It has happened again. The same orthotist had received authorization for
a G2 OA brace, taken a cast (?) and then notified the patient that the HMO
Insurance company will not pay for the cast and will they (the patient) pay
for it or they cannot make the brace.
There are some more twists here. The Orthotist called the prescribing
orthopedic surgeon and asked to have the script changed to a “comparable”
cheaper brace, after receiving authorization at an agreed price for the G2.
The Orthopedic Technologist who took the call said “no-way”. It also
seems there is more than a professional relationship between the primary
care doctor’s office who OK’d the brace and referred the patient to this
orthotist instead of the other available O&P shops on this HMO plan in the
area. It also seems some of the other O&P shops in the area know all about
the “games” this orthotist plays.
>
In this case, the patient is now being serviced by another O&P shop and she
will get her G2. Legal options are now being considered. I would not be
surprised if this orthotist is brought before the Boards. State and
ABC.
>
Charles Barocas, C.O
