Guest guest Posted May 12, 2005 Report Share Posted May 12, 2005 SO after a very frustrating day with the orthotists, I am giving up. The orthotics department said sure, they would order the p/m fab for me - but they refuse to bill them as AFO's and would only bill as straight last shoes w/ bar, of which my insurance will only pay $190. Great, I think, I'll only have to pay about $200 then. Wrong. Because the orthotics department will first jack up the cost to $800. So ordering through them and having them bill my insurance would cost me $610. I have financial aid, so that should cover it, right? Wrong. Financial aid will only pay for standard items they keep in stock. So the hospital is jacking up the cost, then refusing to pay their own inflated fee. They said they called but did not get a satisfactory answer on the billing codes. After spending about 30 minutes bawling my eyes out because I have had a REALLY bad day and this just tops it off, I think I'll go buy a really big gooey brownie. And then go back to rocking Livi, who had casts put back on today and has not stopped crying since we put them on at 1:30. It's my due date - don't I get a cake or a song or something? Kori, can you explain the Shriners thing to me again? What do I need to do? Darby Livi 3.15.04 bi cf due today...... Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 12, 2005 Report Share Posted May 12, 2005 Ahhh sweetie... that's just wrong. What's wrong with those people? Why can't you just order the brace from and send the bill to your insurance co? That's what I was going to do. To get into Shriners, I think all you need to do is call and ask. I can't say that if you call and ask about the shoes that they'd say yes, but if you call and ask to have Livi treated here, come down for the appointment with the info from Dr. Schmall or Mosca saying she needs the P/M's and why... there's a chance. Remember, this is the place where AFO's are standard now and I don't think they are the best choice for care for CF babies in the first place. They may resist entirely and say she needs surgery. But they may not too. It's worth the try though I suppose. However, if your insurance will pay I think the simplest way to do this would be to have send you the impression kits and you just order them from him. When you get your bill, send that to the ins. co. Or, if he can bill them directly that'd be better. As long as you have a script for them from your doc, there's no reason why they can't just be billed to your ins. That's a load of crap that they're jacking up the price. And your ins pays $190 for Markell's?? They only cost somewhere around $100 in the first place! What does Dr. Mosca or Schmall say about all this anyway? I didn't know Orthotist's were in the business to make such huge profits off of poor unfortunate little babies with clubfoot but now I know how to get rich... ugh... hang in there, baby will come and Livi will have straight happy feet. Somehow, some way... I bet baby will come first though :~} Maybe after you load yourself up on chocolate! Kori At 04:01 PM 5/12/2005, you wrote: >SO after a very frustrating day with the orthotists, I am giving up. > >The orthotics department said sure, they would order the p/m fab for >me - but they refuse to bill them as AFO's and would only bill as >straight last shoes w/ bar, of which my insurance will only pay $190. >Great, I think, I'll only have to pay about $200 then. Wrong. >Because the orthotics department will first jack up the cost to $800. >So ordering through them and having them bill my insurance would cost >me $610. I have financial aid, so that should cover it, right? >Wrong. Financial aid will only pay for standard items they keep in >stock. So the hospital is jacking up the cost, then refusing to pay >their own inflated fee. They said they called but did >not get a satisfactory answer on the billing codes. > >After spending about 30 minutes bawling my eyes out because I have had >a REALLY bad day and this just tops it off, I think I'll go buy a >really big gooey brownie. And then go back to rocking Livi, who had >casts put back on today and has not stopped crying since we put them >on at 1:30. > >It's my due date - don't I get a cake or a song or something? Kori, >can you explain the Shriners thing to me again? What do I need to do? > >Darby >Livi 3.15.04 bi cf > due today...... > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 12, 2005 Report Share Posted May 12, 2005 Ugh.... Darby, sweetie, I'm sorry you're having such a lousy time dealing with these people... Tell you what, next time I'm in Seattle (I dunno, later this summer--my parents are up there and insist on seeing their grandchildren) I am taking you out to your favorite