Has anyone had success refusing to pay for Durable Medical Equipment?

<p>Here is the back ground:
My husband was seen by a Podiatrist in our PPO in Nov 2011 for an ankle problem. Our insurance company paid the office visit charges, less our office visit co-pay. The doctor issued my husband an Exoform ankle support brace. It has helped reduce the pain my husband had prior to using the brace. </p>

<p>We received a bill from the doctor's office for $220.41. I contacted the billing department to inquire about the bill. They informed me that the bill was for "Durable Medical Equipment" (the Exoform ankle support brace). They told me that our insurance company adjusted the bill for the ankle brace by $104.59, leaving a balance of $220.41. I was shocked that we were charged $325 for a small, 8 oz ankle brace. </p>

<p>I later found the EXACT brace available for purchase on line. I ordered one to confirm it was in fact the same brace. I paid $25.99 for the brace plus $6.69 for shipping. I plan on disputing the bill. If the podiatrist's billing department insists we owe $220.41, I will ask our local news channel to intervene. </p>

<p>Has anyone else had similar experiences?</p>

<p>Whoa! I guess I got really lucky that I only paid $40 for a $20 wristguard at the doctor's office once. Sorry, I'm of no help here. I wish you luck in disputing the charge. Your idea of contacting a local news channel is not a bad one, if the clinic refuses to deal with you, might need all the help you can get.</p>

<p>I guess this is reminder to all: if you see an ortho doc for a problem that does not require immediate bracing, ask what kind of braces or supports you might need and get your "durable medical equipment" elsewhere, e.g. at CVS or Walgreens.</p>

<p>"Has anyone else had similar experiences?"</p>

<p>More than once, unfortunately. My guess is that since your insurance involves a PPO, and you used a preferred provider, the podiatrist's office is obliged to accept the usual and customary payment determined by your insurer. If that's the case, then a call to your insurance company should resolve the matter. They will (or should) follow up with the podiatrist's office, although it may take a couple of months to get a final resolution. I've gotten good results in several such cases, but not always. It's definitely worth a call (&/or letter) to your insurer.</p>

<p>BTW, your experience with the price difference for the exact same item does not surprise me. At one time, our insurance company insisted that we rent a CPAP from a company on their approved list. Doing so meant that it cost us more in co-pays for a year than outright buying the same machine online. I've also ordered walking casts or surgical boots online for much less than my podiatrist charges. She can't explain the huge discrepancy.</p>

<p>Had a similar experience with price of a foot "brace" for post-bunion surgery that was little more than felt & velcro that the doctor billed my insurance company for $200. Shockingly, they paid most of it and since the doctor was in-network, so I was not responsible for more. </p>

<p>After a few months, it fell apart & and I found a more durable and more effective brace on-line for $35.</p>

<p>List price at the doctor's office is always hugely inflated because list price is a starting point for negotiations with insurance companies (although the price that results from the negotiations between an insurance company and the doctor's office is still often much higher than what one can get by shopping around for items available from other sources).</p>

<p>You took it, used it, said it helped. Now you want to go back on that because you found a better price after the fact? They had to buy the producer, pay for shipping, use office space to store it, they have to pay the Biller, office overhead, etc. </p>

<p>You should have asked before you took it. Why not call and discuss a discount instead of harming a business like that?</p>

<p>I think its reasonable to expect that the charge for something would not be seven times what you could buy it for yourself at retail. C'mon! A lot of things work....like my car....but I don't think I'm very interested in paying multiples of what everyone else pays. </p>

<p>This is only one of many examples of why health care costs are out of control.</p>

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This is only one of many examples of why health care costs are out of control.

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<p>Another are those who feel they shouldn't have to "pay in full" but instead want a discount for everything. That includes (and probably the worst) insurance companies...</p>

<p>I also wanted to add my experience in this regard:</p>

<p>Our PT clinic has found that we are unable to bill insurance for "soft goods" that we give a patient. Therefore that must be paid by the patient and typically we seek that payment when it is issued. This would include things such as ankle braces, compression sleeves, orthotics, eletrodes, theraband, etc.</p>

<p>Does your insurance not cover the equipment, or perhaps you're still under your deductible and that's why you got stuck with it? Just wondering. I have had similar experiences with braces. My D's leg brace for after surgery was $1,200--it was foam, 3 pieces of rebar, and 3 pieces of velcro. Unbelievable. S's ankle brace for sprain was $250. Both of them got written down to u & c by the insurance co. though, and then either paid at 90% or went into our deductible.</p>

<p>"You should have asked before you took it. Why not call and discuss a discount instead of harming a business like that?"</p>

<p>"Harming like that"? Like what? Some greedy businesses deserve to be "harmed".</p>

<p>I know this business well. There isn't this huge markup like you believe. You are also paying for the convenience. You didn't have to wait for days for it to arrive and it was fitted by a professional. That equipment happens to take years of research and development. </p>

<p>Usually the online stuff is commercial grade vs medical grade.</p>

<p>Instead of *****ing about it and calling in media to blow the roof off some local business, call them and be nice. </p>

<p>I'm sure you are also paying for all the people who don't. Just like anything anywhere. </p>

<p>I'm guessing you only got charged what your insurance would allow and it probably went towards your deductible. It is up to the patient to understand what their medical benefits do and don't cover. At the time. Not afterwards.</p>

