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Private Health Insurance - Free Shoes???

Discussion in 'Australia' started by stoken, Mar 25, 2015.

  1. stoken

    stoken Member


    Members do not see these Ads. Sign Up.
    Quick question, during a quiet day I often browse online (both Google and Facebook) and see what other clinics are doing advertising wise. Today I stumbled across a clinic in Melbourne offering free shoes with any orthotics issued in clinic. Please see below as I've copied the ad from Facebook. Is this a legitimate Podiatrist Clinic and if so can we advertise like this?


    "MARCH ONLY OFFER|

    TAKE ADVANTAGE OF YOUR PRIVATE HEALTH INSURANCE PODIATRY EXTRAS COVER!

    FREE PAMPERING PACKAGE & FREE NIKE/ADDIDAS/ASICS/CLARKS SCHOOL SHOES & MORE!!!


    Our pampering package includes a professional pedicure and foot massage.

    To secure your booking, text "PAMPER ME" and your name to <><><><><>.

    To be eligible for this offer, you must be assessed by our podiatrist and have private health insurance podiatry extras cover.

    We specialise in packaging high quality shoes with customised orthotics.

    Customised orthotics can prevent many injuries, relieve aches & pains and enhance movement.
    Weekend and after hours bookings are now available."


    Just if you're wondering about an ulterior motive,, this clinic is located over an hours drive/80Km+ from my clinic and its safe to say we'd have zero patient cross over.
     
  2. thekwie

    thekwie Active Member

    I have seen some patients in the past who have had some cover for shoes in their top-level extras cover. I believe this was more common in the early years of "compulsory" private health, when funds were trying to be a bit more competitive.
    In my experience, it's usually involved a detailed report from the podiatrist.
    I don't think many health funds do this anymore, and if they do, the shoes would rarely end up being "free".
    Not really sure about the ethics of that sort of advertising....
     
  3. APodC

    APodC Active Member

    I'll be brief; read the provider rules for each fund and be aware that if you are in breach of their rules, you may be de-recognised as a provider by funds or ultimately face fraud charges if the breaches are serious. We encourage health funds to look into the very small number of people who act fraudulently and we know some are active in doing so.
     
  4. toughspiders

    toughspiders Active Member

    APodC milking the health funds - it is happening right under our noses. I had a patient of mine complain to you and AHPRA and got the brush off! She was extremely cross.

    She went to buy a pair of joggers in a Podiatry Clinic/Shop only to have the receptionist send out the Podiatrist, who asked her to jump up and down in the said pair of Joggers (she had already decided she was going to have them). She did not request an appointment. They spent literally 2 minutes with her and milked her health fund. She did not realise until she got home that they had even taken her package bonus!
     
  5. APodC

    APodC Active Member

    Hi Toughspiders, I'm not sure when that was but I can give a guarantee that I haven't had a complaint of that nature come across my desk. We'd have put her in touch with a senior person in the relevant fund to have it investigated.

    I should also flag that there will be action taken by some funds shortly to clean up this space. We've been involved over some months in ensuring that all podiatrists are treated respectfully however we have supported substantial work being done to review service statistics in which there are some significant outliers. Where podiatrists are knowingly being dishonest, we support health funds to investigate and pursue appropriate action.

    We are here for members, we fight for members and we support members, however we have no tolerance for fraud.

    Cheers,
    Damian.
     
    Last edited: Apr 1, 2015
  6. trevor

    trevor Active Member

    Hello Toughspiders,
    Your patient would have to have given the store her Health Fund card in order for a claim to be made.
    The terminal would have asked "do you want to claim your bonus".
    This would have required a response from the customer in order for the claim to progress.
    All the details about her rebate would have been printed on the terminal docket that she should/would have signed in store.

    So how did she leave the store without knowing that she had a consult and that her bonus was used?
    If she did not have a consult why did she give the store her Health Fund card?

