Einstein Healthcare Network Plymouth Meeting

Mr [redacted] had originally brought his bill from [redacted] into our office and spoke with Shakira R [redacted] our Site SupervisorShakira informed him she was going to make sure that the correct CPT codes were used for the testingWhen the CPT codes were checked it was found that the testing was processed with the correct CPT codesI then spoke to Mr [redacted] as he was very concerned about getting his monies refunded back to himI explained that I understood that he had paid a lot of money out of pocket for the testing and I wanted to see if I would be able to get any of the testing covered for himThis was the first interaction I had with him about this issueNeither Mr [redacted] nor his wife ever verbally spoke to me about declining the blood testing as he has stated in his letter.I contacted our representative at [redacted] and I provided her with more precise diagnosis codes in the hopes that the insurance would then cover the testing at 100% [redacted] accepted my additional diagnosis codes and resubmitted the claim to Mr***’s insurance, ***When [redacted] processed the claim using the additional diagnosis codes I had provided, the patient would be responsible for paying more for the deductible than first determinedSince the claim was already closed, [redacted] was going to leave the original response on the claim.I also contacted [redacted] Insurance, and was informed that the testing that was performed was covered under Mr***’s [redacted] policy, but it went towards his deductible and he was responsible.It is a policy in the office that if any questions are asked about what insurance will cover or not cover that we refer those patients back to their Insurance carrierWe have even started a new office policy procedure that stemmed from this situationPatients are now given a form that lists different test codes so that they may contact their insurance company directly to see if the test is a covered service

[To assist us in bringing this matter to a close, you must give us a reason why you are rejecting the responseIf no reason is received your complaint will be closed as Answered] Complaint: [redacted] I am rejecting this response because: Almost everything in the response is true; however, none of it addresses my actual complaint My complaint is that an optional blood test was performed that we declined During our office visit at Einstein, the Nurse Practitioner asked if we would like the optional genetic testing and discussed the pros and cons We decided not to have the optional genetic testing performed The Nurse Practitioner told us to tell the front desk that we are declining the optional genetic testing We walked over to the front desk and told them that we decline the optional genetic testing At this point, Einstein accidentally checked the wrong box on the form that was given to *** Einstein checked off a box saying that we accept the optional genetic testing I gave this form (from Einstein) to [redacted] when the blood work was performedOnce we got the bill from ***, there were multiple line items Several of them were the routine blood tests (as we expected), but one line item was for the optional genetic testing (which we had previously declined.) The one line item for the optional genetic testing cost $ Einstein accidentally gave incorrect information to ***, so Einstein is responsible to refund the money to my family Additionally, on September 21st, around 3pm, Shakira at Einstein told me that two other patients had this same exact problem (the optional testing checkbox was accidentally checked) during the same week that we had our problem She told me that those patients never had to pay for the optional testing My case is more difficult because I accidentally paid [redacted] the full amount I paid because I was afraid that my credit would be damaged if I did not pay it Regards, [redacted] ***

[To assist us in bringing this matter to a close, you must give us a reason why you are rejecting the responseIf no reason is received your complaint will be closed as Answered]
Complaint: ***
I am rejecting this response because: Almost everything in the response is true; however, none of it addresses my actual complaint My complaint is that an optional blood test was performed that we declined During our office visit at Einstein, the Nurse Practitioner asked if we would like the optional genetic testing and discussed the pros and cons We decided not to have the optional genetic testing performed The Nurse Practitioner told us to tell the front desk that we are declining the optional genetic testing We walked over to the front desk and told them that we decline the optional genetic testing At this point, Einstein accidentally checked the wrong box on the form that was given to *** Einstein checked off a box saying that we accept the optional genetic testing I gave this form (from Einstein) to *** when the blood work was performedOnce we got the bill from ***, there were multiple line items Several of them were the routine blood tests (as we expected), but one line item was for the optional genetic testing (which we had previously declined.) The one line item for the optional genetic testing cost $ Einstein accidentally gave incorrect information to ***, so Einstein is responsible to refund the money to my family Additionally, on September 21st, around 3pm, Shakira at Einstein told me that two other patients had this same exact problem (the optional testing checkbox was accidentally checked) during the same week that we had our problem She told me that those patients never had to pay for the optional testing My case is more difficult because I accidentally paid *** the full amount I paid because I was afraid that my credit would be damaged if I did not pay it
Regards,
*** ***

This patient has never been seen in our office, we are an OB/GYN office and we do not have any PA's that work in our office.Thank you

