Professional Medical Billing, Inc.

Initial Business Response /* (1000, 5, 2015/06/10) */

The first time Mr.[redacted] call Professional Medical Billing was on 5/26/2015. It was the first and only time he contacted us. We resolved his account with that phone call, the account was cancelled at Premiere collection agency and Mr. [redacted] was...

informed that because it was Professional Medical Billings error he would not have to pay on the account.
His insurance is a Medicaid Plan administered by [redacted] which would considered past the filing limit if we were to bill the charges as he as requested.
The balance has been adjusted off and he is not liable. If you have any questions please contact me.

Sincerely,
Sherri [redacted]
Vice President of Operations Professional Medical Billing

Initial Business Response /* (1000, 5, 2017/09/27) */
I would like to respond to his complaint regarding the processing of his claim. Professional Medical Billing does the billing on behalf of [redacted] who are the Emergency Room physicians that provide care in the Emergency department at...

[redacted] hospital in Danville Indiana.
The emergency room physicians are not employees of the hospital therefore we cannot not bill claims under their tax id or insurance contracts, The emergency room physician's are not contracted with Mr. [redacted] insurance plan. Mr. [redacted] claim was processed correctly by his insurance as being an out of network provider.
We did send his records, file his claim and do everything we were required to do.
His claim was processed in June of 2017. When Mr. [redacted] called our office and spoke with Rolanda she explain to him that the claims was processed correctly they are out of network with his insurance. She informed him we did we applied the disallow on his claim even though we did not have to so the amount owed would be reduced to the amount his insurance company allows for payment.
The amount he owes was applied to his deductible. Unfortunately this is how his plan works and the amount due is his responsibility to pay.
I am sorry he felt PM13 was rude and untruthful but if we did not send his claim and
records we would not have the explanation of benefits from his insurance company.
Initial Consumer Rebuttal /* (3000, 7, 2017/09/27) */
(The consumer indicated he/she DID NOT accept the response from the business.)
This response does not correspond to what my insurer, [redacted] communicated to me. [redacted] has the claim as "pending" and "no patient responsibility" still on their end as PMB has not submitted the claim correctly to them for processing. Until the claim is submitted according to what [redacted] indicated they needed PMB to do, I have no "explanation of benefit" statement that matches the amount on the bill from PMB. This issue is 100% from improper communication between [redacted] and PMB. As they refuse to communicate directly with each other, I have been pulled into the middle to try to get the processing of this claim done properly. This has created considerable stress on my end to get these two companies to do the right thing and get this claim processed properly. A complaint with the Indiana Department of Insurance has also been filed on this issue. PMB has threatened to turn this bill over to collections. If this occurs, I will have no other option than to have my attorney file a lawsuit against PMB and [redacted]
Final Business Response /* (4000, 9, 2017/10/03) */
After Mr. [redacted]r's response I had the claim follow team reach out to [redacted] again regarding the processing of this claim. This time we have the reference number contact name and date and time of the call recorded, Mr. [redacted] is correct they now show the claim in a pended status and have the medical records for review.
It will take approximately 45 days for their next decision regarding the status of his claim and if he will have any payment due at that time. His claim was placed back on hold and we will await their next explanation of benefits.
However we will still be out of network for the processing of this claim. I am not disagreeing that this process with [redacted] is difficult. The first response we received
from them was in June on a March date of service. We too get different stories everytime we call them to inquiry on claims as well even as providers.
We will wait to hear from [redacted] on their final determination.
Final Consumer Response /* (3000, 18, 2017/10/23) */
I noticed the case XXXXXXXX was closed on 10/16/2017. I received no email from the Revdex.com stating it was closed as "assumed resolved". I did not respond to the second response from business as they stated the invoiced amount was back as pending. This issue will not be resolved until PMB correctly send the documents that MDwise has requested (several times) for claim processing i.e. the requested Medical records to show the emergent nature of the ER visit. This case should remain open.