Revdex.com:
I have reviewed the response made by the business in reference to complaint ID ***, and have determined that this does not resolve my complaint.
Regards,
*** *** The business ( ***) is lying about 70% of everything that she saidTo begin with, the original prescription was NOT from my diabetic doctor, but from a foot specialist at *** ***THEY are the ones that did the x-rays and foot examI don't know why *** felt it necessary to send paperwork to the endocrinologist who is NOT the prescribing doctorHad she sent the paperwork to the correct doctor to begin with this entire thing would have been avoided, which is where the problem startedMy diabetic doctor was NOT going to sign off on a prescription written by another doctor...no doctor would do thatThen *** keeps referring to a CONTRACT COMPANY as Medicare, however, Medicare says that Upstate Pedorthic had NOT and has STILL NOT sent in a request/claim for shoes and inserts, so *** needs to check her records and she needs to submit the proper paperwork to the REAL MEDICARE, rather than a contractor...as per Medicare!!! She was told this by Medicare when the 3-way call took place between Medicare, myself and ***She also told Medicare that there was a form that I could sign saying that I could go ahead and get the shoes and inserts, and that IF Medicare didn't pay, I would be responsibilityShe also told Medicare ( while on 3-way ) exactly what she had, what the doctor wrote as far as diagnoses, etc and Medicare told her right then that Medicare WOULD COVER THE SHOES, if that was what the doctor had written and sent them*** didn't submit the paperwork to Medicare, she submitted it to a CONTRACTOR!! I have since submitted all this paperwork to Medicare for reviewMedicare did in fact tell me that Upstate Pedorthic is NOT a supplier for themWhether they are or not is not my problem, I'm simply stating what I was told by Medicare ( THE REAL ONE).Also, Upstate Pedorthic has NOT called me as *** says they have, I've had to continue calling them and was told by *** that it wasn't their responsibility to let me know what they needed from my doctor, that it was my responsibility to make sure my doctor sent them the necessary paperworkAGAIN, why would they ask for paperwork from a doctor that did NOT write a prescription for the shoes and inserts??? Then to top this entire thing off, *** is neglecting to say is that she has been rude, short and nasty with me each time I've called trying to get informationThen she claimed that she had no way to get in touch with the CONTRACTOR for the shoes and inserts and even told Medicare that she only had a fax numberYet in the response to this claim, said that she spoke to them. Funny how that works!!This woman is obviously a very unethical person who would rather continue to tell lies rather than admit her mistakesNot a very good leader in my opinionIn her response to this complaint, her only apology is for Medicare and it's rules, not for her actions, which have been deplorableI have been dealing with Medicare for years and never had a problem INCLUDING this year with new rules and regulations!! I can only hope that one day soon, the owners of this business see that unethical practices will spawn MORE complaints like this one in the future
We are very sorry that the patient was so unhappy with our
services. I would like to address the patient's
complaints that lead up to Medicare not approving her shoes and inserts.
">·
Referred to Upstate Pedorthic Services from Steadman Hawkins
on our RX pads so patient has map, address and phone number of our location
· **
Medicare requirement have changed
o
In the past Medicare required only a certifying statement
completed by the doctor treating the diabetic condition. About a year and half ago requirement changed
to include office notes from the same doctor.
These notes must be very detailed to specify the need for diabetic shoes
and match the condition addressed on the certifying statement
· **
Employee working certifying statement received patient
chart and called her on 8/11/patent said she received certifying statement at
her first appointment "per our protocol" and she has an appointment with her endocrinologist
doctor on 8/16/
· **
All note below are notes in patient charts of
employee working account
o
8/24/received notes/CS from endocrinologist
doctor
o
8/27/we faxed over request for addendum of
feet or foot assessment form to be completed (per Medicare requirements)
o
9/3/Patient upset it is taking so long – we
offered a new program Medicare is allowing a test claim (not a real claim)Practice
sends in all doctor notes and RX, Medicare reviews and inform by letter if
would be a charged by their guidelineso
09/14/Patient endocrinologist doctor left
message explained he does not sign these forms.
