- Report: #1135053
Report - Rebuttal - Arbitrate
Complaint Review: Gary Berke Prosthetics
Gary Berke Prosthetics801 Brewster Ave, Suite 270 Redwood City, California USA
Gary Berke Prosthetics Failed to pre-authorize a medical procedure which cost me $7,200.00. Gary mismeasures me and builds a prosthetic leg that is extremely painful to use. Redwood City California
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I've never dealt with ''medical professionals'' that are more incompetent and completely unethical as I did with Gary and Brenda. Brenda (billing) did not pre-approve my new prosthetic leg with my insurance company. It appears as though Brenda tried to cover-up by sending me documentation that she misrepresented to me. Worse yet, Gary skips a critical step and builds the worst leg I have ever had in the 27 years that I've been wearing prosthetic legs. I believe Gary took steps to hide his mistakes from me. I know by 2011 Gary saw a ''pressure sore'' and chose to say nothing (this is the most critical issue.) It's 2012 and I now have to use crutches due to pain caused by the ''pressure sore/alignment'' issue. It takes until March 2013 for me to realize that this alignment issue was the cause of all my pain. I’m convinced Gary knew why I was experiencing so much pain if not from the beginning (when he realized there was a major measurement issue), then certainly by 2011 when I noticed him inspecting this ''pressure sore. [continued below]....
Disclaimer: I am not a medical professional and all my theories regarding my leg/socket issues are strictly of my own opinion. Furthermore, all statements on the review are strictly of my own opinion and should NOT be regarded as fact.
I originally came to Gary to get a new socket for my prosthetic leg. He talked me into getting a full leg system. I told him that will be okay as long as he checked with my insurance company. Not only did Gary not check with my insurance company but his wife, who is in charge of billing, never even bothered to pre-approve the project. THIS MISTAKE COSTED ME $ 7,200.00 TOUSAND DOLLARS. To put that in perspective my last two legs cost less than $ 400.00/ea. In the beginning Brenda was trying to blame the insurance company but when I started asking too many questions she started blaming me. I then asked Brenda if she pre-authorized this with my insurance company and she said yes. So then I asked her to send me the documentation and she did. A few days later I receive it and take a look at it, it did not seem quite right. I kind of put it on the back burner thinking these people are medical professionals and would not deceive me like this. Turns out I was wrong, Brenda never pre-authorized my leg (I verified this with Blue Shield.) Turns out that documentation Brenda sent me was something she printed off the Internet showing an insurance payout? BTW, there was a cap on my policy but Brenda never checked. If she did, I would have gotten a new socket only (not a whole leg.)
BUT HOLD ON, IT GETS MUCH WORSE. The leg Gary builds turns out to be a complete disaster. The socket is too short. Gary had to make numerous modifications (over ten documented) to my socket/liner. To put this in perspective my last socket/liner had only three modifications during its seven years of life. The leg before that had five modifications, two of which were made after eight years.
It’s really hard to explain what happened so I will attempt to do it chronologically:
At one point I go to his office to walk on the test socket (and leg) for the first time. His intern comes in with my finished leg. OMG, I never get to walk on the test socket/leg. I immediately say something to the intern but I don’t recall what her response was. BTW, Gary is not here… he’s in his office when I get my new leg. Anyways, I get up to walk on this leg for the first time and it’s so painful I start to go down. Gary’s intern grabs me and keeps me from hitting the floor. This is the beginning of my painful (literally) experience with this leg. She (the intern) goes and gets Gary and of course I am asking questions but he’s not talking much. He remeasures the distance between just below my kneecap (patella tendon) and the bottom of my stump (this is key to my whole problem.) He tells me he will have to do some work and I will need to make another appointment. At this stage I don’t know about the insurance problem and I’m confident (or hoping) Gary can correct this issue.
I return and apparently Gary has modified my socket well enough for me to walk on during our short office visit. I took it home and used it for a week (on and off) but it was hurting so I put it in the closet for awhile. Mind you I did not know how serious the problem was and I was just too busy to deal with it at the time (I am self-employed.) It’s during this period I’m starting to realize there is an insurance issue. I now realize this leg is going to cost me a lot of money ($ 7,200.00.) I still believe the insurance company had made a mistake (according to Brenda.) Never-the-less I bring my leg back to Gary and tell him I can barely use it. I also ask why it feels so funny... it was so tight that all I could ware was a 2ply sock and there was no pressure under my knee (this is key.) Gary tells me there is a “new school of thought” on how to build sockets. At this point I’m a little suspicious because of the prior incident coupled with his unwillingness to tell me the exact problem.
Now that I have made my third visit to Gary (for the same issue) and I'm ready to actually use Gary's leg. I used the leg one evening (4+ hours) but it is more sitting than walking and it does feel okay except that I can only use a 2-ply sock and there is still relatively no pressure under my knee. The next day I go on my hike and at about 1/2 mile I am starting to feel some pain. I turn around and head towards my car. By the time I get to my car I am in major pain. I take off the leg and the bottom of my stump looks like a cherry. I now know what the problem is. The socket is too short. This should have never happened. It is unbelievably easy to check for this type of "bottom-out" problem. All you need to do is drop a little baby powder in the bottom of the liner and walk on it and see if the powder is still at the bottom of the liner. This happened after my third visit for the same issue. I'm sure Gary knows it's a "bottom-out" issue but he never bothers to check. I'm assuming he does not check because he would expose the issue. BTW, I did not know how to check for "bottom-out" at this time.
