so back in aug 10' my regular PT physical therapist was seeing me for a shoudler injury while doing rehab my left elbow area started hurting one day. He tried something called ASTYM (like a massage) on it with did nothing but irritate it. I tried a regular massage and then myofacial release session all did nothing.
So my usual PT sent me over to this other PT (first i called my regular doctor to get a referral just told him i had elbow pain) who's a specialist in elbow area. She yanked on my arm every which way and did all sorts of tests. Several times I pointed out this gap under my bicep down by the elbow...had her compare both sides....right side there was stuff there preventing me from pushing my finger in under bicep...left side nothing. SHE DISMISSED IT as "asymmetry". She insisted we do 5 or 6 sessions of ASTYM to which I informed her that one session did nothing. She insisted that more would do the trick. SO after 2 sessions I quit going to her cuz it did NOTHING for the pain.
Was at my GP for my kid and asked him if he would suggest someone else. He sent me over to this ortho surgeon. He looked at my arm for 30sec after i mentioned the gap. He said you have a torn biceps tendon and apronosis which is a fan of tendons that off shoot from the biceps tendon. He said you don't feel anyting vs the right side cuz it's completely torn away and your bicep is slightly retracting upward. He said stay off of it for 3 weeks and it'll fix itself but the apornosis fan of tendons would need to be surgically reattached.
So I told all of this to the owner of the firm where I saw the PT and told him look i'm not paying the co-pays and I think your PT really screwed up the call and I think you should return the money BCBS insurance paid you. I also said I thought his PT was clearly negligent for missing such a simple elementary call since that area was her expertise and she had 15-20yrs experience...or I said if she wasn't negligent she was trying to keep me coming back. Further I mentioned that my orthosurgeon dude said that ASTYM was clearly not a treatment for a torn tendon and it prolonged the injury from healing.
Anyway the owner guy has been a total prick. I was going to file a complaint with my insurance but I feel that if I do they would investigate my regular PT and GP docs which I have long standing great relationships with and I am kind of dependent on them right now to get me better. So the insurance bothering them would likely affect our relationship somehow. Plus my wife and kids go to the GP.
Latest emails below. Basically I told him I'm not paying no matter what. And he is pursuing collections. They DO NOT have my SSN or DL #. I refuse to put that info out there to anyone. So should I be worried?
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--------------------------------------------------------------------------------
From: 300wsm
Sent: Tuesday, March 08, 2011 9:06 AM
To: Jim H. OSI
Jim,
With the way work has been I have not had time to look at the BCBS complaint form until this morning. My apologies on that delay.
After thinking on it some...I've decided not to file it. I don't want to make trouble for my other doctors whom I have long standing relationships with. (obviously there is a decent chance that BCBS would involve them in some way)
Furthermore after researching ASTYM a little and asking around: Obviously ASTYM is not a treatment for a torn tendon.
Mrs. Andersen wanted to continue ASTYM several times. Which would of only aggravated the injury further.
If I were trying to rip you off I would of kept coming. (in case that is your theory on this matter)
As for your argument that you must collect co-pays. I know that is not true. My other doctor refunded the two copays I paid him regarding my elbow. Of course I have a long standing relationship but he did it with out me asking because he felt it was the right thing to do.
You of course know my feelings that I strongly believe you should refund BCBS the $192. As for the $50 it goes against my beliefs to pay it. It would be like a contractor agreeing to put new cedar siding on your house and then just painting over your existing siding. Would you pay for that?...even if the insurance paid for it and you only owed a copay of $50? I didn't think so. I bet you wouldn't pay even a 10 cents. ...nor would I.
If you decide you want to collect me, I respect your decision. But please do not have your business office call me again. I've said all I have to say on this situation and obviously I will never pay you or any collection agency.
If you decide to refund BCBS I obviously applaud your decision to do the right thing.
I'd like to stop in and show you my arm so you could see just how obvious of a mistake this was but I just don't get over that way very often. So I made a 40 sec video attachment sent separately after this email.
Respectfully,
300wsm
his response - ********************************
300wsm
We stand behind Stacia's treatment and its appropriateness for the symptoms you presented with to her on your two visits.
To your point regarding collecting co - pays - per our contractual agreement with BCBS, we are to attempt to collect co-pays from patients to the best of our ability. Exceptions can be made in the case of financial hardship. We feel it is best to abide by our BCBS contract and to apply this policy consistently to all of our patients. If there is a case of hardship for you, I would be glad to talk to you about it.
To your other point about paying a co-pay - when I sign an agreement with a health care provider to pay a co-pay, I pay it.
It is obviously your decision whether to file a complaint with BCBS regarding your care and charges for services at OSI. They would be an objective, outside source for a decision. In absence of their input, we will continue to expect you, like other OSI patients, to pay your co-pays. We are definitely at an impasse on this, Julian. You may want to reconsider getting BCBS input, and we will agree to comply with it.
I have discussed this issue with Mike R, PT, co-owner of OSI and Jody R, OTR, MAOL, Director of Clinic Operations of OSI. They agree with this decision.
