For one patient, the clinic made nine prosthetic fingers. This was a complex and costly procedure and months after providing the prosthetic fingers, the clinic had trouble getting paid by the insurance company.
Humana Military, a contractor for TRICARE East, approved the procedure before the clinic moved forward with the treatment. Carolyn Hicks, the patient care coordinator at The Anaplastology Clinic showed ABC11 the official documentation confirming all nine fingers were authorized. Still, once the work was done and the prostheses were delivered, payment didn't follow.
"They've denied it many times," Hicks told ABC11 Troubleshooter Diane Wilson. "We've called, I've got reference numbers and everything stating that, at one point, they said they never received the invoice, they never received the office notes, and we have submitted them many times."
They did receive a check for about $1,600, but that only covered a small portion of what they were owed. "It's almost $60,000," said Hicks. "We're a very small practice here, so this has really impacted our money flow that comes into the building."
After seeing a similar story ABC11 had covered, Office Manager Taffy Jones called the Troubleshooter team. "I thought we need help too," Jones said. "So I'm like, I'm calling Diane."
ABC11 Troubleshooter Diane Wilson contacted Humana Military. While the company did not respond directly, a notice was posted on their website at the time that acknowledged claim processing delays due to a major system transition and stated they were working to expedite resolutions.
Just a week and a half after ABC11 got involved, Jones says the clinic received a full payment of about $56,000. "We really thank you for it," Jones said. "Because I don't think we would have gotten it resolved if it hadn't been for you."
While the clinic is relieved this long-standing claim was finally paid, they're still waiting on reimbursements from other insurance providers for additional claims dating back more than a year. The ABC11 Troubleshooter team is continuing to work with them and will keep you updated on any developments.
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