I get back in Gary's office and I am very upset. I tell Gary I've finally figured out he made my socket too short. He does not say much but he pulls out the bottom insert and hands it to me. I get up and walk and it seems okay. Gary still does not check for the "bottom-out" issue. He has even more incentive now because there is no more inserts to modify or remove. So I leave and start using it. It still feels strange because it is so tight (I can still only fit in with a 2ply sock.) I'm still having a problem with how far I can walk and how long I can stand. I do confront Gary about the fact that the bottom insert is totally gone. He responds by telling me that the purpose of the bottom insert is to adjust it up or down to fit correctly. He's absolutely correct to some extent but Gary is not telling me the whole story. There is also an alignment issue and it turns out to be the source of my pain for the next few years. This alignment issue is key to all my pain and I will get to that soon. BTW, I have been missing a leg for over 27 years and I have never had a liner/socket system that did not have a bottom-insert.
I finely decide to go to another prosthetist to get a second opinion. Unfortunately Gary use to work at this place in the past and I told them (her) it was Gary who built it. She told me there were a few small issues, but she thought Gary should be able to fix it. I voiced my concern about how tight it was and She agreed “it was a little too tight” but she also told me it really should not cause any problems. Honestly I was left with the feeling that I should get a third opinion but I never follow-up on that. I did ask her if she could start taking care of my leg but she could not because of liability issues (makes sense to me.) This is when I realize that I am dependent on Gary and that is why I'm writing this review so long after the incident... either I get a new leg or I work with Gary. Of course I choose the less expensive route and stick with Gary (ironic.)
Now it is early 2011 and I notice I am developing a pressure sore. Not sure when it started but it does not seem to hurt or bother me so I do not think much of it. I'm still having to visit Gary's office often for adjustments. I notice Gary inspecting my sore. I told him it's been there for a while but it was not bothering me. He moves on and says nothing. Unfortunately I did not understand the significance and Gary does not say anything. All these months I'm concentrating on the fact that my socket is too short when the real problem is an alignment issue which of course is directly related to the socket being too short. I still don't understand about the alignment issue yet but I mention it here because (In retrospect) I'm sure Gary already knows this.
Many visits later In September 2012 I take a trip to France. I visited Gary three times within 30 days of my trip hoping to see if he can make my leg work a little better. Unfortunately it did not work... one night in Paris I was in so much pain it took me 1½ hours to walk about ½ mile. The pain was terrible. It feels like my stump is being zapped with a low powered stun gun. The worst part is the pain lasts for hours after I stop walking. I had to buy crutches the next day. IN THE 27 YEARS I’VE HAD A PROTHECTIC LEG I HAVE NEVER HAD TO USE CRUTCHES BECAUSE THE LEG HURTS FROM WALKING TOO MUCH. True, prior to Gary's leg I would have to sit because of pain, however, I could walk 2 to 3 times the distance and my recovery time was only 5 to 10 minutes. Recovery time on Gary's leg can be hours. There is a good reason for this, Gary's leg has an alignment issue which in turn agitates the end of my severed (amputated) nerve. I believe this nerve is called the Tibial Nerve which is one of the two nerves that branch off the Sciatic Nerve. The end of this severed nerve is the source of what is called phantom pain. Anybody (non-diabetic) who's missing a leg knows how sensitive this spot is and I'm guessing a person who builds legs should also have this knowledge.
After my trip I go back to Gary and I'm telling him it's impossible to walk very far. BTW, over the years (by around 2011) I told Gary several times I cannot walk as far as I use to but he never followed up with any questions and I was afraid to let him make any aggressive adjustments so I let it go. But now I’m upset that I can’t walk very far and I’m willing to let him make some more aggressive changes. For the most part the changes don’t work because it’s impossible to get past the short socket issue (aka Bottom-Out, aka alignment.)
It's November or December 2012 (can't remember which one of the five visits I had those two months) and Gary finally checks for bottom-out and that's when I realize I am still bottoming-out. I also see how easy it is to check for bottom-out. All these years and he never checked. All you need to do is drop a little baby powder in the bottom of the liner and walk on it and see if the powder is still at the bottom of the liner. Even after I confronted him with the problem he does not admit this is a problem. I still have not figured out the alignment issue yet.
January 2013 : I have been wearing Gary's leg regularly for a little over three years (since the October 31, 2009 incident.) I am complaining about the "bottom-out" problem. Gary is putting more patches on my liner but it is not working. Gary tells me he thinks my leg has changed shape. OMG, I was bottoming-out since day one! He has the nerve to tell me this five or six times. I made a very sarcastic statement and left. I was very upset and I was determined to find proof of how he screwed up the whole thing. I began to take measurements of my liners which are a direct match to the sockets. It is a little tricky but I could determine that Gary's socket is about one inch short. I can also look down into my liner and clearly see where the original insert was (I have known that for years.) As I start matching my stump with my liner I begin to realize there is a much more serious problem than what I previously understood before. My Fibula is "wedging" down into my socket which is causing it to flex into the severed end of my Tibial Nerve. I tested this by pressing down on the pressure point and in a few seconds I could start to feel my nerve tingling. I have finally figured it out. That sore is the source of all my pain. I really feel stupid. Of course Gary has never told me this. In my defense it can be difficult to pinpoint the source of pain (anybody missing a leg knows this.) Not only that, the physical evidence (pressure point/sore) is almost two inches from the real pain. I have little doubt that Gary knew this was the actual origin of my pain. He knew about that pressure sore a couple of years ago (2011.)
This report was posted on Ripoff Report on 03/31/2014 10:37 AM and is a permanent record located here: http://www.ripoffreport.com/r/Gary-Berke-Prosthetics/Redwood-City-California-94063/Gary-Berke-Prosthetics-Failed-to-pre-authorize-a-medical-procedure-which-cost-me-72000-1135053. The posting time indicated is Arizona local time. Arizona does not observe daylight savings so the post time may be Mountain or Pacific depending on the time of year.
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