CHESTERFIELD COUNTY, Va. -- It took her eight months and some help from the Problem Solvers, but persistence paid off for a Chesterfield woman who says an orthopedic practice owes her $200.
“I had this terrible pain,” 67-year-old Ava Reaves said of her troubles with diabetes-related Plantar Fasciitis. “I went back and pulled out old custom orthotics and put them on and started wearing them. And the pain went away. That's when I said, ‘you need new orthotics.’ So I sent out on a quest to find some.”
Reaves says she contacted her Medicare Advantage administrator, United Healthcare, for help finding an in-network provider. She also checked to be certain the service and orthotics would be covered under her healthcare plan.
In February, Reaves visited a SynergyHealth Foot and Ankle Clinic with the understanding that she would be responsible for about 10 percent of the bill.
“The doctor was really nice and she said this is 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 had the support she needed to stay mobile during retirement.
However, Reaves said she was surprised by a request at checkout for a $200 deposit on the orthotics. A form shared with the Problem Solvers explains the practice’s policy of collecting a deposit from patients and then refunding that money if an insurance plan makes a full payment. The policy also suggests the cash price for patients not filing an insurance claim is $400 total.
Initially, Reaves’s claim was denied by United Healthcare due to a diagnosis code for hammertoe, a condition not covered under her healthcare plan. Reaves filed an appeal and asked SynergyHealth to correct the billing code to reflect her status as a diabetic. A letter from United Healthcare and copies of Reaves’s Evidence of Coverage show SynergyHealth was paid $700 for the orthotics on September 2.
“I got two bills and that's when I thought I need to call them. I'm like, ‘Hey, I don't owe this. You owe me!’”
On top of withholding Reaves’s deposit, SynergyHealth sent multiple bills for $109.02 to cover the doctor’s consultation. A statement from United Healthcare dated June 10 indicates her plan covered all but $4.51 for the service.
“I thought I better get on top of this before they send this to the credit bureau and mess up my credit,” said Reaves of her increasing efforts to sort out the billing error and obtain a refund of her $200 deposit.
The Problem Solvers reached out to United Healthcare and SynergyHealth Foot and Ankle Clinic on behalf of Reaves. SynergyHealth and its billing partner were immediately responsive to our inquiries.
A partner for SynergyHealth expressed regret that a mistake was made, saying the practice is a small family-centered business that takes pride in helping its patients. He said had he been aware of the dispute sooner, they would have taken action to remedy the situation.
Following another look at her file, SynergyHealth determined Reaves is due a refund. Representatives for the practice assured the Problem Solvers they would mail Reaves a check this week.
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