    I do not defend the store for what they may or may not have done, but I do question your patients claims.

    The store may even have video of her visit on their security camera system?
     
  7. trevor

    trevor Active Member

    Damian,
    One for you.
    As you are spending lots of time with the health funds.

    Item 201 the AFO item number and its on the HICAPS quick reference guide for podiatrists.

    HCF are claiming that podiatrists are not qualified to issue AFOs.
    Why could this be?
     
  8. APodC

    APodC Active Member

    Have asked HCF to investigate.
     
  9. APodC

    APodC Active Member

    Confirmed with HCF management that they accept a 201 from podiatrists.
     
  10. jos

    jos Active Member

    I also have a patient who was advised by his GP to go to a clinic not far from me (why?...good question..) anyway- he went along and was asked for his BUPA card then told he could have a 'free' pair of shoes (I think they were Orthaheel, but not sure).
    he was furious that because he felt that 'they were ripping off' the health fund.
    But how many people take up the 'offer' ??
    and what impact will it have on the rest of us honest practitioners?
    If they ARE doing the wrong thing-we will all suffer audits etc....
     
  11. adamoto

    adamoto Welcome New Poster

    I have seen or know of several 'clinics'/businesses in my local area that provide the said offer in the original post... My concern is that these so called podiatry 'clinics' are opened BY non-podiatry/health persons hiring podiatrists to issue low cost custom orthotics, but charging patients all their insurance claims and then offering 'free shoes'.

    To me, I don't believe these sort of business is very ethical and does reputation of the profession any good.
     
  12. toughspiders

    toughspiders Active Member

    Hi Trevor, this client of mine is a long term client whom I have been seeing for over 5 years. I trust her. She did not ask for a Podiatrist appt she just wanted to buy some shoes. The Podiatrist was then called out by the receptionist, who then asked her to "jump up and down". She was seen for no longer than two or three minutes. Was asked for her health fund card , so they could " discount" her shoes. She just signed, like these trusty souls do. She got home and realised it was for a consult and her package bonus was used. She rang Ahpra and the local Podiatry branch and was fobbed off, as was I.
     
  13. trevor

    trevor Active Member

    Lots of health fund plans cover footwear when recommended by a podiatrist.
    Lots of podiatrists sell depth width footwear. ( we dont)

    The item number for non custom footwear is F618. ( depth-width footwear)
     
  14. toughspiders

    toughspiders Active Member

    Yes Trevor i am aware of that although they are dwindling, the ones that do often ask for a letter stating clinical need. This patient bought New Balance joggers and the item code was that used was that of a standard consult.
     
  15. trevor

    trevor Active Member

    should there not have been two item numbers, a consult and footwear.
    Something does not make sense here.
     
  16. toughspiders

    toughspiders Active Member

    Nope there wasn't Trevor, just the consult fee which used up her package bonus. She was told the Podiatrist was checking the fit, that's it... she paid cash for the shoes. I think from memory they knocked 20% off the shoes.
     
  17. Paul Bowles

    Paul Bowles Well-Known Member

    But hang on a second, if a consultation was actually performed - ie the Podiatrist talked to the patient, checked the fit of the shoes, gave them advice of any kind, can the Podiatrist not charge for that? Can they not accept a health fund rebate no gap?

    I'm confused....

    Based on the above post from ToughSpiders i'm failing to see what the Podiatrist actually did wrong or how they have acted inappropriately? The Podiatrist charged the health fund for the consult and the patient paid cash for the shoes.
     
  18. trevor

    trevor Active Member

    perhaps they claimed for the shoes and but they were not covered.
     
  19. toughspiders

    toughspiders Active Member

    It really does depend on how you look at it Paul. I'm sure others may deem it acceptable practice.
    In my view it is giving a discount for shoes if you have a so called consultation.
    The client did not realise that she would be billed for that service. She was not advised of charges nor consented to charges. She wasn't advised it would be a consultation and it lasted around 3 mins??? I guess it depends on what you a view a consultation is?
    I don't class that as a consultation.
    The place she went to was a shoe shop with a Podiatrist employed there.
     
