Can anyone explain this please??

  1. I went to a podiatrist last summer as I have a sero negative rheumatoid arthritis - ankylosing spondylitis- it attacks the spine-SI joint-hips knees -shoulders-feet- any or all!! He recommended orthodics as I had plantar fashitis which is part of my systemic arthritis. I agreed to try them as they are terribly expensive. He informed me that insurance would not pay and I also was informed at the desk that insurance would not pay!! Well I get back my EOB and they were going to pay a good portion of the orthodics but because I had not gotten a pre authorization?????? they would not pay!!! I wrote an appeal and today I hears from them that they are not going to pay!! Isn't that a crock of !!!&&&***????? so because I was misguided by the podiatrist and staff, and did not get a pre authorization I am being penalized. I know better and am usually up on things but this disease just takes it out of you!!! I used my feet for patient care for 40 years. I will be 60 in October and am on long term disability through my hospital. I am just sick about this. do you think I will get anywhere calling the office manager??? I am going to write to the doc. He was so good. But doubt I will go back over this mess!! If you have any ideas I thank you in advance!!! It is no fun being on the receiving end of health care today!!!! Please appreciate your
    health because nursing will rob you of it eventually!!
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    About 68RN

    Joined: Aug '05; Posts: 47; Likes: 11


  3. by   Morgan314
    Thank you for the reminder of the importance of appeciating our health. You are so right, nursing does rob us of our health eventually. I've seen it so often. You describe a very unfair and unfortunate situation, but I appreciate you bringing this to our attention because most of us would never think about the need for "pre-auth" when a doctor orders something. Why is it that insurance companies always look for any little reason not to pay for something? A friend of mine had to be seen by a specialist because of a hormone imbalance, but her insurance refused to pay because her diagnosis was coded as "infertility" instead of "amenorhea." She was able to talk to the doctor who corrected the code and eventually the insurance did pay, but by that time, my friend had already gone through the humiliation of having to get on a payment plan with the billing office and had paid for the service out of pocket. I think you should not be penalized for someone else's mistake. The doctor's office should cover the expense of their mistake.
  4. by   68RN
    Hi Morgan 314,
    Thanks so much for your kind words!!! I appreciate your taking time to give me some advice. I think I will go in person and see the office manager and ask for an adjustment on this bill. My insurance was going to pay $240.00, soI think it is worth a try. Take care now!!! 68 RN