Wheels within Wheels

I wrote it about three weeks ago, but I’ve been putting off posting it because I don’t like conflict. I did promise these people that I’d post about it, though, and now that the doctor has told me to start walking without the support boot, it’s time and past time.

Now that my broken ankle is healing, I’ve been wearing a boot for support. The boot was supplied by Rocky Mountain Medical Equipment, and they’ve sent me an invoice for $240.92. I called them last week to see if I can get a discounted price, because I don’t have medical insurance. Most places will give discounts to people without insurance, because there’s less paperwork involved, and my understanding is that the payments tend to come through more quickly if an insurance company isn’t in the middle of the process. I couldn’t get an answer when I called, because the manager (whose name I wasn’t given, and forgot to ask for) was out of the office that day, and all discount requests had to be approved by the manager.

I heard back from them Friday, to the effect that the price quoted in the invoice already included a 15% discount. I find this difficult to believe, because of the evidence shown in the following two pictures.

I scanned these from the invoice package. Note that the price of the “walker boot” on the form in the first photo is what I was invoiced, and note that there is no entry in the area provided for “discount” in the second photo. I suppose it’s possible that the price list I saw at Dr. Shannon’s office is a custom one specifically for people without medical insurance, but how likely is that? I’d say there’s zero possibility, since another part of the form talks about what may or may not be covered by insurance. Wouldn’t you expect the invoice to show the original price and the discount? I certainly would. And how hard is it for them to determine whether an invoice has had a discount applied? I see three possibilities here:

1. The price includes a 15% discount that is not noted on the invoice, and I was shown a custom “discounted for no insurance” price list.
2. The price is not discounted, but they presumed it is because I asked about it, and they didn’t bother checking the invoice.
3. The price is not discounted, but they told me it was so they could get full payment.

The billed price is troubling to me, because I found the exact same boot available online for $79.95. I realize that things are normally cheaper online, but by a full factor of three? I was presuming that the invoiced price was the full retail price, and felt that if Rocky Mountain Medical Equipment provided me with the same 40% discount that both Dr. Shannon’s office and the hospital have already provided me, then the price would not have been tremendously out of line. Presuming about $20 shipping costs (which is probably high) for the online purchase, a 40% discount would have made the prices about $140 versus about $100. This is still a significant difference, but justifiable.

If the quoted price is already discounted by 15%, then their retail price is more than $280, well over three times the cost to purchase online, possibly even including shipping. This, to me, is unreasonable, if not unconscionable. Either Rocky Mountain Medical Equipment is price-gouging, or their overhead costs are so high that it’s obvious that they don’t know how to run an efficient business. Not to mention that their staff appears to be dishonest, clueless, or lazy.

I got my cast off last Friday morning, and got a boot to replace it. Life is better now, both for me and for those around me.

For me, it’s better because I can get around better now that I can put weight on my right foot. I can make do with one crutch if I need a hand free, and can even hobble a few steps without crutches. Now that the cast is off, I don’t have to spend time sealing a plastic bag over my leg to take a shower, so I’m not only taking them more often, but I’m able to scrub my right leg, and let me tell you, it needs it. I’ve got so much skin coming off it’s like I subjected my lower leg and foot to multiple sunburns.

The leg is ugly, though. Between the swelling and the loss of muscle tone, it looks like a flabby pipe – pretty much cylindrical all the way down, and no definition visible. That’s going to change as I accustom myself to using it again. It’s slow going, though – after two months of “don’t use the right foot,” I find myself forgetting to put it down and suddenly realizing that I’m moving around on just the left leg and the crutches.

I don’t wear the boot all the time; I have to exercise the ankle joint for flexibility, and the boot prevents that. Dr. Shannon talked about “writing the alphabet” with my toes, but I tried that once, and decided that I preferred just doing twists, tilts, and rotations. They seem to force a greater range of motion than practicing “air penmanship” with my foot. Then again, maybe some Palmer Method exercises … ?

Well, one, at least.

I went in yesterday morning to have my cast removed and X-rays taken to evaluate how it’s healing. The break is healing, but not as quickly as hoped. What looks to be the big problem is that my foot is out of position within the ankle joint – it’s positioned too far to the outside, leaving a gap next to the tibia.

What this means is that I’m more likely to come down with arthritis in the joint at some indeterminate time in the future. There’s still a lot of bruising evident on the foot, and Dr. Shannon’s concern is that the ligaments on the inside of the foot may not be healing quickly enough, which could leave me with the dreaded “floppy ankle” if the ligaments lag too far behind the bone in healing.

In any case, I’ve got another cast on, and go back for my next scheduled evaluation in a month.