Mr*** had originally brought his bill from *** into our office and spoke with Shakira R*** our Site SupervisorShakira informed him she was going to make sure that the correct CPT codes were used for the testingWhen the CPT codes were checked it was found that the testing was processed
with the correct CPT codesI then spoke to Mr*** as he was very concerned about getting his monies refunded back to himI explained that I understood that he had paid a lot of money out of pocket for the testing and I wanted to see if I would be able to get any of the testing covered for himThis was the first interaction I had with him about this issueNeither Mr*** nor his wife ever verbally spoke to me about declining the blood testing as he has stated in his letter.I contacted our representative at *** *** and I provided her with more precise diagnosis codes in the hopes that the insurance would then cover the testing at 100%*** accepted my additional diagnosis codes and resubmitted the claim to Mr***’s insurance, ***When *** processed the claim using the additional diagnosis codes I had provided, the patient would be responsible for paying more for the deductible than first determinedSince the claim was already closed, *** was going to leave the original response on the claim.I also contacted *** Insurance, and was informed that the testing that was performed was covered under Mr***’s *** policy, but it went towards his deductible and he was responsible.It is a policy in the office that if any questions are asked about what insurance will cover or not cover that we refer those patients back to their Insurance carrierWe have even started a new office policy procedure that stemmed from this situationPatients are now given a form that lists different test codes so that they may contact their insurance company directly to see if the test is a covered service

Mr. [redacted] had originally brought his bill from [redacted] into our office and spoke with Shakira R[redacted] our Site Supervisor. Shakira informed him she was going to make sure that the correct CPT codes were used for the testing. When the CPT codes were checked it was found that the testing was processed...

with the correct CPT codes. I then spoke to Mr. [redacted] as he was very concerned about getting his monies refunded back to him. I explained that I understood that he had paid a lot of money out of pocket for the testing and I wanted to see if I would be able to get any of the testing covered for him. This was the first interaction I had with him about this issue. Neither Mr. [redacted] nor his wife ever verbally spoke to me about declining the blood testing as he has stated in his letter.I contacted our representative at [redacted] and I provided her with more precise diagnosis codes in the hopes that the insurance would then cover the testing at 100%. [redacted] accepted my additional diagnosis codes and resubmitted the claim to Mr. [redacted]’s insurance, [redacted]. When [redacted] processed the claim using the additional diagnosis codes I had provided, the patient would be responsible for paying more for the deductible than first determined. Since the claim was already closed, [redacted] was going to leave the original response on the claim.I also contacted [redacted] Insurance, and was informed that the testing that was performed was covered under Mr. [redacted]’s [redacted] policy, but it went towards his deductible and he was responsible.It is a policy in the office that if any questions are asked about what insurance will cover or not cover that we refer those patients back to their Insurance carrier. We have even started a new office policy procedure that stemmed from this situation. Patients are now given a form that lists different test codes so that they may contact their insurance company directly to see if the test is a covered service.

[To assist us in bringing this matter to a close, you must give us a reason why you are rejecting the response. If no reason is received your complaint will be closed as Answered]
 Complaint: [redacted]
I am rejecting this response because:  Almost everything in the response is true; however, none of it addresses my actual complaint.  My complaint is that an optional blood test was performed that we declined.  During our office visit at Einstein, the Nurse Practitioner asked if we would like the optional genetic testing and discussed the pros and cons.  We decided not to have the optional genetic testing performed.  The Nurse Practitioner told us to tell the front desk that we are declining the optional genetic testing.  We walked over to the front desk and told them that we decline the optional genetic testing.  At this point, Einstein accidentally checked the wrong box on the form that was given to [redacted].  Einstein checked off a box saying that we accept the optional genetic testing.  I gave this form (from Einstein) to [redacted] when the blood work was performed. Once we got the bill from [redacted], there were multiple line items.  Several of them were the routine blood tests (as we expected), but one line item was for the optional genetic testing (which we had previously declined.)  The one line item for the optional genetic testing cost $953.  Einstein accidentally gave incorrect information to [redacted], so Einstein is responsible to refund the money to my family.  Additionally, on September 21st, 2015 around 3pm, Shakira at Einstein told me that two other patients had this same exact problem (the optional testing checkbox was accidentally checked) during the same week that we had our problem.  She told me that those patients never had to pay for the optional testing.  My case is more difficult because I accidentally paid [redacted] the full amount.  I paid because I was afraid that my credit would be damaged if I did not pay it.  
Regards,
[redacted]