Upstate tried to return called, having to leave message that this is Medicare
requirements to cover patient's shoes and insertso
9/04/Called patient explained we are still waiting
on Medicare reply from testo
09/10/patient called upset no reply from Medicare. We called Medicare and was told we have to
wait on letter from Medicare, informed patient
o
9/17/Patient called very upset we do not
have an answer yet. Also patient doctor
called left message, will not do foot assessment form that her podiatrist
should do that. We tried to return MD's
call but no luck, left message with nurse.
We did fax over sheet of Medicare requirements to nurse. Patient said she would call Medicare and get
some answerso
9/18/Medicare called me on a way
call. Medicare would not have called Upstate
Pedorthic Services if we are not a providerI'm not sure why one of patient's complaints
was we are not a providerUpstate Pedorthic Services have been
a provider with Medicare for + years.
I explained the test that Medicare was offering and we were waiting on
reply and that we were unsure if Medicare would cover with the notes we were
provided. After talking to the Medicare Rep we agreed patient
could sign an ABN and we could start the process of her shoes. Patient was very upset she was not offered
that before. I explained we do not offer
this because Per Medicare we cannot use this as a blanket to all patients. The patient needs to understand that if Medicare
does not cover items she will be responsible She understood and wanted us to start the
processes
· **
I went to order patient shoe the next day and
the shoe had been discontinued. Called patient
and she told me what she needed. I
talked to the Pedorthist within the next day or two and we ordered the shoe
· **
9/25/received letter from Medicare that
they denied test – the reason below is what the office was questioning
o
Clinical notes do not document the presence of
one or more conditions on the certifying statement
o
Patient was called and told the results, as a
result of test patient wanted her RX returned.
o
I mailed her Certifying statement and MD notes
to her
· **
Shoes could not be cancelled as they were in
transit and when they arrived employee did not pull chart and by mistake called
patient to inform her shoe were in. This
was a mistake. I talked to patient and apologized
for calling, she then asked me to mail her original RX. I apologized again for not sending it the
first time I thought I sent everything.
She was upset RX was on Upstate Pedorthic Service pad. I apologized again saying this helps patient
know where to go for services
I am very sorry for all the rules
and guidelines Medicare has. Upstate
Pedorthic Services tries our best to follow the rules and we know it can be
very frustrating for the patients and doctors.
I don't understand why patient thinks she was lied to. As you can see we document in her chart very
well all that took places. Patient did
not want items when told Medicare denied test.
With the information we have shoe and inserts would be self-pay. At this time we are unable to go further to
help this patient
Sincerely
[redacted]
The majority of our patients
are referred to us from Orthopedist, Podiatrist, Rheumatologists, Wound Care
Centers and other doctor that treat foot conditionsThat is why patients are
given the diabetic packet that includes all of the required documents needed by
Medicare to file a claimThe packet was given and explained to patient as noted
in first letterMedicare requires that the doctor that treats a patient's
diabetes is the only physician that can complete the certifying statementIn
addition that physician must perform a foot examination and dictate into the
patients chart the findingsAgain this is a Medicare requirement, not an
Upstate Pedorthic requirementThe first five calls to or from patient [redacted], who along with her husband, the Pedorthist owns Upstate Pedorthic
ServicesMrs[redacted] was concern that there was insufficient documentation
for this claim to be approved by MedicareMrs[redacted] came to me and asked my
opinion and I felt like, after working with new requirement from Medicare for
the past year and a half it was unlikely they would cover for shoes and inserts
with the documentation we haveAbout that same time Medicare offered a way to
send in documentation (not claim) to determine if patient's inserts and shoes
would be coveredThe information we received about program stated we would
receive reply by mail within daysWe were only given a fax number for
communication for this programPer Medicare rules we cannot bill Medicare
until patient has received their shoes and insertsMrs[redacted] explained to
patient that if we filed a real claim and it was denied she would become
responsible for paymentIt is our policy to protect our patients from
unexpected cost by trying all the means at our disposal to assure claims would
be coveredMrs[redacted] explained to patient in a phone conversation about program
Exactly ten days after the documentation was faxed patient called office spoke
to Mrs[redacted] and was very upset we had not received a replyMrs[redacted]
explained this was a new program and asked [redacted] to call Medicare for status
As I previously stated in last letter, Medicare said we had to wait on letter
