurance provider via the information provided to APO from Mr.. The insurance carrier (provided) denied
coverage of devices due to patient being uninsured by the carrier at time of
service. (We are unable to retro bill to his ‘new’ insurance
carrier because we did not have the required documents in place at time of service that his
‘new’ insurer requires because we did not know we would need them.) Foot Orthotics are not a
covered benefit under his insurance plan(s). Patient was aware of this prior to
being provided the devices on 6.20.19 and agreed for a self-payment of the foot
orthotics. Mr. signed
a delivery form at time of receiving the devices which states: By
providing my signature, I acknowledge receipt of the above listed devices and
or service. I authorize payment of medical benefits to APO for any services
furnished to me (or to the patient from
whom I am the responsible party) by the practitioners. I authorize you to
release my insurance company information concerning healthcare, advice, treatment or
supplies provided to me. I understand that I am financially responsible for
services provided to me if I am uninsured, if I have a deductible,
or if I have not obtained the necessary prior authorization or referral from
PCP. Patient was aware
of this and a payment plan was mutually arranged for
both the knee orthosis and the foot orthotics at time of service. He has
been making monthly payments up until January 2020. We continue to strive to provide
exceptional patient care. We are happy to work further with Mr. if
he would like to work with us in the future. Sincerely, Sarah
C***, Owner Anacortes Prosthetics & Orthotics
Complaint: ***
I am rejecting this response because:
I had no idea that my insurance was changing due to *** taking over.Although they did not either, my insurance was active at the time of service. I understand about the shoe insoles not being covered, even though *** confirmed they would be. And I understand we setup a payment schedule. But at this point I've paid $350 towards the brace with $175 remaining. I feel it's only fair that they cover the remaining balance, as rightfully *** should have covered it given the initial date of service. And second the brace is made cheaply, does not fit properly and never could wear it for it's purpose of surgery. And last because $350 is far more than the brace was ever worth. I'm fine not getting anything back but refuse to pay anymore towards a useless piece of equipment.
Sincerely
I am terribly sorry that your insurance coverage changed without either you or I's knowledge. This is not something that we would have had any way of knowing either. As a patient, this is your responsibility to notify our business of this information. We processed your claim with the most current information provided to us via you. Unfortunately the information provided to use via you is incorrect. Ultimately this remains your balance. Thank you for your time.
Complaint: ***
I am rejecting this response because:
I don't even have the means to continue payments on this brace. If I ever get my Social Security back pay, I will just pay it off. But until then it will have to just remain where it is.
Sincerely
There have been ongoing coding issues with my insurance, *** Cross. I understand that it is frustrating for a business to not get paid by the insurance company in a timely fashion. I also understand that the insurance company needs the proper code for payment. When Anacortes Prosthetics & Orthotics contacted me about my insurance not paying, I reached out directly to my insurance company about seven times thus far. On the third occasion, I asked the business if I could come to their office to call the insurance company for a three way call. At that point in time, Anacortes Prosthetics & Orthotics heard that I was fully covered for one pair of orthotics per calendar year, and that the coding was done incorrectly. At that point, the business faxed over new coding. About a month later, I was contacted by the business again. I will leave the person's name out of this complaint but she stated very clearly that it was my responsibility to pay the bill. I indicated that I will not be paying since my insurance company states that I have zero liability. Then the person preceded to say "I am a bully" and that I have been bad mouthing their business. The conversation ended abruptly, and I wish the call could have been recorded like the previous phone calls with the insurance company. Again I understand the frustration in this very long process. No matter what, customer service should be a priority for Anacortes Prosthetics & Orthotics. Right now, the relations department at *** is dealing with the business since the business is in network. I also filed an appeal to the insurance company since the business stated that they will be sending me to collections.
Anacortes
Prosthetics & Orthotics has worked extensively with
patient and insurer on getting this claim paid- without success. Patient’s coding for this claim was
confirmed to be valid and appropriate with her insurer prior to any work being
completed. Upon submission of the claim, her insurer denies payment. This
claim has been denied for various reasons over course of this process via her
insurer. This
claim was submitted to her insurer multiple times via her insurer provider
assistance unit. Ultimately the insurer stated that the wrong diagnosis is
being billed with this claim. Provider Relations via her Insurer has
explained that as an in-network provider APO should have conferred with her
physician and billed with a diagnosis that patient does not have. This is
fraud, and APO refuses to do. A compliant is in process with the Washington
State Office of Insurance Commissioner regarding this claim. Ultimately patient signed a
delivery form at time of receiving the devices which states: By providing my signature, I
acknowledge receipt of the above listed devices and or service. I authorize
payment of medical benefits to APO for any services furnished to me (or to
the patient from whom I am the responsible party) by the
practitioners. I authorize you to release my insurance company information
concerning healthcare, advice, treatment or supplies provided to me. I understand
that I am financially responsible for services provided to me if I am
uninsured, if I have a deductible, or if I have not obtained the necessary
prior authorization or referral from PCP. Patient was adamant that she would
personally never pay for this claim. Unfortunately, this is her balance. APO
sincerely apologizes for any inconvenience and distress this has caused
patient.
Complaint: ***
I am rejecting this response because:
I am hundred percent not liable in paying for the orthotics received from Anacortes Prosthetics & Orthotics (APO). The company is fully aware that my insurance covers one orthotic annually per calendar year. I left their office with the orthotics and the employee saying I am covered via my insurance (hence why no money was exchanged). When I was contacted in October about my insurance company denying the claim, I took the time to contact Premera. I have made countless recorded contacts with Premera. One contact, as previously noted, I was in the APO office with a representative who heard that I was fully covered via my insurance. Now APO is filing a claim with the insurance commissioner saying Premera is asking them to commit fraud, this seems ludicrous. In fact, I just contacted Premera to let them know. I also asked the representative to check on my appeal. I want APO to get paid (hence why I filed an appeal). I absolutely do not want to be send to collections by APO. I kindly asked Premera to please resolve this ASAP. Perhaps APO being in net-work with Premera is not a good decision if customer service is not being upheld. My intent is this is resolved ethically. Thank you.
Sincerely
Ms., I understand your frustration. I also understand that you came to use for a specific service that was promptly provided in a efficient and professional manner. Your insurance is trying to play us off of each other indicating that you should not pay, and I should not get paid, unless we bill fraudulently. Protocol is to respond within our scope of practice. Your insurance is asking me to conduct myself out of my scope of practice in diagnosing and working outside of my licensure. Again, this issue has been submitted to the Insurance Commissioner for review.
In conclusion, I truly hope that your feet issues have been resolved.
Complaint: ***
I am rejecting this response because: I am saddened to hear that you think Premera Blue Cross is asking you to bill fraudulently based on a pair of orthotics for a total of $278.00. I highly doubt Premera is trying to be fraudulent. I also understand your frustration in trying to resolve the matter. I do feel you lacked customer service in trying to handle this situation professionally with me when it came to the insurance conflict. I am hoping/praying that this will be resolved ethically soon. I received in the mail (March 16, 2020) that my appeal is being processed from Premera Blue Cross (the letter was signed/dated by me on January 20, 2020). I am asking my insurance company to pay you ASAP so I can no longer be part of the equation. I look forward in hearing the response back from Premera in addition to the Insurance Commissioner. I know we all need extra patience right now while dealing with the current crisis of COVID-19.
Sincerely