brownie shop, or your favorite bar or whatever and we are going to indulge. And you're going to tell me all about how swell this all ended up. Ooooh--and will be there! I can hardly wait. I can only say that I'm really sorry this is so frustrating for you. It SHOULD NOT have to be. Do you have to go through this particular orthotics place, or do you have choices? If Dr Scmale writes you an order for the P/M FAB and none other, can you then just go through and deal with the insurance yourself (getting them to pay the fairly standard 80%)? I think that's what most folks have done. What did Dr Schmale have to say about her feet anyway? Did he re-cast (both feet?) only because you insisted? Sorry, this is not really very helpful. But I'm rooting for you and I hope some of this goes away soon--at least the being pregnant part. And the awful worrying about your sweet girl's feet. Naomi The Family Naomi Hannah(02/21/01) Jonah(06/20/03, bilateral clubfoot, FAB 14/7) Darby darby206@...> wrote: SO after a very frustrating day with the orthotists, I am giving up. The orthotics department said sure, they would order the p/m fab for me - but they refuse to bill them as AFO's and would only bill as straight last shoes w/ bar, of which my insurance will only pay $190. Great, I think, I'll only have to pay about $200 then. Wrong. Because the orthotics department will first jack up the cost to $800. So ordering through them and having them bill my insurance would cost me $610. I have financial aid, so that should cover it, right? Wrong. Financial aid will only pay for standard items they keep in stock. So the hospital is jacking up the cost, then refusing to pay their own inflated fee. They said they called but did not get a satisfactory answer on the billing codes. After spending about 30 minutes bawling my eyes out because I have had a REALLY bad day and this just tops it off, I think I'll go buy a really big gooey brownie. And then go back to rocking Livi, who had casts put back on today and has not stopped crying since we put them on at 1:30. It's my due date - don't I get a cake or a song or something? Kori, can you explain the Shriners thing to me again? What do I need to do? Darby Livi 3.15.04 bi cf due today...... Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 12, 2005 Report Share Posted May 12, 2005 I think you're right. The most simple way to get this is to just order them and submit myself. As Aetna doesn't recognize as an orthotics provider, they said it would take a very long time for any claim to go through, so I'd be looking at a long time to get reimbursed. But I just can't deal with this any more - I'm not sleeping at night because I'm so preoccupied with getting these shoes. And I really don't want to have to drive to Portland every time Livi has an appointment, nor do I want to have to try convincing someone else she must have them. I wish there was another option, but oh well. It's just a really awful time for us to pay this out of pocket- I'm only getting 1 week paid maternity leave, so we're using all of our savings (by ALL, I mean, every last penny) for me to take the bare minimum 6 weeks off. We'll figure something out. THank you for sympathizing with me through this whole headache! Darby In nosurgery4clubfoot , " frogabog " wrote: > > Ahhh sweetie... that's just wrong. What's wrong with those people? Why > can't you just order the brace from and send the bill to your > insurance co? That's what I was going to do. > > To get into Shriners, I think all you need to do is call and ask. I can't > say that if you call and ask about the shoes that they'd say yes, but if > you call and ask to have Livi treated here, come down for the appointment > with the info from Dr. Schmall or Mosca saying she needs the P/M's and > why... there's a chance. Remember, this is the place where AFO's are > standard now and I don't think they are the best choice for care for CF > babies in the first place. They may resist entirely and say she needs > surgery. But they may not too. It's worth the try though I > suppose. However, if your insurance will pay I think the simplest way to > do this would be to have send you the impression kits and you just > order them from him. When you get your bill, send that to the ins. > co. Or, if he can bill them directly that'd be better. As long as you have > a script for them from your doc, there's no reason why they can't just be > billed to your ins. > > That's a load of crap that they're jacking up the price. And your ins pays > $190 for Markell's?? They only cost somewhere around $100 in the first > place! What does Dr. Mosca or Schmall say about all this anyway? I didn't > know Orthotist's were in the business to make such huge profits