How much time would you put in to get $450.00 back from your insurance company? I have been working with my client to file for reimbursement for orthotics which cost $450.00 for nine months. The patient suffered from Plantar Fasciitis. He saw a podiatrist who ordered orthotics as part of the plan of care. The insurance gave him several companies to choose from within the network. I called several companies to make an appointment. With each, I was told they could make the orthotics, but the patient would have to pay for them upfront and then go back to the insurance company for reimbursement. Although this would be a hardship for the patient, he used his credit card as well as his wife to put the make the two payments (one for the initial visit and the 2nd when he picked up the orthotics).
The patient was fitted for the orthotics in late December 2021 and picked them up the end of February2022. He has been wearing them since and has found them helpful.
I called the insurance company to find out what the patient needed to do to get reimbursed. I was directed to fill out reimbursement forms and gather the required documentation. I gathered the information and mailed everything to the insurance in mid March of 2022. I waited a few weeks and called to see about the status of the claim, and was told they could not find the paperwork and resend it. I did resend it and was told it would take 4-6 weeks to process. I called in 6 weeks and was told they were working on the file. This has gone on for the past few months. As of today, November 14, 2022, we are still waiting for reimbursement.
I have talked to several claims people and their supervisors, and everyone tells me the same thing; they are working on it and to call back. It has been maddening….when I ask what they are working on, they don’t have an answer, just to call back in 4-6 weeks. It has been so frustrating but I am determined to get that $450.00 back for my patient.
Wish me luck!
Don’t give up Anne! The customer service “runaround” is by design. The want people to quit trying.
I KNOW you will prevail for your good clients!
One thing I learned (the hard way) was to never, never, NEVER give up … if there’s a will there’s a way. I’ve also gone toe-to-toe with providers, like you, to get a refund. In one case it took me more than a year to fight a health insurance company for a $90,000 health insurance claim that was denied due to “pre-existing conditions”. I won that battle and learned that no matter what it takes justice must be done. So, I’m in your corner Anne and rooting you on. Your story would be perfect for the 6 o’clock news! Be sure to put it out there on Google Reviews as well. That’s where I’ve gotten the most traction. Providers don’t like their “dirty laundry” being aired. Good luck.
This is what we do–advocate with persistence sometimes to the point of being respectfully threatening. I think the insurance companies hope the waiting will wear people down and they will take the loss and give up! So sad that they have so little respect for their clients–for them it’s all about keeping the money.
Please keep us posted of your eventual success!!
Love that term ‘respectfully threatening’. You are so right Dana……
Does the client have an MD order?
They need one
If so and it is denied the MD needs to write a letter justifying why the need for the orthotic.
It is frustrating and I would say that the consumer needs the money to pay other medical expenses and they are a barrier in his being able to secure additional medical supplies. Don’t forget to confirm it is a recorded line! Good luck!
Dear Anne, this is everyday story for many patients (members). I wish you the best in obtaining the reimbursement. Fingers crossed!