Dr. Andrew Cassidy Lone Star Podiatry went in to get a bum toe checked out and left spending $375 on custom orthotics Internet

 I saw Dr. Cassidy (Lone Star Podiatry) twice; once to get the fungal infection on my toe addressed and a second time to get fitted for custom orthotics. The first time I saw him he seemed distracted throughout the consult. I was there to get an infection on my toe fixed. I was prescribed a compounded RX available at only one pharmacy. Because the RX was a compounded (mixture of various drugs) variety, I had to submit endless forms to my insurance provider directly in order to get reimbursed. If I had been warned of this by anyone at the doctor's office I would have very unlikely agreed to the treatment as I needed to jump through hurdles every time I got refill to get reimbursed.
 
The second time I went in it was to get fitted for custom orthotics. Dr. Cassidy seemed present and attentive this time. He even cracked a few jokes and shared a few insightful tips on running and riding - a few hobbies we share. Thirty minutes later I was done. The receptionist checked me out and said I was to pay them full retail for the orthotics, $375. I reluctantly paid but had my doubts since all of the doctors I see are preferred, in-network providers of BCBS and my out-of-pocket costs are either a co-pay of $20 or a contracted rate before I meet my deductible. The doctor and his staff seemed nice enough and said charging full retail is what they always do with their other patients so I just paid and waited for them to call to get my brand new, custom-fitted orthotics. They gave me a sheet to submit to my insurance provider, Blue Cross/Blue Shield, to get reimbursed. I submitted the necessary forms to BCBS and was told the following: Dr. Andrew Cassidy is a preferred in-network provider (a participating provider) whereby BCBS and the doctor have agreed to contracted rates he is allowed to charge his patients. He should have charged you $190.63, not $375. You are entitled to recuperate the overpayment of $184.37. He refused to comply with refund request and BCBS has since filed a grievance with him on my behalf. Ultimately, if Dr. Cassidy/Lone Star Podiatry does not agree to refund the overpayment, he will no longer be a participating provider and I will be out $184. I need to note that I have made several attempts with the doctor's office to resolve this before getting BCBS to intervene, however, Rose, their manager, insisted they always charged full price for custom orthotics to avoid dealing with insurance providers themselves. Since they don't submit claims to to insurance companies themselves "they do not need to comply with the contracted rates". HOWEVER, BCBS has since confirmed that they have indeed filed an insurance claim but not on my behalf but for themselves, so essentially they double-billed;  they billed me once and got $375 and they billed BCBS to get more money! And this is how they've been doing business for as long as he's been fitting for custom orthotics!

NOTE: the service provider (in this case, Dr. Cassidy/Lone Star Podiatry) is responsible for submitting claims directly to your insurance provider if they are a network provider. The onus is on them to recuperate whatever fees they have agreed to with your insurance; it is never the patient's responsibility.