CHESTERFIELD COUNTY, Virginia – It took her eight months and some help from problem solvers, but persistence paid off for a woman in Chesterfield who says an orthopedic practice owes her $ 200.
“I had this terrible pain,” said Ava Reaves, 67, of her diabetes-related plantar fasciitis issues. “I went back and took out some old custom orthotics, put them on and started wearing them. And the pain is gone. That’s when I said, “you need new orthotics”. So I launched a quest to find some.
Reaves says she reached out to her Medicare Advantage administrator, United Healthcare, to help find a network provider. She also verified that the service and orthotics would be covered by her health care plan.
In February, Reaves visited a SynergyHealth foot and ankle clinic, knowing she would be responsible for about 10% of the bill.
“The doctor was really nice and she said that was what I needed. And what a difference! So they were good with their product, ”Reaves said of the pain relief she felt once her shoes finally got the support she needed to stay mobile during retirement.
However, Reaves said she was surprised by a demand at the credit union for a $ 200 deposit on orthotics. A form shared with problem solvers explains the firm’s policy of collecting a down payment from patients and then refunding that money if an insurance plan makes a full payment. The policy also suggests that the cash price for patients who do not file an insurance claim is $ 400 in total.
Initially, Reaves’ claim was turned down by United Healthcare due to a hammer toe diagnostic code, a condition not covered by his health care plan. Reaves appealed and asked SynergyHealth to correct the billing code to reflect his diabetic status. Letter from United Healthcare and copies of proof of coverage from Reaves show SynergyHealth received $ 700 for orthotics on September 2.
“I received two invoices and that’s when I thought I should call them. I’m like, ‘Hey, I don’t owe this. You owe me!'”
In addition to withholding Reaves’ deposit, SynergyHealth sent several invoices for $ 109.02 to cover the doctor’s visit. A statement from United Healthcare dated June 10 said its plan covered everything but $ 4.51 for the service.
“I thought I’d better take care of it before they send it to the credit bureau and mess up my credit,” Reaves said of his growing efforts to fix the billing error and get the refund of his deposit of $ 200.
The Problem Solvers contacted United Healthcare and SynergyHealth Foot and Ankle Clinic on behalf of Reaves. SynergyHealth and its billing partner responded to our inquiries immediately.
A SynergyHealth partner regretted that a mistake was made, saying the practice is a small, family-centered business that takes pride in helping its patients. He said if he had known about the dispute earlier, they would have taken steps to remedy the situation.
After another review of his case, SynergyHealth determined that Reaves should be reimbursed. Representatives of the practice assured problem solvers they would send Reaves a check this week.
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