  20. Boots n all

    Boots n all Well-Known Member

    l think it wrong that the one can prescribe and supply.

    l know a shoe shop that has the Pod on staff to do just this, they are not breaking any laws, but that doesnt make it right either.
     
  21. Paul Bowles

    Paul Bowles Well-Known Member

    I tend to sit on this fence with Boots n All.

    What amuses me about Podiatrists or Podiatry organizations is that they are the first people to cry foul when someone steps on their turf "How dare Physios or Chiros or Sports Physicians or Orthopods or GPs or Pedorthists prescribe and make orthoses!!!!" However when they step on someone elses turf those same Podiatrists don't see the issue!

    I'm a Podiatrist - not a shoe salesman. I have better things to do with my day than sell shoes. No offense to shoe salesman but i'm sure they get what I mean!!!!
     
  22. Paul Bowles

    Paul Bowles Well-Known Member

    Yes I tend to agree its about perspective. I guess in the end it would that Podiatrist who is answerable to the health fund when they get audited. I have done enough audits now for private health funds to know that keeping good detailed notes, good accurate billing records and an excellent notated/computerized day diary is essential. I wouldn't want to be caught out.....
     
  23. björn

    björn Active Member

    I have at least two “clinics” promoting this in the vicinity of my practice.

    Both promise free shoes and orthotics paid for by the health fund.
    I have seen the shoes, and range in brands from casual to running, and are usually quite podiatrically sound. The orthotics are (claimed to be) custom (They have sizes on the bottom!! S, M, L etc and look like an ICB off shelf with a luxaflex topcover on them) and get measured and fitted apparently all in the one consult (within about 10 minutes according to one patient).

    Often, the whole family are invited to claim their free shoes and orthotics and I believe that different gifts are given depending on how many shoes/ and orthotics. Based on what patients are telling me is that the shoes and orthotics total get billed to the health fund at a given amount. My guess is the health fund is "maxed out" and any "gap" is waived or written off but that is merely conjecture.

    Surely an easy way to prove it would be for the health fund to ask the questions of a given clinic and say can we please have tax invoices from the patient as well as the health fund slips and see how they correlate ?

    If podiatrists don't own the clinic as adamoto suggests, then the podiatrist is removed, a new one employed - and the process could theoretically start all over again.
     
  24. Paul Bowles

    Paul Bowles Well-Known Member

    When a health fund audits a clinic or clinician they send you a very detailed letter - in it they usually ask that you DO NOT contact the patient and they ask you for details from a very specific timeframe - for example they may ask: Can we please see ALL patient notes from 1st Dec 2015 until the 5th May 2016. They also ask for all payment records, invoices, receipts, HICAPS and EFTPOS receipts.

    Its a very demanding task. We get audited randomly - but our clinic was audited last year in mid December by a certain private fund I wont name here. They gave us 10 days to gather 10 patients information, correlate it and send it to them. As you can imagine literally a week or so before Christmas with staff on leave and a packed clinic this was extremely unreasonable.

    By the time we did collate it it took almost 3 weeks, was around 200+ pages of information (enough to fill a large binder folder). They reviewed it and provided constructive criticism of where they thought we could improve. Needless to say I then wrote back to them giving them constructive criticism of where I thought they could improve!

    Its a large task to do correctly! If the people described in this thread got audited, I can't imagine how they would hold up.
     
  25. Boots n all

    Boots n all Well-Known Member

    The long term result of this "poor behaviour" may well be the PHI will tighten up or even stop all footwear being claimed, so those that really need it will miss-out.

    Its a poor business model either way, imagine what would happen to their business if the PHI did review their position on footwear claims?
     
  26. trevor

    trevor Active Member

    I am with you Paul,
    I do not like health insurance companies.

