Select Medical Corporation

[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 Administratively Resolved] Complaint: [redacted] I am rejecting this response because: There were obvious missed communications between Select Physical Therapy and [redacted] South when [redacted] of SC and [redacted] of TNwere separate entities in Neither Select Medical or [redacted] notified me that Select Physical Therapy was not in the network of [redacted] of TNSelect Physical Therapy provided the services agreed to, but should have done further checking to make sure [redacted] of TN was going to provide payment for these servicesThe office manager at the [redacted] ***, SClocation obviously telephoned [redacted] of SCfor benefit verificationI clearly pointed out that I have [redacted] of TN, not [redacted] of SCThis was the first mistakeI was not made aware that Select Physical Therapy was not in network with [redacted] of TNuntil all physical therapy sessions were completedThis was the second mistakeSelect Physical Therapy turned my account over to collections without proper notificationThis was the third mistakeI am now holding "the bag" for another $bill that could have been completely avoided, if Select Physical Therapy had communicated with both myself and [redacted] correctlyI also now have a mark on my credit through Select Physical Therapy's collection agency, which should have never happenedI have paid this balance in full on 7/under protestAgain, corporations duck responsibility and act unprofessionally, yet still get their way [redacted] of Select Medical has been very helpful in getting to the bottom of this issueThis problem stemmed from poor communication between ***, Select Physical Therapy and myself resulting in an injustice that I am left to payThis is not right! Regards, [redacted]

Yes, I received the check, which was an accountingor claim error on their partThey legally have to pay me that moneyBut I still expect to have resolution by an apology for dragging this out until I filed with the Revdex.com months laterFrom their mishandling

-------- Forwarded message ----------From: Revdex.com of Metro Washington DC< [redacted] >Date: Thu, Apr 23, at 9:AMSubject: Fwd: You have a new message from the Revdex.com of Metro Washington DC & Eastern Pennsylvania in regards to your complaint # [redacted] .To: [redacted] < [redacted] > ---------- Forwarded message ----------From: [redacted] < [redacted] >Date: Wed, Apr 22, at 5:PMSubject: RE: You have a new message from the Revdex.com of Metro Washington DC & Eastern Pennsylvania in regards to your complaint # [redacted] .To: [redacted] Thank you for your help [redacted]

To whom it may concern,We have received the rejected response from Mr [redacted] dated May 5", Again, we do apologize to him for any inconvenience and hope to be able to resolve his outstanding balance of $amicably.To address his continued concerns, the dates of service that he was seen with us for where his insurance did request additional documentation were resolved with no balance being billed to himAs a company, even though we felt that of the therapy visits provided to Mr [redacted] were medically necessary, with the insurance having denied them, 59,was written off in November with no Cost pushed to the patientAt this time, there is nothing further to provide the insurance company; the $balance is the patient's responsibility under their insurance carrier benefits through ***.AS for the phone Calls and verbal permission given to speak with his mother, verbal permission is only good for the day the Call is made and verbal permission from the patient grantedEvery effort was made each time the patient's mother called in and the patient gave verbal permission to explain that we still needed documentation for any future communication with his motherMultiple emails were sent t email address [redacted] and email address [redacted] with the documentation attached that the patient needed to complete and send back so his mother would be formally listed on the HIPAA compliant billing disclosure form, No response was ever received.We want to continue to try and work with Mr [redacted] on this outstanding balanceMr [redacted] has days to resolve the balance owed by setting up a monthly, interest-free, payment plan or issuing payment in full for the $outstanding, if this balance is not resolved by July 26, 2016, the account may be turned over to our collection agency.if you have any further questions, please feel free to contact me at the number below between the hours of 8am to pm EST.Respectfully, Theresa ML***, M.ACollections Manager

To whom it may concern:This letter shall serve as confirmation that Select Medical, has received correspondence from the Revdex.com, in reference to complaint number, Revdex.com # [redacted] , regarding a patient that was treated at Kessler Rehabilitation Center (“KRC).This patient was seen at KRC for an initial evaluation for hip painThe concerns of the patient have been reviewed previously and we have responded directly to this patient in writingSpecifically, KRC has interviewed the staff members present at the center on the day of his initial evaluation, and his medical record was reviewed.Based upon our review of the schedule and the patient's medical record, we found that the patient was early for his appointmentAll new patients are asked to arrive a half hour prior to their treatment time in order to complete necessary paperworkHis treatment did begin at 9am, as scheduled.The centers have basic assistive devices for training purposes during therapyPatients are requested to bring their own assistive device to and from therapyUnfortunately, staff members are unable to routinely leave the center to assist patients to and from vehiclesPatients are advised to bring a caregiver if assistance is neededIn addition, the patient was offered the option of transferring to a neighboring location that would have been better equipped to meet his needs; he declinedFollowing KRC's review, we have reminded staff members to effectively communicate this process to patients.Based upon a review of the medical record, the patient's initial evaluation was conducted according to Kessler's standards and the patient received interventions consistent with his conditionThe patient was seen by a physical therapy student who was supervised by the center manager in accordance with our practicesAfter hearing about these concerns, the staff members were reminded to effectively introduce and explain student competency and Supervision to patients.Sincerely,Bill A [redacted] , President

