Play Works

In response to the complaint filed by ***:We do empathize with Mrs. with regards to how much confusion there has been regarding payment, any monies owed, and in general the financial ambiguity around the services received by her child. You'll find more detail on that later in this response.

With that said, I can attest on behalf of myself and my office that Play Works has not wittingly billed for any services not rendered or attempted to collect any outstanding balance from any family that we did not believe was owed in good faith; from Mrs. or any other families that we have worked with.

Per our insurance contracts, it is permissible to submit claims for services up to one year after the date of service, dependent upon the specific details of each contract/relationship. This client's insurance plan capped visits which would have prevented access from a service the family wished their child to participate in. The primary service would ultimately pull from an unlimited visit pool based on diagnosis code, but the secondary would be limited if both billed simultaneously. Both parties agreed to withhold submitting claims to assure access to the secondary treatment. This is not fraudulent, nor was it a method to double bill the client and the funder. This client held a high deductible plan, therefore our office and the client were tracking up to the amount of the deductible, and collecting payment at the time of service. The client was invoiced via Square and paid invoices promptly.

There was a duplicate charge for two dates of service (applied to deductible). These dates were 1/3/19, and 1/8/19. The billed amount was $97.16 per date of service. The client brought this to our attention as she was reviewing her records to determine if/when she would meet her deductible.

Shawn (operations), me (owner), and the client held a meeting, with the resolution being us writing an overpayment refund check at that meeting. At the same meeting, the client questioned assessment charges and indicated that she didn't feel she owed Play Works any money for four dates of assessment. At that time, the client had been billed $250 for the first date of assessment (2/20/2019), but this charge had not yet been paid, and no other invoices had been generated for assessment. It was communicated that our office would contact her if there were additional financial adjustments that needed to be made once we received EOBs for the assessment. We left that meeting confident that we were all of the same understanding that we (Play Works) would continue to look through our records and inform the family were we to find any other administrative errors. Unfortunately, we did, and they were not limited to one family. Based on what we learned, Play Works took immediate corrective actions, which resulted in, among other changes:

The departure of one front office member (left on her own accord after being presented a new scope of work that we felt better aligned with her skills)On-boarding a full-time SLP immediately to take on the majority of my (at the time) caseload so that I could shift my focus (along with Shawn) toward operations and leadership work. It's worth mentioning that when I made this change, I went from treating over 40 sessions per week to seeing only three specific children, one of which was *** child.An internal audit of over 1,000 claims submitted in 2019 to ensure we had not made the same mistake with other families. While we do not wish to share the full outcome of that audit here, I will share that while we found no evidence of families being overcharged, Play Works absorbed significant financial losses. We were (are) well within our rights to create invoices for these families, (both legally and due to our internal policies that are signed by every family that receives services at Play Works), however, we made the decision that it did not seem ethical or fair to invoice families, into the thousands of dollars in some instances, due largely in part to a lack of internal oversight on process. It was my understanding that this situation was resolved for all parties until an email I received from the client on 12/4/2019 which you already have in your records.The client and I spoke the next day (12/5/2019) at her child's appointment with the goal to make sure that all parties involved were on the same page. The client repeatedly stated that she was ready to let it go, that they love coming to Play Works, and that there were no hard feelings. At this time, our office administration indicated there were no monies due to the client. A meeting to resolve any outstanding billing issues was extended, but denied by the client.In response to canceling appointments for her son repeatedly to get them to withdraw their son from care:Most recent DOS 12/10/2019. To answer the allegation that appointments were canceled in some retaliatory manner, that is simply not true. When I reduced my caseload to focus on getting the business side of things to a place I felt comfortable, I specifically asked that *** child be one of three clients that stayed on my caseload. The cancellations were a combination of being sick (self and children), office closures due to Holidays and my canceling appointments because we had signed a lease on a second space (Play Works Center for Autism Services), and we (Shawn and I) were working 18 hours a day getting the Clinic ready to open while trying to manage the existing site and take care of our own three children that were out of school on holiday break. This accusation feels very personal, and it's quite hurtful given what I had always considered a strong personal and professional relationship. The client was offered an alternate clinician for that week so that her child did not have to miss any appointments. This extension was declined by the client.Play Works was closed for business 12/23/2019-1/1/2020 for holiday break, a reward to our staff for exceeding clinic productivity. During this window of time, the personal decision to take a medical leave of absence from treatment, but continue to run the business was made. This was applied across all of my clients. Each client was rescheduled with another wonderful therapist so that services would not be disrupted. This medical/personal leave of absence was due private, unexpected news received over the holiday break. A benefit and eligibility check was also performed by Play Works' Office Manager at the new year, and it was uncovered that *** child was no longer covered by insurance, therefore child was unable to be rescheduled with an alternate therapist. On 1/15/20, I noticed a dismal Google review by the client, which was my first knowledge of her continued upset. I immediately reached out via email to work through any misunderstanding between Play Works and the client. This email was immediately followed up by a phone call, where the client stated "I can't talk to you" and hung up the phone. One more email followed from me hoping for clarity. You will find these correspondences within the original complaint.Based on what she stated in her review, on 1/16/20 I contacted her funder to see if we had an action to take. What was revealed is that her funder initially sent an EOB with $250 patient responsibility (applied to out of network deductible) for an assessment. This was put on an invoice and sent to the client. The client did not pay this invoice, so there were no funds for her to recoup. Prior to checking our invoicing, I sent the client a check in the amount of $250 as a sign of good faith. Correspondence was emailed on a Saturday morning with the unpaid invoice attached so she had visibility on her end that we did not obtain $250 for the incorrectly processed claim. The client emailed me after receiving the unpaid invoice receipt indicating that she had paid for this service by way of overpayment of her patient responsibility/deductible charges at the beginning of 2019. I spent the next 3 hours that morning going line by line of historical EOBs and the client's invoices. The client was charged at the time of service due to a high deductible plan. While the client was receiving services with our practice, they had medical bills apply to their deductible outside of our office. Their deductible was met prior to our office and the client anticipating, so payment continued to be collected at the time of service. The following is what was uncovered and the client has been notified, and an overpayment check has been written.$5,235.47 Paid via Square invoices$4,202.75 Applied to deductible EOB$1,032.72 Overpayment Balance-$250 check 1/16/2020$782.72 check sent 1/17/2020We are disappointed to lose a client who up until a couple of weeks ago had a very positive relationship with Play Works.

Please let me know what supporting documentation you need, although it seems you have in your possession all of the written correspondence.

Invoices were generated and sent via Square to email address we have on file. Receipts were also sent after payment. Our office will resend, and send via US Post for her record keeping.Tell us why here...