(WSVN) - He lost his prosthetic eye. An even bigger problem: his insurance company said they will not pay for a replacement eye for three years, so he would have to live with just one eye. Can they do that? Can Help Me Howard With Patrick Fraser help? Let’s take a peek.
Patrick Payton called to tell us something no one ever had. He lost his prosthetic eye.
Patrick Payton: “Oh, man. My reaction was, ‘Oh, no!’ (laughs) ‘Oh, no! I need that.'”
When Patrick’s eye was destroyed in an accident, he got the replacement eye — and liked having it.
Patrick Payton: “Yeah, I was fine with it, ’cause instead of walking around with my eye like this and the other gray dead, yeah, they did a good job.”
Then one day, he took the eye out for the normal cleaning.
Patrick Payton: “I was washing and cleaning it, and it fell, slipped from my hand and fell down the drain.”
Down the drain. He couldn’t get it, and he says that eye is not just for looks.
Patrick Payton: “It still can get infected if I don’t keep it covered with something.”
But Patrick’s insurance company only pays for the replacement eye every five years. The eye that went down the drain was just two years old.
Patrick Payton: “They wanna get it from me, out of my pocket. They want me to pay for it.”
Since Patrick doesn’t have the $3,000 for the replacement eye, he contacted the insurance company.
Patrick Payton: “So I explained to them how important it is and how bad it often is. So they came around and said, ‘OK.'”
The insurance rep said they would pay for the eye, but they would not put that in writing. And the company that creates the eye wouldn’t make the replacement till they got the guarantee in writing that they would be paid.
Patrick Payton: “Yes, I’m upset, ’cause it should have been done already. I shouldn’t be forced to walk around like this.”
Patrick has now been battling months to try to get the eye. Finally, he gave up and made that call to Help Me Howard.
Patrick Payton: “That might scare the bejesus out of them.”
Well, Howard, he lost the eye. Can the insurance company say, “You have to wait a few years to get a new one?”
Howard Finkelstein: “In Patrick’s case, it was his fault the eye was lost. Therefore, he has to pay to have the prosthetic eye replaced or wait until the five years are up, and his insurance company will cover it.”
But an insurance company can cover it if they want to, so we made some calls — and everything fell into place. SNG, which creates the fake eyes, told us in the past they had made prosthetic eyes for people, and when they billed the insurance companies, they would not pay.
But not Humana. After we contacted them, they quickly put it in writing that they would pay for Patrick’s replacement eye, and SNG created it.
Patrick Payton: “Very pleased, man, very pleased.”
Howard Finkelstein: “A verbal promise from an insurance company to pay for a procedure is binding, but proving it could be difficult if they change their mind, so get the agreement to pay in writing.”
Patrick Payton: “Until Help Me Howard stepped in and came through for me. Everything came together after that.”
Patrick is thankful he got the eye, thankful to Help me Howard — and certain he won’t be washing over a drain again.
Patrick Payton: “No, that is not going to happen.”
Stay away from those drains, Patrick, and now, when we talk about getting it in writing, it doesn’t have to be a letter from the insurance company. It can be an email; anything electronic counts as confirmation.
Your hopes of solving a problem going down the drain? Need a different set of eyes to look at it? Get in contact with us, and see if we have the vision to help you out.
CONTACT HELP ME HOWARD:
Email: helpmehoward@wsvn.com
Reporter: Patrick Fraser at pfraser@wsvn.com
Miami-Dade: 305-953-WSVN
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