[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 Administratively Resolved] Complaint: [redacted] I am rejecting this response because: LIE #1.There was no written response to my complaint. The first written response that I saw is their letter responding to BBB complaint. Someone did call but did not identify himself. LIE #2 No one at Kessler told me to bring my own device or that I could no get help into the facility. If that had been the case I would never have gone in the first place. LIE # 3 They never offered me the choice of transferring to a neighborhood location. LIE #4 I was never " given interventions consistent with his condition". They don't even know what my "condition" is! "Hip pain" is not a condition!How a supposedly reptutable company can act in this manner is hard to believe. Ask them to produce a copy of the letter or written communication that they supposedly sent to me. Alsoask them what neighborhood location they referred me to! Regards, [redacted] ***

This letter is in response to above online compliant and case numberFirst and foremost Select Medical would like to apologize to Mr [redacted] for any inconveniences this matter has caused.Mr [redacted] was referred to Rehab Clinics for Physical Therapy to treat for his knee, he treated from 10/10/through 2/15/2013, a total of visitsWe received notification in August from his insurance carrier [redacted] that of his visits denied for medical necessityThis was after consistent monthly follow-ups with them asking for claim statusAfter the medical necessity denial was received the treating therapist wrote the attached page Medical Necessity Letter and submitted it to the insurance in hopes of overturning their denialOur Regional Care Coordinator also reviewed the letter and medical notes and felt the treatment was necessaryIn October we received notification from [redacted] stating they reviewed our Letter of Medical Necessity and they determined their denial was upheidMr [redacted] never received a statement for these visitsEven though we felt the treatment was necessary the total charges totaling $9,were written off in November We are hopefully that this Summary and attached documents shows sufficient documentation was submitted and communicated properly to the insurance carrier.?in regards to Mr [redacted] complaint regarding the balance of $997.28, this balance is what [redacted] shows as the patient's responsibilityMr [redacted] was advised during his initial evaluation that his insurance carrier would only cover at 100% until a certain dollar amount of treatment was reached then [redacted] would only cover 80% pushing the remaining balances to patient responsibilityMr [redacted] acknowledges this in his letter We consistently billed the patient monthly from August to March We did agree to place the account on hold from going to collections until the medical necessity issue was resolved but our account notes do not show we agreed to stop billing the patient for the visits that processed and paidOn 12/17/Mr [redacted] 's mother called into our customer service department inquiry about this balanceUnfortunately we were unable to answer her questions because she is not listed on Mr [redacted] 's billing disclosureWe explained releasing information to a party not listed on the disclosure is a HIPAA violationIn good faith, after her call we immediately tried reaching Mr [redacted] to make sure all of his inquiries were answeredUnfortunately we were unable to reach him, a voicemail was leftWe followed up with a letter explaining that we were unable to reach him, why he was being billed, if he felt the balances were incorrect to contact [redacted] and provided him with the direct contact information of the Select Medical representative handling his account if he had any additional questionsAttached is a copy of the letterWe never received a response from Mr [redacted] We have contacted [redacted] on numerous occasions and they have assured us the balance being billed to the Mr [redacted] is correctPer our contract we are only permitted to bill a patient what their insurance carrier pushes as their responsibilityAttached you will find [redacted] explanation of benefits showing the balance of $owedAfter reaching out to the Mr [redacted] on 12/27/we sent three additional monthly statements (copies attached) and a pre-collections letter stating if he did not contact us to question his balance or set up a payment plan the account was in danger of going to collectionsOn 4/5/Mr [redacted] 's mother called again to question the balance,we apologized and explained we were not able to release information to herAfter the call we tried reaching Mr [redacted] via phone and had to leave another voicemailThe account was sent to collections on 4/25/2016.in good faith we have removed the account from collectionsThis will have no negative impact on Mr [redacted] 's credit report at this timeMr [redacted] has days to resolve the balance owed by either contacting his insurance carrier, setting up a payment plan or issuing paymentIf this is not resolved by 7/26/the account may be recommended to our collection agency again Sincerely, Ashley Y [redacted] Collections Manager

