Medical Billing Dispute - What would you do SJ.COM

I've gotta go with IJAG and Ace on this one. You should have called the insurance company directly to make sure they'd cover it. It sucks and you should absolutely try to calling the insurance company and the doctor's office to rectify the situation, but in the future, check with the insurance company.

 

First of all, your insurance company doesn't get off scot free here and this is why: when medical offices call insurance companies, they don't just ask for random coverage information, they give them your ID number and run your coverage. But, I know this because it has happened to my husband, insurance companies lie. All the time. They will tell the medical office, and you for that matter, that something is covered and it's not. I know because my husband got tagged a lot of cash for eye surgery that the insurance company told us was covered. In fact, the doctor we used warned us it might not be, because the insurance company had done the same thing to other people.
Anyway, the truth of the matter is that you're responsible for the cost of the brace, which they will not take back at this point. Plus, if it makes the quality of your life better, you need it.
Your insurance company is not going to pay for it, though. They never were and that is not necessarily the medical office's fault.
Your best bet is to talk to the billing department of the medical office, and get something in writing that details the troubles you had and work out a payment plan. Trust me, you do not want this fouling up your credit report right now, which it will if it goes to collections.

 

Yeah. I'd argue that it does make my quality of life better. But so would a lot of things. I can't afford $1,28 for a brace to play sports. Instead I'll have to work my ass off to get my knee strong enough to not worry about playing sports. It's another year down the road.

I appreciate all of the input from everyone. I will keep everyone posted. I'm probably going to the medical office to dispute the bill sometime next week.

 

Hate to tell you this mustang, but your needing the brace to play sports is not exactly a medical necessity.
Now, if you needed it just to be able to walk, then the insurance might cover it.

I have no idea how old you are but maybe the torn ACL is a sign that it's time to grow up and quit trying to be a jock.

 

I don't thin insurance companies necessarily lie. What do they gain by saying that they will pay for a brace and then refuse. It's the medical company you have to pay, not the insurance company.

If you are doing anything out of the ordinary you need to call your insurance folks in advance and fight if need be. They aren't necessarily trying to rip you off, they are following the rules of whatever plan you or your company signed up for.

 

Sorry, Ace. Happens all the time -- maybe it's not an outright 'lie' but they surely misstate what they're covering. The thing that medical offices do is double bill because they think no one is checking. But if there's a payment dispute, it almost always comes back to the insurance company.

 

I will give you that they like the ol' slow pay trick.

 

I never expected my insurance to cover it. Not saying they should have. Not saying I deserved to get a brace or it is a necessity. It's not. All I'm saying is I was told numerous times it was covered. They told me they dealt with stuff like this all the time. Not to worry about it.

By the way, I'm 23 years old. When I tore my ACL, I was 22 years old and in great shape. Chalk it up to an unlucky circumstance. Shit happens. If that means "I'm trying to be a jock" so be it. But don't imply that I need to grow up because I am doing things my body can't handle. My body can handle just about anything. I played on my torn ACL for two games, unknowingly. Furthermore, after my surgery, I was running after 8 weeks. I was sprinting after 3 months and cleared to play 3 on 3 basketball after 5 and a half months. I was cleared to play full court, competitive basketball after 9 months. A lot of professional athletes don't have turnaround time like that. I've been playing basketball 2-3 times per week for up to two hours plus one game every week with no setbacks. And it hasn't even been a year since my surgery. So, yeah I'm in pretty good health.

 

That's what I was thinking. $10 bucks a month.

 

Went to the medical supply store and they provided me a copy of the printout they received when they input my insurance information in the computer. It says "orthotics" are covered up the price of or repair of a new brace.

So I called the insurance company. They said no, they are wrong we don't cover it. That's why we billed them. So whatever the mistake was, it was made by the medical supply company. Looks like I will be on the hook for the cost of the brace so now it's time to just be an annoying ass hole and send letters to the Consumer Protection Agency, Better Business Bureau as well as top members of the medical company explaining how I am telling everyone I can about their unfair business practices. I figure if I'm going to lose $1,500 on this, I might as well go nuts.

 

Take 'em to small claims court.

 

If'n I was you, I'd get a copy of that paper from the medical company... put together an email to the insurance company, or even a certified letter so you know they got it.. and ask for a written explanation of why the medical company received information that the brace was covered, but you're being told it's not. Do it writing, though, not on the phone. Phone calls are gossamer.