There was no way to contact that departmentPatient was very upset that we had
said days and Mrs[redacted] explained we were giving her the information that
Medicare had given to us about this programThis program is a Medicare
program, the denial letter is on Medicare letterheadThe next day the patient contacted Medicare
who then called me on a way callFirst Medicare said shoes and inserts are a
covered services and I replied to Medicare rep that the information is correct,
they are covered as long as the provider, in this case Upstate Pedorthic
Services, has all the documentation requiredI went on to tell the Medicare
rep where to find Medicare guidelines on Medicare's website and she agreed
That is when I explained what an ABN is, which is a form patient can sign if
items are not covered by MedicareWe cannot give this form to diabetic
patients to sign until we have confirmed or expect they do not meet Medicare
guidelinesIt is Upstate Pedorthic Services desire to provided needed shoes
and insets for our patients, but to also protect them from a significant cost
We are very sorry that patient has been so dissatisfiedThankfully patient's
chart is well documented of all that took place and our office staff in trying
to assets patient and her providerWe cannot make any provider sign forms or
perform foot exams for Medicare requirementsWe have been in business for
years and our goal has always been to give the best care to our patients
This patient
NEVER received any inserts or shoes from usIn addition we have spent
countless man hours trying to help this patient get items above covered by
MedicareWe also ordered shoes and had to return them, which cost us money for
the shipping back and forth to the manufactureThis entire event is because
the patient's physician that treats her diabetes refused to do a foot
examinationWe have dismissed this patient and will not provide any services
Revdex.com:
I have reviewed the response made by the business in reference to complaint ID ***, and have determined that this does not resolve my complaint.
Regards,
*** *** The business ( ***) is lying about 70% of everything that she saidTo begin with, the original prescription was NOT from my diabetic doctor, but from a foot specialist at *** ***THEY are the ones that did the x-rays and foot examI don't know why *** felt it necessary to send paperwork to the endocrinologist who is NOT the prescribing doctorHad she sent the paperwork to the correct doctor to begin with this entire thing would have been avoided, which is where the problem startedMy diabetic doctor was NOT going to sign off on a prescription written by another doctor...no doctor would do thatThen *** keeps referring to a CONTRACT COMPANY as Medicare, however, Medicare says that Upstate Pedorthic had NOT and has STILL NOT sent in a request/claim for shoes and inserts, so *** needs to check her records and she needs to submit the proper paperwork to the REAL MEDICARE, rather than a contractor...as per Medicare!!! She was told this by Medicare when the 3-way call took place between Medicare, myself and ***She also told Medicare that there was a form that I could sign saying that I could go ahead and get the shoes and inserts, and that IF Medicare didn't pay, I would be responsibilityShe also told Medicare ( while on 3-way ) exactly what she had, what the doctor wrote as far as diagnoses, etc and Medicare told her right then that Medicare WOULD COVER THE SHOES, if that was what the doctor had written and sent them*** didn't submit the paperwork to Medicare, she submitted it to a CONTRACTOR!! I have since submitted all this paperwork to Medicare for reviewMedicare did in fact tell me that Upstate Pedorthic is NOT a supplier for themWhether they are or not is not my problem, I'm simply stating what I was told by Medicare ( THE REAL ONE).Also, Upstate Pedorthic has NOT called me as *** says they have, I've had to continue calling them and was told by *** that it wasn't their responsibility to let me know what they needed from my doctor, that it was my responsibility to make sure my doctor sent them the necessary paperworkAGAIN, why would they ask for paperwork from a doctor that did NOT write a prescription for the shoes and inserts??? Then to top this entire thing off, *** is neglecting to say is that she has been rude, short and nasty with me each time I've called trying to get informationThen she claimed that she had no way to get in touch with the CONTRACTOR for the shoes and inserts and even told Medicare that she only had a fax numberYet in the response to this claim, said that she spoke to them. Funny how that works!!This woman is obviously a very unethical person who would rather continue to tell lies rather than admit her mistakesNot a very good leader in my opinionIn her response to this complaint, her only apology is for Medicare and it's rules, not for her actions, which have been deplorableI have been dealing with Medicare for years and never had a problem INCLUDING this year with new rules and regulations!! I can only hope that one day soon, the owners of this business see that unethical practices will spawn MORE complaints like this one in the future
We are very sorry that the patient was so unhappy with our
services. I would like to address the patient's
complaints that lead up to Medicare not approving her shoes and inserts.