    Allied Health practitioners do most, if not all of their front end data entry for FREE, so most health funds have closed all of their shopping centre offices as a result.
    Who then gets abused when a claim is not paid as the patient expects?
    Your poor receptionist.
    And you do all this at no cost to the health fund.
    Plus you then do complete reviews of their patient records for free.

    Pharmacies get a dispensing fee from the government to dispense a script.
    Doctors also get fees and a bonus to install and use online claiming systems. ( Hardware system grants are paid by the govt)
    Allied health practicioners should likewise get a fee from the health fund companies to cover all the above costs.
    But no.....................
     
  27. surfboy

    surfboy Active Member

    Completely agreed Trevor. Pharmacists get paid a prescription filling fee for every script! And yes the health funds have just about closed all of their shop fronts greatly reducing their costs through HICAPS point of claiming. - And after all of our hard work who then cops it in the audits?! Your local Podiatrist!!
     
  28. trevor

    trevor Active Member

    Surfboy, If the ADA ( dentists) and the chiros and physios etc peak bodies were to ask HICAPS to review their busness model so that the health funds paid for terminal costs and fees it would be a little fairer.
    Allied health is a position of strength here. Like stop processing health fund claims for a week and see what we would be offered.
     
  29. Paul Bowles

    Paul Bowles Well-Known Member

    Agreed Trevor - I have been in dialogue with several of the major health funds throughout 2015 regarding this. At least they are willing to meet and listen to some degree.

    The one health fund that audited us last December got very angry and sent threatening letters when we would not reveal 2 patients information as they had not claimed through the clinic - ie they had paid in full and we had issued them with a receipt. Now this particular private health fund were telling me that these patients subsequently had made a claim through them online - they included them as part of the audit process.

    Now just in case people aren't aware - when a patient signs the bottom of their HICAPS receipt when claiming from a health fund it basically gives that health fund the right to request information about that patients consultation.

    So we had a dilemma - no signed HICAPS receipts, and how was I supposed to know if these patients were even members of that particular health fund. So abiding by the Privacy legislation I told the health fund that I would happily release the patients private information once the patient signed our consent to do so. The private fund went berserk! I wasn't to notify the patient, contact them, they just wanted the information. Nasty letters from their legal department ensued.....

    So I told this particular health fund in the future I would NOT accept HICAPS from their patients. I would insist they go to claim in person and I would give them a letter outlining the reason why.

    Guess what happened....they stopped requesting the patients information and wrote a lovely letter apologizing. I then asked who I should bill for all the time this has taken? Haven't had a response yet.....in 4 months....

    So - the long and the short of it. Abide by the law, keep great notes and records, stand up for yourself and your profession and remember its not always APODC that does the leg work....couldn't help myself tying this into the other insurance thread!!!! :dizzy:
     
  30. TL74

    TL74 Active Member

    Unfortunately after all is said and done, whether legal or not, the Podiatry profession suffers. I agree we should not be sales people. We are health professionals that should be able to give our advice and treatment free from pressure of outside influences. Our patients should be safe in the knowledge that we are giving them the best treatment possible for them not the most lucrative treatment for us. I understand that we need to make money, everybody does. But no one makes money if the public loses respect for our profession.
     
  31. Boots n all

    Boots n all Well-Known Member

    Mail is in today, PHI must be reading these posts on PA...good stuff l say.
     
  32. APodC

    APodC Active Member

    Hi Boots and All, a small number of podiatrists were contacted last week by one of the large funds to let them know they are to be suspended. I reviewed the data with the fund and a small number were billing at remarkable levels.

    We have urged health funds to err on the side of caution and to ensure practitioners get a fair hearing but we can't condone billing for things that aren't clinically justified.
     
  33. Boots n all

    Boots n all Well-Known Member

    l think this is the sort of thing that bought down a very large American brand shoe company a few years ago.
     
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