I had gone to an orthopedic for prescription shoe inserts. The office had said that my insurance would not cover my cost for prescription shoe inserts. The inserts cost $400 but I was told my insurance would cover the office visit. I had paid for this cost myself and have been charged for the services.

I recently reviewed my claims against my insurance carrier and noticed claims for 3 office visits of approx. $100 each, and the cost of the inserts at $800. I was misinformed by the doctors office, the doctor is not covered at all by my carrier.

Although I know that some of the responsibility lies with me in checking beforehand with my insurance company, I due feel I was mislead by the doctors staff. Of the 3 visits I was only consulted once by the doctor. Of the other 2, one visit was to put in the order for the inserts and the other simply to pick them up. I can't see how that would constitute a visit and validate a charge.

How can I go about disputing these charges? Would I have case in small claims court? Is it worth the time and effort

Have you spoken to the doctor's office manager about this yet? If not, explain the situation nicely and ask how they can help you. If they're smart and want to keep you as a patient they should be willing to write off a portion of the charge. If they refuse, let them know that you will consult a lawyer about taking this to small claims court and see if they are willing to help then. If not, small claims may be able to help you, but I suggest consulting an attorney first just to see if it would be worth the effort of pursuing it. Good luck

Wnen you say Doctor are you referring to a Physician - or someone using the title "Doctor"? I've seen both when it comes to corrective shoes.

Yes, if you walked in, picked up the shoes and walked out the bill is incorrect. There was no second visit. If you were charged for the time it took to place the order the bill is incorrect.

If the Doctor's office told you the inserts were covered and they were not I would go to Small Claims Court (it's worth the small cost of filing) and sue for the extra visits AND the cost of the shoes.

For most corrective shoes, there are certified "fitters" who actually do the mold. You will need to look at the coding but a office visit does not mean you see your doctor, I go in and see a PA, I questioned one time if the doctor was still alive and just stored in the back room, since I had not actually seen him in months. I would say that when you picked them up, they were suppose to fit them or a final fitting, have you put them in and try them. If so that was a office visit. If you just walked up to the desk and they handed you a box and you walked out, it would not be.

So they filed this against the insurance, but are they billing you ? Often, if they know that they are out of network. they are still paid by the insurance, but at a lower percentage, so while perhaps not right, they often show additional visit, so that when finally paid, they are paid the amount had they been in network

It is not what they turned into your insurance, but what they bill you, that matters.
Also when I worked in the medical equipment field, we were required by rules, to always bill the insurance, even if we know we are not going to get paid.
And normally the price billed is not the price you had to pay if you paid cash.

So please let us know, are you being billed this ? Or was this just what they submitted to your insurance.