">·
Referred to Upstate Pedorthic Services from Steadman Hawkins
on our RX pads so patient has map, address and phone number of our location
· **
Medicare requirement have changed
o
In the past Medicare required only a certifying statement
completed by the doctor treating the diabetic condition. About a year and half ago requirement changed
to include office notes from the same doctor.
These notes must be very detailed to specify the need for diabetic shoes
and match the condition addressed on the certifying statement
· **
Employee working certifying statement received patient
chart and called her on 8/11/patent said she received certifying statement at
her first appointment "per our protocol" and she has an appointment with her endocrinologist
doctor on 8/16/
· **
All note below are notes in patient charts of
employee working account
o
8/24/received notes/CS from endocrinologist
doctor
o
8/27/we faxed over request for addendum of
feet or foot assessment form to be completed (per Medicare requirements)
o
9/3/Patient upset it is taking so long – we
offered a new program Medicare is allowing a test claim (not a real claim)Practice
sends in all doctor notes and RX, Medicare reviews and inform by letter if
would be a charged by their guidelineso
09/14/Patient endocrinologist doctor left
message explained he does not sign these forms.
Upstate tried to return called, having to leave message that this is Medicare
requirements to cover patient's shoes and insertso
9/04/Called patient explained we are still waiting
on Medicare reply from testo
09/10/patient called upset no reply from Medicare. We called Medicare and was told we have to
wait on letter from Medicare, informed patient
o
9/17/Patient called very upset we do not
have an answer yet. Also patient doctor
called left message, will not do foot assessment form that her podiatrist
should do that. We tried to return MD's
call but no luck, left message with nurse.
We did fax over sheet of Medicare requirements to nurse. Patient said she would call Medicare and get
some answerso
9/18/Medicare called me on a way
call. Medicare would not have called Upstate
Pedorthic Services if we are not a providerI'm not sure why one of patient's complaints
was we are not a providerUpstate Pedorthic Services have been
a provider with Medicare for + years.
I explained the test that Medicare was offering and we were waiting on
reply and that we were unsure if Medicare would cover with the notes we were
provided. After talking to the Medicare Rep we agreed patient
could sign an ABN and we could start the process of her shoes. Patient was very upset she was not offered
that before. I explained we do not offer
this because Per Medicare we cannot use this as a blanket to all patients. The patient needs to understand that if Medicare
does not cover items she will be responsible She understood and wanted us to start the
processes
· **
I went to order patient shoe the next day and
the shoe had been discontinued. Called patient
and she told me what she needed. I
talked to the Pedorthist within the next day or two and we ordered the shoe
· **
9/25/received letter from Medicare that
they denied test – the reason below is what the office was questioning
o
Clinical notes do not document the presence of
one or more conditions on the certifying statement
o
Patient was called and told the results, as a
result of test patient wanted her RX returned.
o
I mailed her Certifying statement and MD notes
to her
· **
Shoes could not be cancelled as they were in
transit and when they arrived employee did not pull chart and by mistake called
patient to inform her shoe were in. This
was a mistake. I talked to patient and apologized
for calling, she then asked me to mail her original RX. I apologized again for not sending it the
first time I thought I sent everything.
