I was disappointed chiropractor Dr. Matthew Waldron and his staff, such as Kiana Eaton.
My husband and I were referred by our primary doctor and insurance company, the Boeing Company's Blue Cross plan, directly to Dr. Waldron. We confirmed with our primary doctor and Blue Cross that Dr. Waldron was an approved provider.
We immediately called Dr. Waldron's practice and scheduled appointments with him, and over the telephone verified the visits were to be reimbursed by Blue Cross. We advised him over the phone in advance of the specific treatment we were seeking, which is covered by our insurance. Subsequently, at our first appointments, we presented our insurance cards and again confirmed coverage with him. Dr. Waldron handed us both off to his assistant, Kiana Eaton.
My husband and I began receiving treatments at Dr. Waldron's clinic approximately once a week for several weeks. We showed our insurance card at every visit. During every appointment and when we scheduled upcoming appointments, we diligently asked Ms. Eaton if Blue Cross was taking care of payments. She appeared to respond affirmatively to this repeated question.
After several appointments each, my husband and I both stopped attending treatments there, as we found that our health issues were actually worsening. In addition, we had growing concerns about the professionalism and methods at this practice. It's fortunate we both made this decision then, for the situation we are now facing with this business would be even more serious.
Months after we ceased our treatments there, my husband and I each received substantial bills from Waldron's practice, on his letterhead and envelopes, for the full costs of the appointments. There was no indication on the bills of our insurance reimbursing any costs.
I called the telephone number we had used to make our initial appointments, as listed on Dr. Waldron's business card. Dr. Waldron himself answered with an unprofessional, "Yeah." Surprised by this greeting, I asked if I was calling Dr. Waldron's clinic. With that confirmed, I calmly explained the confusing bills and asked if our insurance had been properly billed. I was not angry or confrontational with him, because I assumed that this was simply an inadvertent billing mistake that would be solved. He said his assistant would "handle it," and he tersely and abruptly ended the call.
We heard nothing again for a few months, when we received bills for the same amounts. Again, we assumed that there was simply a billing error, and were not angry or otherwise confrontational. I calmly called the same clinic number, and experienced Dr. Waldron's unsettling telephone greeting and demeanor yet again. Subsequently, Dr. Waldron advised me that the reason for the full billing amounts were due to his assistant Kiana Eaton's not being a Blue Cross-enrolled provider. Immediately, he used the word "fraud" to describe my and my husband's reasonable expectations that the appointments would be covered. His unprovoked, belligerent tone was strange, as I was not confrontational or otherwise negative with him. I'd assumed no wrongdoing on his part when I called. Regardless, I did not engage him. I politely ended the call by saying I'd double-check my insurance coverage. He said nothing and disconnected the call. We have not communicated with him since then. A follow-up letter from him again on his letterhead offensively alleged "fraud" on my end.
At no point were my husband and I ever advised that interactions with Dr. Waldron's assistant would be financially handled as a separate medical practice that was not Blue Cross-enrolled. Nor did Ms. Eaton herself at any point inform us of her unusual status on the numerous occasions we directly asked her about reimbursement, specifying Blue Cross. Certainly the shared clinic and reception spaces, telephone line, billing and letterhead indicate to a reasonable person that he or she is receiving care from Dr. Matthew Waldron's practice. In addition, it seems odd that Waldron and Eaton repeatedly took our insurance information if they believed we weren't covered.
If there is any "fraud" that happened in this situation, it would appear to be on the parts of Dr. Matthew Waldron and Kiana Eaton. This seems to be a problematic medical business. If we have run into this issue despite repeatedly attempting to proactively confirm insurance reimbursement, less diligent patients may be encountering worse. This is especially of concern in this area, in which there are tens of thousands of Boeing employees on the company's Blue Cross plan. My husband and I have never had the problem of "surprise bills" from a provider because we've been diligent about coverage.
If you use this provider or his assistant, record all of your phone calls and visits with them. Get in writing from them on every visit that they're billing your insurance and/or that they're authorized to bill for the specific procedure you're receiving. read more