I will tell the business office to no longer call you, however, if you do not pay your bill it will be sent to collections. This is consistent with how we handle other cases as well.
Respectfully,
Jim H
So my usual PT sent me over to this other PT (first i called my regular doctor to get a referral just told him i had elbow pain) who's a specialist in elbow area. She yanked on my arm every which way and did all sorts of tests. Several times I pointed out this gap under my bicep down by the elbow...had her compare both sides....right side there was stuff there preventing me from pushing my finger in under bicep...left side nothing. SHE DISMISSED IT as "asymmetry". She insisted we do 5 or 6 sessions of ASTYM to which I informed her that one session did nothing. She insisted that more would do the trick. SO after 2 sessions I quit going to her cuz it did NOTHING for the pain.
Was at my GP for my kid and asked him if he would suggest someone else. He sent me over to this ortho surgeon. He looked at my arm for 30sec after i mentioned the gap. He said you have a torn biceps tendon and apronosis which is a fan of tendons that off shoot from the biceps tendon. He said you don't feel anyting vs the right side cuz it's completely torn away and your bicep is slightly retracting upward. He said stay off of it for 3 weeks and it'll fix itself but the apornosis fan of tendons would need to be surgically reattached.
So I told all of this to the owner of the firm where I saw the PT and told him look i'm not paying the co-pays and I think your PT really screwed up the call and I think you should return the money BCBS insurance paid you. I also said I thought his PT was clearly negligent for missing such a simple elementary call since that area was her expertise and she had 15-20yrs experience...or I said if she wasn't negligent she was trying to keep me coming back. Further I mentioned that my orthosurgeon dude said that ASTYM was clearly not a treatment for a torn tendon and it prolonged the injury from healing.
Anyway the owner guy has been a total prick. I was going to file a complaint with my insurance but I feel that if I do they would investigate my regular PT and GP docs which I have long standing great relationships with and I am kind of dependent on them right now to get me better. So the insurance bothering them would likely affect our relationship somehow. Plus my wife and kids go to the GP.
Latest emails below. Basically I told him I'm not paying no matter what. And he is pursuing collections. They DO NOT have my SSN or DL #. I refuse to put that info out there to anyone. So should I be worried?
*************************
--------------------------------------------------------------------------------
From: 300wsm
Sent: Tuesday, March 08, 2011 9:06 AM
To: Jim H. OSI
Jim,
With the way work has been I have not had time to look at the BCBS complaint form until this morning. My apologies on that delay.
After thinking on it some...I've decided not to file it. I don't want to make trouble for my other doctors whom I have long standing relationships with. (obviously there is a decent chance that BCBS would involve them in some way)
Furthermore after researching ASTYM a little and asking around: Obviously ASTYM is not a treatment for a torn tendon.
Mrs. Andersen wanted to continue ASTYM several times. Which would of only aggravated the injury further.
If I were trying to rip you off I would of kept coming. (in case that is your theory on this matter)
As for your argument that you must collect co-pays. I know that is not true. My other doctor refunded the two copays I paid him regarding my elbow. Of course I have a long standing relationship but he did it with out me asking because he felt it was the right thing to do.
You of course know my feelings that I strongly believe you should refund BCBS the $192. As for the $50 it goes against my beliefs to pay it. It would be like a contractor agreeing to put new cedar siding on your house and then just painting over your existing siding. Would you pay for that?...even if the insurance paid for it and you only owed a copay of $50? I didn't think so. I bet you wouldn't pay even a 10 cents. ...nor would I.
If you decide you want to collect me, I respect your decision. But please do not have your business office call me again. I've said all I have to say on this situation and obviously I will never pay you or any collection agency.
If you decide to refund BCBS I obviously applaud your decision to do the right thing.
I'd like to stop in and show you my arm so you could see just how obvious of a mistake this was but I just don't get over that way very often. So I made a 40 sec video attachment sent separately after this email.
Respectfully,
300wsm
his response - ********************************
300wsm
We stand behind Stacia's treatment and its appropriateness for the symptoms you presented with to her on your two visits.
To your point regarding collecting co - pays - per our contractual agreement with BCBS, we are to attempt to collect co-pays from patients to the best of our ability. Exceptions can be made in the case of financial hardship. We feel it is best to abide by our BCBS contract and to apply this policy consistently to all of our patients. If there is a case of hardship for you, I would be glad to talk to you about it.
To your other point about paying a co-pay - when I sign an agreement with a health care provider to pay a co-pay, I pay it.
It is obviously your decision whether to file a complaint with BCBS regarding your care and charges for services at OSI. They would be an objective, outside source for a decision. In absence of their input, we will continue to expect you, like other OSI patients, to pay your co-pays. We are definitely at an impasse on this, Julian. You may want to reconsider getting BCBS input, and we will agree to comply with it.
I have discussed this issue with Mike R, PT, co-owner of OSI and Jody R, OTR, MAOL, Director of Clinic Operations of OSI. They agree with this decision.
I will tell the business office to no longer call you, however, if you do not pay your bill it will be sent to collections. This is consistent with how we handle other cases as well.
Respectfully,
Jim H
