Complaint: Last year after an auto accident, I had to have surgery on my left shoulder. After it was healed, I went back to my surgeon’s office for an evaluation of loss of function in that shoulder, so that I could settle with the insurance company of the person who ran into my auto. My surgeon’s office said that they did not do a FCE (Funtional Capacity Evaluation) and referred me to Pride, a group of doctors in downtown Dallas that specialized in Orthopeadic Consultation. When I spoke to the new patient scheduler about an appointment she asked me about my insurance. I told her that I had Medicare and a medicare suppliment. I told her I also had Travelers Insurance medical payments. She said she needed to check on my insurance and would call me back. A little later, she called, and said that Medicare had refused coverage and said to bill GEICO, which is the insurance that covered the driver of the car that hit me. I explained that GEICO had told me that they were not going to pay anything until they did a final settlement with me, I told her that Travelers would pay under my medical payments. She said that since Medicare had said GEICO was the primary, she could not bill Travelers. I did not understand that, then I asked her what the charges would be. She said $269.00. I said, no worries, I would just pay out of pocket, and file a claim with Travelers myself. She put me on hold, then came back on the phone, and told me if I was going to pay, then there would be an extra $400.00 fee for me to consult with one of the doctors before they could evaluate me. I said, so if I pay, instead of Medicare or one of the insurance companies, you are going to charge me an extra $400? she said yes. I said, thats discrimination, that’s a rip-off!! She said thats the policy. An individual paying, instead of Medicare or an insurance company, has to pay an extra $400.00. I told her no thanks, Im would find someone else to do the evaluation.
Address: 5701 Maple Ave, suite 100 Dallas, Texas USA