Maybe I'm the one who is confused - medical insurance

[_19disnA]

Every medical insurance plan is different, so to try to and 'figure out' what someone on social said they did/didn't pay is probably a waste of time. Deductibles for medical care is separate from drug co-pays/deductibles. You can't mix/match them. Someone struggling financially may decide to stop taking some medication until the new year starts and annual deductibles reset. Probably not a good idea as certain drugs cannot be suddenly stopped without negative consequences. However, that person should discuss their situation with their doctor and not ask random social media strangers for medical advice.

 

[china mom]

I have a question........

What did the doctor do for you/to you to determine the type of orthotics you need?

The Chiropractor I work for sells the brand Foot Levelors. He has a scanner that our patients stand on with bare feet, and the scanner scans their feet to the tiniest detail and then the company makes the orthotics from that data. The orthotics come long, and then the patient (or the doctor if the patient would prefer) takes the original insert out of their shoe, matches it up to the orthotic and then cuts the excess off the front/top/toe area so it fits perfectly into their shoe. We've never had a problem with an orthotic not fitting or working well.

In regards to your question on what happens if they don't work - I honestly don't know since I've never had this happen to us. I would imagine that what would happen to us, would be the patient wouldn't pay us, we would call the insurance company to tell them the orthotics weren't accepted by the patient, the doctor would have to reimburse the insurance company the money paid to him, the insurance would debit the patients deductible and the doctor would be out the money he paid to the orthotics company.

Orthotics aren't cheap - if yours don't work, I wouldn't accept them. A good doctor will work with you to make sure you get the right fit to make you feel better.

Years ago, my primary podiatrist casted my feet for orthotics while I was in a sitting/reclined position. I think my feet must have been flexed or something but they were not in a normal standing position. I could not wear those orthotics for even a minute.

Fast forward to 2020. I had my right foot totally reconstructed due to a progressive condition. That summer, I had custom orthotics made my my surgeon's orthotist. He had me step in foam boxes for the mold. When they came in - at the same time as my double depth shoes, he did use the removable insole to trim.

I have since had my left foot reconstructed and my right one redone so my feet are once again different. My old specialist has moved on. My primary podiatrist wanted to to the plaster again but I said I wanted the foam. He did that but did not order me new shoes at the time (even though I am insurance eligible). We received three sets of orthotics and they would not fit in the shoe so he is ordering me a size larger. These orthotics are pretty thick and he did not think that trimming them was advisable or possible.

Then, there was a whole comedy show about what size shoe to order. His assistant insisted on measuring my feet to see what shoe to order. I know what size show I wear, what we needed to know is what size shoe the orthotics would fit in. She just could not grasp what I was saying. As it stands now, I have no idea what size shoes are coming, when they are coming and if they are going to work. I can't use the orthotics I have just received. I plan to go to a shoe store this weekend and try to fit them in various size shoes and when I figure out what size they fit in, I will order the doubled depth shoes on my own and hope for the best when the other ones come in. But, I know I am going to end up with giant clown shoes because the orthotics are huge.

 

[slo]

@china mom - you've had a lot of foot problems - I am very sorry to hear this

By what you wrote, I can totally understand why you are having confusion and frustration - I know I would be if I were you. Since I don't know the doctor or their staff, it's hard for me to give an opinion, but it sorta sounds like the left hand doesn't know what the right hand is doing. The orthotics and shoes should have been ordered at the same time and weren't. The assistant doesn't seem to know how to order shoes for the orthotics you have. No one is giving you information. My head is spinning just reading all of it.

Your feet are important - so important - they are your foundation. If you aren't happy with what you receive when it comes in, I'd definitely tell them - no thank you!

Good luck - I truly hope everything works out for you

 

[barkley]

the person may have some other avenue of meeting their deductable with an upcoming appointment/procedure. if say they qualify for the financial assistance program many hospitals/associated medical groups offer in our area their insurance is billed but after that's processed and the provider is notified that they have an unmet deductable then anywhere from 70-100% of the remaining balance is written off and the insurance company never verifies that the deductable has actualy been paid, so as an example-

med procedure $500 of which insurance pays $0 due to unmet deductable but financial assistance covers say 70% (around here that's what a person w/just shy of $60K per year income would qualify for). person ends up paying $150 out of pocket and then their yearly deductible is met at a $350 savings.

