Pacific Cataract & Laser Institute

Complaint: ***I am rejecting this response because:
Hello,
As suggested by the Pacific Cataract and Institute, I have talked to my insurance company over the phone (Case# ***, Ms.Rolanda)They have told me that they don't have any record of re-claim after the first initial claim, so if the clinic makes claim again, they told me that they will review the claim againTherefore, I ask the business to stop sending the bills to me and re-claim to the insurance companyAlso, I ask that Pacific Cataract and Institute to pay me a refund for the exceeding amount from the original contract ($407.01) that has been paid until now at the earliest possible dateI have attached the copy of an original agreement we signed
Sincerely,*** ***

Thank you for the informational letter regarding our patient and theopportunity to make a response. We have indeed experienced billing issues inregards to this patient and the insurance involved. The patient's insurance hasa split billing scenario, meaning certain types of claims are sent to one...

branchof the carrier and another type of claim is sent to a different branch.The patient's benefits were verified prior to services and the patient wasadvised of a deductible of $550 that would be owing. However, when claimsprocessed with insurance, almost $1100 (nearly double) was actually appliedto the deductible. We questioned this personally with the insurance via phone(our notes indicate we spoke with Sandra on 10-31-16) who concluded thateach branch was not communicating with the other and they had assessed thedeductible twice. Sandra was having this reviewed and corrected. As of 12-7-16 there had been no response from the insurance carrier. We then filed adispute form with the insurance to have all claims reviewed. We respondedback to the daughter of this course of action and also advised her the patientmay want to contact the insurance carrier as the deductible is patientresponsibi lity and Grievances/Appeals are a patient right.Upon receipt of this letter today from Revdex.com we again called the insurancecarrier, spoke with Debbie, who verified receipt of the dispute. Debbie alsostated enough time had not yet elapsed for this review and to allow another30-45 days. We are attempting to help the patient resolve this issue with
insurance. We again would encourage the patient to contact her insurance, aletter may be most appropriate, but sometimes a telephone conversation willwork, stating she is being assessed her deductible twice and request aresolution.We will keep following up on this patient's account until insurance eitherreprocesses correctly or advises us that we have exhausted our options.Sincerely,Wava G[redacted]Patient Accounts Team LeaderPacific Cataract and Laser Institute
*Please view attached document