off of poor > unfortunate little babies with clubfoot but now I know how to get > rich... ugh... > > hang in there, baby will come and Livi will have straight happy > feet. Somehow, some way... I bet baby will come first though :~} Maybe > after you load yourself up on chocolate! > > Kori > > > > > > At 04:01 PM 5/12/2005, you wrote: > >SO after a very frustrating day with the orthotists, I am giving up. > > > >The orthotics department said sure, they would order the p/m fab for > >me - but they refuse to bill them as AFO's and would only bill as > >straight last shoes w/ bar, of which my insurance will only pay $190. > >Great, I think, I'll only have to pay about $200 then. Wrong. > >Because the orthotics department will first jack up the cost to $800. > >So ordering through them and having them bill my insurance would cost > >me $610. I have financial aid, so that should cover it, right? > >Wrong. Financial aid will only pay for standard items they keep in > >stock. So the hospital is jacking up the cost, then refusing to pay > >their own inflated fee. They said they called but did > >not get a satisfactory answer on the billing codes. > > > >After spending about 30 minutes bawling my eyes out because I have had > >a REALLY bad day and this just tops it off, I think I'll go buy a > >really big gooey brownie. And then go back to rocking Livi, who had > >casts put back on today and has not stopped crying since we put them > >on at 1:30. > > > >It's my due date - don't I get a cake or a song or something? Kori, > >can you explain the Shriners thing to me again? What do I need to do? > > > >Darby > >Livi 3.15.04 bi cf > > due today...... > > > > > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 12, 2005 Report Share Posted May 12, 2005 Thanks Naomi, Yes, we definately have a date - whenever you come out here let me know and we will find some very good brownies and maybe a drink or two... that sounds wonderful today! I'm just going to have to suck it up and order the darn things. It sure would be nice to get some help from the hospital, but oh well. I will bring my baby in and impress them with what a wonderful product they didn't help me get! I really feel much better now that I got to vent and I've had some time to calm down. The brownie I ate helped, too! Livi is back in casts (both feet) until the brace comes. Dr. Schmale was all for ordering it and even talked to the orthotics people for me, but no go. She's pretty mad at us for putting the casts back on but we've done this before. I cannot begin to say how much the support from this board has helped me deal with these things - thank you!!!!! Darby > SO after a very frustrating day with the orthotists, I am giving up. > > The orthotics department said sure, they would order the p/m fab for > me - but they refuse to bill them as AFO's and would only bill as > straight last shoes w/ bar, of which my insurance will only pay $190. > Great, I think, I'll only have to pay about $200 then. Wrong. > Because the orthotics department will first jack up the cost to $800. > So ordering through them and having them bill my insurance would cost > me $610. I have financial aid, so that should cover it, right? > Wrong. Financial aid will only pay for standard items they keep in > stock. So the hospital is jacking up the cost, then refusing to pay > their own inflated fee. They said they called but did > not get a satisfactory answer on the billing codes. > > After spending about 30 minutes bawling my eyes out because I have had > a REALLY bad day and this just tops it off, I think I'll go buy a > really big gooey brownie. And then go back to rocking Livi, who had > casts put back on today and has not stopped crying since we put them > on at 1:30. > > It's my due date - don't I get a cake or a song or something? Kori, > can you explain the Shriners thing to me again? What do I need to do? > > Darby > Livi 3.15.04 bi cf > due today...... > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 12, 2005 Report Share Posted May 12, 2005 Darby- I feel for you! I don't know your whole story but does your daughter require the shoes or would the Markell's do??? If the Markell's would do I have several sizes left (they were used by my son) and would be willing to give you a pair and then all you would need to do is purchase the bar. If that would work let me know what size she needs and I'll check and see what I have left. > SO after a very frustrating day with the orthotists, I am giving up. > > The orthotics department said sure, they would order the p/m fab for > me - but they refuse to bill them as AFO's and would only bill as > straight last shoes w/ bar, of which my insurance will only pay $190. > Great, I think, I'll only have to