She was upset RX was on Upstate Pedorthic Service pad. I apologized again saying this helps patient
know where to go for services
I am very sorry for all the rules
and guidelines Medicare has. Upstate
Pedorthic Services tries our best to follow the rules and we know it can be
very frustrating for the patients and doctors.
I don't understand why patient thinks she was lied to. As you can see we document in her chart very
well all that took places. Patient did
not want items when told Medicare denied test.
With the information we have shoe and inserts would be self-pay. At this time we are unable to go further to
help this patient
Sincerely
[redacted]
The majority of our patients
are referred to us from Orthopedist, Podiatrist, Rheumatologists, Wound Care
Centers and other doctor that treat foot conditionsThat is why patients are
given the diabetic packet that includes all of the required documents needed by
Medicare to file a claimThe packet was given and explained to patient as noted
in first letterMedicare requires that the doctor that treats a patient's
diabetes is the only physician that can complete the certifying statementIn
addition that physician must perform a foot examination and dictate into the
patients chart the findingsAgain this is a Medicare requirement, not an
Upstate Pedorthic requirementThe first five calls to or from patient [redacted], who along with her husband, the Pedorthist owns Upstate Pedorthic
ServicesMrs[redacted] was concern that there was insufficient documentation
for this claim to be approved by MedicareMrs[redacted] came to me and asked my
opinion and I felt like, after working with new requirement from Medicare for
the past year and a half it was unlikely they would cover for shoes and inserts
with the documentation we haveAbout that same time Medicare offered a way to
send in documentation (not claim) to determine if patient's inserts and shoes
would be coveredThe information we received about program stated we would
receive reply by mail within daysWe were only given a fax number for
communication for this programPer Medicare rules we cannot bill Medicare
until patient has received their shoes and insertsMrs[redacted] explained to
patient that if we filed a real claim and it was denied she would become
responsible for paymentIt is our policy to protect our patients from
unexpected cost by trying all the means at our disposal to assure claims would
be coveredMrs[redacted] explained to patient in a phone conversation about program
Exactly ten days after the documentation was faxed patient called office spoke
to Mrs[redacted] and was very upset we had not received a replyMrs[redacted]
explained this was a new program and asked [redacted] to call Medicare for status
As I previously stated in last letter, Medicare said we had to wait on letter
There was no way to contact that departmentPatient was very upset that we had
said days and Mrs[redacted] explained we were giving her the information that
Medicare had given to us about this programThis program is a Medicare
program, the denial letter is on Medicare letterheadThe next day the patient contacted Medicare
who then called me on a way callFirst Medicare said shoes and inserts are a
covered services and I replied to Medicare rep that the information is correct,
they are covered as long as the provider, in this case Upstate Pedorthic
Services, has all the documentation requiredI went on to tell the Medicare
rep where to find Medicare guidelines on Medicare's website and she agreed
That is when I explained what an ABN is, which is a form patient can sign if
items are not covered by MedicareWe cannot give this form to diabetic
patients to sign until we have confirmed or expect they do not meet Medicare
guidelinesIt is Upstate Pedorthic Services desire to provided needed shoes
and insets for our patients, but to also protect them from a significant cost
We are very sorry that patient has been so dissatisfiedThankfully patient's
chart is well documented of all that took place and our office staff in trying
to assets patient and her providerWe cannot make any provider sign forms or
perform foot exams for Medicare requirementsWe have been in business for
years and our goal has always been to give the best care to our patients
This patient
NEVER received any inserts or shoes from usIn addition we have spent
countless man hours trying to help this patient get items above covered by
MedicareWe also ordered shoes and had to return them, which cost us money for
the shipping back and forth to the manufactureThis entire event is because
the patient's physician that treats her diabetes refused to do a foot
examinationWe have dismissed this patient and will not provide any services