 

[KPeterso]

Medical insurance comes in all shapes and sizes. I work for one of the largest in the country. I have several options, but all are high deductible plans. All my medical costs (doctors, specialists, rxs, etc..) will apply towards my $3400 deductible. While I do put a lot in my HSA (health spending) account (with a match for up to $750 from my employer), $3500 is a lot for me all at once if I had a really pricy med. I personally have not met my deductible in the last 10 years or so. Now, I would not be stopping a med that is needed, but would probably looking for ways to possibly save on it a little bit.

 

[lanejudy]

Deductibles for medical care is separate from drug co-pays/deductibles. You can't mix/match them.

That depends on the plan. Some plans have a single deductible that applies to all healthcare - medical and prescription.

 

[barkley]

That depends on the plan. Some plans have a single deductible that applies to all healthcare - medical and prescription.

yup, that's how my oldest's works so i suggested that when due for refills in december to hit the doctor up to make everything possible a 90 day scrip (which also was less expensive copay wise than 3 30 day fills).

 

[Pea-n-Me]

Regardless of the insurance issue, I’m guessing it’s not a good idea to not take the medication prescribed until meeting a deductible. No doubt there is follow up with the doctor who ordered it, and that patient is either going to have to delay follow up, tell the doctor they didn’t take it, or lie about taking it, and none of those are good options in dealing with a prescribing doctor. Basically wasted time, and back to square one. How can they help, then? Realistically, that doctor will also lose some faith in the patient. Many may say, who cares? But it is important to have a good working relationship with our doctors, especially when we need them - which you can’t put a price on, really.

 

[monsterkitty]

I knoow, That is what makes me so crazy to hear. It is not something that one should just go on and off of.

I feel for people who can't afford medication or care but the tone of that particular post gave me the impression that they could afford it if they had to but were waiting to meet their deductible.

In my case with my shoes, I was given new orthotics and they do not fit in my old shoes so I need new shoes. It is a non issue for me because I can afford shoes but if money were an issue, I wouldn't die or anything by not getting new shoes for another month. But, medication is a whole different situation.

I think the call to let you know that your shoes would be $100 was a call to say, "Hey, these are going to cost you $100 because you haven't met your deductible. Do need to hold off on ordering the shoes because of the cost?"

Insurance is so confusing.

 

[Pea-n-Me]

Regardless of the insurance issue, I’m guessing it’s not a good idea to not take the medication prescribed until meeting a deductible. No doubt there is follow up with the doctor who ordered it, and that patient is either going to have to delay follow up, tell the doctor they didn’t take it, or lie about taking it, and none of those are good options in dealing with a prescribing doctor. Basically wasted time, and back to square one. How can they help, then? Realistically, that doctor will also lose some faith in the patient. Many may say, who cares? But it is important to have a good working relationship with our doctors, especially when we need them - which you can’t put a price on, really.

Just to clarify, too. I think it’s absolutely fine to tell the doctor you don’t want to take something, then an alternative plan can be formulated. Or to be honest and say you can’t afford it until you meet your insurance deductible, etc. That is understandable, and they see it a lot. But to leave an appt with an agreement and plan to take it, and then not actually take it, when the doctor thinks you are taking it, just isn’t a great idea. That said, I totally sympathize with anyone who has to pay an exorbitant amount for meds, for sure.

 

[china mom]

I think the call to let you know that your shoes would be $100 was a call to say, "Hey, these are going to cost you $100 because you haven't met your deductible. Do need to hold off on ordering the shoes because of the cost?"

Insurance is so confusing.

Yes, that was exactly what it was. But the orthotics are useless without new shoes and I will have to shell out $100 one way or the other so I might as well spend it on the shoes.