pay about $200 then. Wrong. > Because the orthotics department will first jack up the cost to $800. > So ordering through them and having them bill my insurance would cost > me $610. I have financial aid, so that should cover it, right? > Wrong. Financial aid will only pay for standard items they keep in > stock. So the hospital is jacking up the cost, then refusing to pay > their own inflated fee. They said they called but did > not get a satisfactory answer on the billing codes. > > After spending about 30 minutes bawling my eyes out because I have had > a REALLY bad day and this just tops it off, I think I'll go buy a > really big gooey brownie. And then go back to rocking Livi, who had > casts put back on today and has not stopped crying since we put them > on at 1:30. > > It's my due date - don't I get a cake or a song or something? Kori, > can you explain the Shriners thing to me again? What do I need to do? > > Darby > Livi 3.15.04 bi cf > due today...... Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 12, 2005 Report Share Posted May 12, 2005 Is there not another orthotics shop in Seattle? Call around, all you need is the script. One of them surely would be able to bill your insurance for you. Kori At 06:27 PM 5/12/2005, you wrote: >Thanks Naomi, > >Yes, we definately have a date - whenever you come out here let me >know and we will find some very good brownies and maybe a drink or >two... that sounds wonderful today! > >I'm just going to have to suck it up and order the darn things. It >sure would be nice to get some help from the hospital, but oh well. >I will bring my baby in and impress them with what a wonderful >product they didn't help me get! I really feel much better now that >I got to vent and I've had some time to calm down. The brownie I >ate helped, too! > >Livi is back in casts (both feet) until the brace comes. Dr. >Schmale was all for ordering it and even talked to the orthotics >people for me, but no go. She's pretty mad at us for putting the >casts back on but we've done this before. > >I cannot begin to say how much the support from this board has >helped me deal with these things - thank you!!!!! > >Darby > > > > > SO after a very frustrating day with the orthotists, I am giving >up. > > > > The orthotics department said sure, they would order the p/m fab >for > > me - but they refuse to bill them as AFO's and would only bill as > > straight last shoes w/ bar, of which my insurance will only pay >$190. > > Great, I think, I'll only have to pay about $200 then. Wrong. > > Because the orthotics department will first jack up the cost to >$800. > > So ordering through them and having them bill my insurance would >cost > > me $610. I have financial aid, so that should cover it, right? > > Wrong. Financial aid will only pay for standard items they keep >in > > stock. So the hospital is jacking up the cost, then refusing to >pay > > their own inflated fee. They said they called but >did > > not get a satisfactory answer on the billing codes. > > > > After spending about 30 minutes bawling my eyes out because I have >had > > a REALLY bad day and this just tops it off, I think I'll go buy a > > really big gooey brownie. And then go back to rocking Livi, who >had > > casts put back on today and has not stopped crying since we put >them > > on at 1:30. > > > > It's my due date - don't I get a cake or a song or something? >Kori, > > can you explain the Shriners thing to me again? What do I need to >do? > > > > Darby > > Livi 3.15.04 bi cf > > due today...... > > > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 13, 2005 Report Share Posted May 13, 2005 Darby. Hang in there! I'm with Kori, can't you just order the shoes directly from and then send the bill to the insurance co? That's what I do. These orthotists should be slapped for this behavior. What was their reason for the mark-up again? And by so much? I can't figure that out to save my life. Their labor is like 5 minutes for a phone call!! Quite frankly, you don't need the orthotists to fit the shoes for you. Just tell to put them on the bar for you, so all you have to do is adjust the bar length. Please eat a brownie for me, I have been on a diet and when I read that, boy does that sound good!!! Shook Retail Operations Manager/Baking Instructor Vie de France Yamazaki, Inc. 2070 Chain Bridge Rd. Suite 500 Vienna, VA 22182 x374 x374 fax Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 13, 2005 Report Share Posted May 13, 2005 i don't have any advise but i am so so so sorry that you are having to deal with this... especially when you should be enjoying and getting all excited about the new baby arrival... this really puts a damper on it... but try to relax and enjoy livi for right now because any time now it won't be just you two... so please get that big gooey brownie, sit back and eat it and love and hug livi... mommy to Grace 12-03-03 BCF Dobb's Brace 16/7 Darby darby206@...