<p>So yes, I think it's skunky to call and give some poor receptionist crap because you don't want to pay a bill you probably signed for and agreed to pay. Regardless of what I think of the pricing.</p>

<p>"You didn't have to wait for days for it to arrive and it was fitted by a professional. That equipment happens to take years of research and development."</p>

<p>Uhm, respectfully disagree about the fitted part. We are not talking about a custom made cast or sling. It is a standard brace that comes sized S, M, L and XL and is predominantly made in China. R&D - I do not think it took years of research. It is all pirated and copied from one or two companies' designs left and right. Days of wait? Zappos and Amazon and many other sites offer overnight shipping, and one can get this stuff from a shelf at CVS.</p>

<p>Did you read the OP's post? She said alerting the media would be her last resort, which I think she should do if the clinic does not correct their ways of doing business. I think it is skunky to rip off patirents and their insurance. The ortho doc I went to see told me exactly what and where to get for my problem instead of pulling the brace out of her desk drawer and charging me 10X for it. She also told me how much to expect to pay for the items. Yes, there are clinics that are not into ripping off their patients.</p>

<p>I also think it is skunky not to tell how much things would cost upfront. My family doc told me right away that the wrist guard would cost me $40. Okay, I knew it was more than I would pay at a Walgreens, but what the heck. If he said $100, I would have refused. My dog's neurosurgen recommended a special sling and told us that it would set us back $150. Okay. H went for it. If it were $500, we would have simply towel-walked the dog, no big deal. I think convenience fee equal to 9X the product's retail cost is ridiculous.</p>

<p>Imagine that an audit finds that govt office supplier charges 10X inflated prices compared to, let's say, Office Depot? There would be a big public outcry! Why is it OK for a "small business" to play these games with private citizens?</p>

<p>^Agreed. l disputed the unpaid portion of an expensive and flimsy wrist brace once and the insurance company handled it (PPO). Since then, the ortho and PT that we use (unfortunately, we are frequent fliers there) have always told us the charge up front and given us other local sources for the equipment. They're not in the business to sell this stuff and it's not in their best interest to have unhappy patients. There are several stores in my somewhat rural area that specialize in this, are trained to fit or will make appointments with the rep for that company to do so, and will bill the insurance co.</p>

<p>
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Imagine that an audit finds that govt office supplier charges 10X inflated prices compared to, let's say, Office Depot? There would be a big public outcry! Why is it OK for a "small business" to play these games with private citizens?

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<p>Umm.. the government is one reason this kind of thing happens in the first place! They (the government through Medicare/Medicaid) decide they are going to pay say 70% of the price for something... So clinics have to raise their prices in order to recover the cost.</p>

<p>I do believe the price listed in the OP is crazy and I'd be quite upset as well. I think what we charge for some of our stuff is high, but it is what it is.</p>

<p>facts: You pay for what others can't. There's no such thing as a free lunch. It's one reason the insurance companies have become gorillas in this regard.
The proberbial $10 aspirin (hyperbole but not far off) in the hospital occurs because the government does not pay for it. Elderly people don't often get aspirin--they get Tylenol. The insurance company gets a bill for the aspirin (and many more outrageous bills ) that are skewed toward the young or insurance patrons (anyone who pays real money). The aspirin is $10 and the tylenol 1 cent.<br>
The government has contracts for care (medicare and medicaid) with payments to providers that are ridiculously low. But someone (you, insurance, independent payers) has to foot the bill. As long as things "average out" it is deemed acceptable. That means your ridiculously high cost brace has paid for someone else's breathing device.
My personal opinion is that prices for all services and devices should be clearly posted.<br>
I don't really want to compare healthcare to many other retail outlets but when's the last time you went to a restaurant or any store and didn't look for the price first before ordering? Competition and openess in pricing would bring prices in healthcare down drastically I believe.</p>

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My personal opinion is that prices for all services and devices should be clearly posted.

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<p>If everybody would pay their full bill, then they could clearly post their charges.</p>

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Competition and openess in pricing would bring prices in healthcare down drastically I believe.

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<p>Bills actually getting paid would keep prices down.</p>

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<p>Only if the user were also the payer. Most users are not the (direct) payers, so they are not price sensitive.</p>

<p>eyemamom, I respect you opinion but I do not agree with your logic. </p>

<p>My husband was not told of the price of the brace before the doctor strapped it on his foot. Should my husband have asked before the doctor put the brace on his foot? That could be argued if he had previous experiences needing durable medical equipment. This is not the case. The doctor did not inform my husband that this type of brace can be purchased without a written Rx either. </p>

<p>How often do you pay your bills without reviewing the charges? I don't! This is a matter of principle. I don't mind paying a reasonable retail price for the brace. I do understand the doctor's office has carrying costs for keeping durable medical equipment readily available to those who need it. Do you feel $300 in carrying costs are reasonable for a very small, 8 oz brace that may cost less than $10 to manufacture? I don't! </p>

<p>I have attempted to contact the billing specialist twice already. She will be in the office later this week. I will give her the benefit of the doubt and give her an opportunity to make things right. I have not contacted the "Six on your side" news department yet. This will depend on the outcome of my conversation with the billing specialist. </p>

<p>I am not "harming" anyone. I am educating and alerting the consumer to look twice at their bills before they pay inflated prices for durable medical equipment.</p>