R and J Prosthetic Appliance

Visited R & J in August 2013 for a pair of custom foot orthotics for my bad case of plantar fasiatis I developed. I called to make an apt and was able to get in fairly quickly. I was happy to see it was a small family business. I believe in supporting local families and when I asked the front office they said they have been in the community over 40 years. So, I was casted for custom supports by a technician named Joe. He was very knowledgeable and friendly. He took his time with me and taught me a lot about my condition that I hadn’t known before as this was my first experience with it. He also took me outside and showed me some stretches I could do to help alleviate daily pain. I left and returned about a week later to receive my supports. They took a bit of getting use to but eventually I got use to them. A few weeks pasted and I called to ask if there was anyway they could soften up the firm supports as my heel bones were very sensitive. They gave me an appointment for that afternoon and for no extra charge they added a soft layer of material to the top. Wow! What a difference. Now I can say, 4 months later, my foot pain is almost completely gone! Very thankful for all they did for me. I won’t go anywhere without my new supports. I had no trouble with my Co-​pay and them billing my PPO insurance. (That’s why I love PPOs!) I would recommend these guys if you are need of some help. I had nothing but a very good experience and would go back again if I needed something in the future.

Two stars or less note. I truly don’t like downgrading a business, especially those small and independent. They are the backbone of our economy. They typically don’t have an easy time to survive, let alone thrive. I am not saying the people that work here are dishonest or incompetent. I may be the exception to otherwise good service and results. I hope that is the case. Management and/​or ownership may change between now and when you read this. If not, they may improve. Don’t write this business off as a result of my criticism, but take it into your overall consideration. My experience:
As a result of a bike accident December 3, 2011, I was fitted with a couple of braces supplied by R&J Prosthetic in Ventura. January 20, 2012 R&J bills Blue Cross (Medigap) insurance for $ 3,026.41 for both braces. I receive a statement from Anthem toward the end of February 2012, that it is my responsibly to pay $ 615.90 and not my responsibility to pay $ 2410.51. Early April 2012, I receive a bill for $ 615.90 from R&J which I pay in full with a credit card and is posted on 4-​7-​2012. Approximately 9-​9-​2012 I receive a copy of another bill from R&J to Anthem for $ 3026.41 which says it’s not my responsibility to pay that amount. Curious as to why a second identical bill was sent several months later, I called Haylea at Anthem on 9-​9-​2012 for an explanation. She didn’t know why, but said she would notify Medicare. A month of so later I received a notice from CMS (Medicare Summary Notice) indicating that R&J had been requested to repay Medicare $ 1903.58 against it’s claim of $ 3026.41. Flag that. Then, approximately 1-​3-​2013 I received a bill from R&J for services on 1-​20-​2012 of $ 356.85, including $ 5.27 late interest. The bill stated I had only paid $ 182.93 on 4-​7-​2012. I wrote R&J that I had paid the full amount due of $ 615.90 on 4-​7-​2012 and included documentation from the credit card company. Then, on 2-​7-​2013, I received a final notice that I owed $ 356.85 and that collection action would be taken in 10 days. So, today 2-​7-​2013, I called Medicare to notify them that I was getting bills which I had already paid. Representative One took down my information and handed me to Representative Two, a fraud investigator (I think). To my astonishment, she said another claim, February 2013 from R&J was being negotiated for this bill. She also starts talking about my previous insurance (Anthem) and my new insurance company (Colonial Penn) being involved. She says I should call R an J. I am near speechless, but ask to speak to her supervisor, Representative 3. This person is somewhat more intelligible, but does confirm negotiations are ongoing, a year after service, and many months after I paid my one and only bill from R &J, until January 2013. I ask about the second bill to Medicare, September 2012, and she says, don’t worry, Medicare wouldn’t pay twice. I wondered why then, R&J was asked to repay almost $ 2000 after I notified them. Representative 3, without explaining why negotiations were still going on over a year after service for a couple braces (that appeared vastly over priced), cuts to the chase, and said she would contact the contractor and R&J about these late bills. After over an hour on the phone with Medicare trying to unravel this mess, I wonder what we’re in for with Obama-​care. When I was growing up in the 1940’s and 50’s Dr. Garrett made affordable house calls and we directly paid our bills to him or though a single private insurance company. It appears to me, complications not involving health care, but bureaucracy, are going to drive HC prices through the roof.
UPDATE 2-​12-​2013 Michelle from R and J called and said she verified my information and would clear it up with the bookkeeper. She said she had no idea how this happened. Neither do I. However, because Michelle responded to my letter and was polite. I will upgrade to two from one star, solely because of poor bookkeeping. The rest of the operation was acceptable to me.