> wrote: SO after a very frustrating day with the orthotists, I am giving up. The orthotics department said sure, they would order the p/m fab for me - but they refuse to bill them as AFO's and would only bill as straight last shoes w/ bar, of which my insurance will only pay $190. Great, I think, I'll only have to pay about $200 then. Wrong. Because the orthotics department will first jack up the cost to $800. So ordering through them and having them bill my insurance would cost me $610. I have financial aid, so that should cover it, right? Wrong. Financial aid will only pay for standard items they keep in stock. So the hospital is jacking up the cost, then refusing to pay their own inflated fee. They said they called but did not get a satisfactory answer on the billing codes. After spending about 30 minutes bawling my eyes out because I have had a REALLY bad day and this just tops it off, I think I'll go buy a really big gooey brownie. And then go back to rocking Livi, who had casts put back on today and has not stopped crying since we put them on at 1:30. It's my due date - don't I get a cake or a song or something? Kori, can you explain the Shriners thing to me again? What do I need to do? Darby Livi 3.15.04 bi cf due today...... love, lisa before i made you in the womb, i knew you... love God. __________________________________________________ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 13, 2005 Report Share Posted May 13, 2005 omg Darby, you have had an awful day. So frustrating!! and it being your due date too. Lots of (((hugs))) to you!! I just had my own fight with our insurance company...well, our secondary insurance. I'm seriously considering having Seth switch insurance companies!!!! They are always messing things up and refusing to pay. I am STILL trying to get them to pay their portion of the bill from Jake's leg fracture back in NOVEMBER!!! They said (in Feb/March) that they never received the eob's from our primary insurance (the hospital of course said they had faxed them over). So, I copied everything I had received and mailed it to them. Come to find out today, the agent who had been handling our claim has since left the company and apparently no one could find the eob's I mailed them!! So now they're working with the hospital to get another set of eob's. It wouldn't have been so bad but the b***h I was talking to in their customer service department (aren't they supposed to be at least a *little* friendly?) was horrible, very condescending. I was so mad when I got off the phone with her!! Of course when she had to call me back and tell me THEY screwed up she was nice as pie. GRRRRR!!!! Sorry, had to vent a little... Kassia 3/22/01 (Lt clubfoot, ATTT surgery April 2004) and 11/22/02 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 13, 2005 Report Share Posted May 13, 2005 Actually I had to pay I believe around $35 for Jake's Markell shoes. Now, granted that was 2 yrs ago, but I can't imagine the price has gone up that much. I did have to pay completely out-of-pocket for them, and that was through Hanger Orthopedics, the orthotist here in town. We didn't have to go through the hospital or anything, they're an outside business. I did have a prescription from Jake's dr for the first set of shoes, but the shoes still weren't covered (not surprising, it said in our coverage book that they don't pay for shoes). After the initial visit I just had to go back when Jake needed a larger size and they'd order them for me, still $35 per shoe but that's not terrible imo. I just can't believe the prices you all are getting charged for the shoes!! How awful. That is so frustrating. Definitely hit the chocolate! (((hugs))) Kassia 3/22/01 (Lt clubfoot, ATTT surgery April 2004) and 11/22/02 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 13, 2005 Report Share Posted May 13, 2005 , THank you for the offer! Unfortunately the Markells seem to be the problem. Hopefully the s work or I don't know what we'll do! We have a couple sizes here too if anyone is interested - I think we have 00 and 0 but I'd have to check. We also have two gold bars - I think a 9 " and a 10 " . Darby Livi 3.15.04 bi cf is now officially late! (Her father's daughter I guess) > > SO after a very frustrating day with the orthotists, I am giving > up. > > > > The orthotics department said sure, they would order the p/m fab > for > > me - but they refuse to bill them as AFO's and would only bill as > > straight last shoes w/ bar, of which my insurance will only pay > $190. > > Great, I think, I'll only have to pay about $200 then. Wrong. > > Because the orthotics department will first jack up the cost to > $800. > > So ordering through them and having them bill my insurance would > cost > > me $610. I have financial aid, so that should cover it, right? > > Wrong. Financial aid will only pay for standard items they keep > in > > stock. So the hospital is jacking up the cost, then refusing to > pay > > their own inflated fee. They said they called but > did > > not get a satisfactory answer on the billing codes. > > > > After spending about 30 minutes bawling my eyes out because I have > had > > a REALLY bad day and this just tops it off, I think I'll go buy a > > really big gooey brownie. And then go back to rocking Livi, who > had > > casts put back on today and has not stopped crying since we put > them > > on at 1:30. > > > > It's my due date - don't I get a cake or a song or something? > Kori, > > can you explain the Shriners thing to me again? What do I need to > do? > > > > Darby > > Livi 3.15.04 bi cf > > due today...... Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 13, 2005 Report Share Posted May 13, 2005 Kassia, I'm not sure what is worse - having a really awful mean customer service person, or having a really nice but unhelpful customer service person. At least with the mean ones you have something to direct your frustration at! I have a hard time getting upset at the insurance company whenever I talk to someone super nice! Darby > omg Darby, you have had an awful day. So frustrating!! and it being > your due date too. Lots of (((hugs))) to you!! > > I just had my own fight with our insurance company...well, our secondary > insurance. I'm seriously considering having Seth switch insurance > companies!!!! They are always messing things up and refusing to pay. I > am STILL trying to get them to pay their portion of the bill from Jake's > leg fracture back in NOVEMBER!!! They said (in Feb/March) that they > never received the eob's from our primary insurance (the hospital of > course said they had faxed them over). So, I copied everything I had > received and mailed it to them. Come to find out today, the agent who > had been handling our claim has since left the company and apparently no > one could find the eob's I mailed them!! So now they're working with > the hospital to get another set of eob's. It wouldn't have been so bad > but the b***h I was talking to in their customer service department > (aren't they supposed to be at least a *little* friendly?) was horrible, > very condescending. I was so mad when I got off the phone with her!! > Of course when she had to call me back and tell me THEY screwed up she > was nice as pie. GRRRRR!!!! Sorry, had to vent a little... > > > Kassia > 3/22/01 (Lt clubfoot, ATTT surgery April 2004) > and 11/22/02 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 13, 2005 Report Share Posted May 13, 2005 My diet starts as soon as this baby comes out! BTW, I ordered the impression kit today. Yay! Darby > Darby. > Hang in there! I'm with Kori, can't you just order the shoes directly > from and then send the bill to the insurance co? That's what I do. > These orthotists should be slapped for this behavior. What was their > reason for the mark-up again? And by so much? I can't figure that out to > save my life. Their labor is like 5 minutes for a phone call!! Quite > frankly, you don't need the orthotists to fit the shoes for you. Just > tell to put them on the bar for you, so all you have to do is adjust > the bar length. > > Please eat a brownie for me, I have been on a diet and when I read that, > boy does that sound good!!! > > > > > > > > > > Shook > Retail Operations Manager/Baking Instructor > Vie de France Yamazaki, Inc. > 2070 Chain Bridge Rd. Suite 500 > Vienna, VA 22182 > x374 > x374 > fax > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 13, 2005 Report Share Posted May 13, 2005 I have some of s shoes that my Sophia is too big for. Would you like them? Just get yourself the bar. I mean what am I going to do with these anyway? Let me check my stock of old shoes and I'll let you know what I have. Go to 's website and print out the shoe size form and measure them against the shoes you already have. I believe I have 's size 2 and soon a size 3 available. Expain to your dire financial situation and I'm sure he'll sell you just the bar for now. Email me offline if you're interested in this option. I'm not always up to date on this board so that's the best way to reach me. I just happened to see your post today. mom to Chloe 11/16/01 and Sophia 12/16/03 bi cf Plymouth MI Quote Link to comment Share on other sites More sharing options...
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