[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 Administratively Resolved]
Complaint: ***
I am rejecting this response because: Below is the response from the Insurance CompanyAccording to them, they never received documentation, and if they were requesting external review, I was never notifiedGood Afternoon,
Thank you for contacting ***, Educational Markets Customer Service
Upon further review we have found that the denial of the 3rd appeal was sent to the providers office with instructions of how to request an external
review Please contact your provider for assistance
If you would like to request the Explanation of Benefits for the referenced services we will need a request from the member
It has been our pleasure to be of service to you todayPlease, let us know if you need additional assistance
*** ***
Customer Service
***
Regards,
*** ***

[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 Administratively Resolved]
Complaint: ***
I am rejecting this response because:
LIE #1.There was no written response to my complaintThe first written response that I saw is their letter responding to Revdex.com complaintSomeone did call but did not identify himself LIE #No one at Kessler told me to bring my own device or that I could no get help into the facilityIf that had been the case I would never have gone in the first place LIE # They never offered me the choice of transferring to a neighborhood location LIE # I was never " given interventions consistent with his condition" They don't even know what my "condition" is! "Hip pain" is not a condition!
How a supposedly reptutable company can act in this manner is hard to believeAsk them to produce a copy of the letter or written communication that they supposedly sent to meAlso
ask them what neighborhood location they referred me to!
Regards,
*** ***

To whom it may concern:This letter shall serve as confirmation that Select Medical, has received correspondence from the Revdex.com, in reference to complaint number, Revdex.com #***, regarding a patient that was treated at Kessler Rehabilitation Center (“KRC).This patient was seen at KRC
for an initial evaluation for hip painThe concerns of the patient have been reviewed previously and we have responded directly to this patient in writingSpecifically, KRC has interviewed the staff members present at the center on the day of his initial evaluation, and his medical record was reviewed.Based upon our review of the schedule and the patient's medical record, we found that the patient was early for his appointmentAll new patients are asked to arrive a half hour prior to their treatment time in order to complete necessary paperworkHis treatment did begin at 9am, as scheduled.The centers have basic assistive devices for training purposes during therapyPatients are requested to bring their own assistive device to and from therapyUnfortunately, staff members are unable to routinely leave the center to assist patients to and from vehiclesPatients are advised to bring a caregiver if assistance is neededIn addition, the patient was offered the option of transferring to a neighboring location that would have been better equipped to meet his needs; he declinedFollowing KRC's review, we have reminded staff members to effectively communicate this process to patients.Based upon a review of the medical record, the patient's initial evaluation was conducted according to Kessler's standards and the patient received interventions consistent with his conditionThe patient was seen by a physical therapy student who was supervised by the center manager in accordance with our practicesAfter hearing about these concerns, the staff members were reminded to effectively introduce and explain student competency and Supervision to patients.Sincerely,Bill A***, President

This letter is in response to above online compliant and case numberFirst and foremost Select Medical would like to apologize to Mr*** for any inconveniences this matter has caused.Mr*** was referred to Rehab Clinics for Physical Therapy to treat for his knee, he treated from
10/10/through 2/15/2013, a total of visitsWe received notification in August from his insurance carrier *** that of his visits denied for medical necessityThis was after consistent monthly follow-ups with them asking for claim statusAfter the medical necessity denial was received the treating therapist wrote the attached page Medical Necessity Letter and submitted it to the insurance in hopes of overturning their denialOur Regional Care Coordinator also reviewed the letter and medical notes and felt the treatment was necessaryIn October we received notification from *** stating they reviewed our Letter of Medical Necessity and they determined their denial was upheidMr*** never received a statement for these visitsEven though we felt the treatment was necessary the total charges totaling $9,were written off in November We are hopefully that this Summary and attached documents shows sufficient documentation was submitted and communicated properly to the insurance carrier.?in regards to Mr*** complaint regarding the balance of $997.28, this balance is what *** shows as the patient's responsibilityMr*** was advised during his initial evaluation that his insurance carrier would only cover at 100% until a certain dollar amount of treatment was reached then *** would only cover 80% pushing the remaining balances to patient responsibilityMr*** acknowledges this in his letter. We consistently billed the patient monthly from August to March We did agree to place the account on hold from going to collections until the medical necessity issue was resolved but our account notes do not show we agreed to stop billing the patient for the visits that processed and paid.On 12/17/Mr***'s mother called into our customer service department inquiry about this balanceUnfortunately we were unable to answer her questions because she is not listed on Mr***'s billing disclosureWe explained releasing information to a party not listed on the disclosure is a HIPAA violationIn good faith, after her call we immediately tried reaching Mr*** to make sure all of his inquiries were answeredUnfortunately we were unable to reach him, a voicemail was leftWe followed up with a letter explaining that we were unable to reach him, why he was being billed, if he felt the balances were incorrect to contact *** and provided him with the direct contact information of the Select Medical representative handling his account if he had any additional questionsAttached is a copy of the letterWe never received a response from Mr***We have contacted *** on numerous occasions and they have assured us the balance being billed to the Mr*** is correctPer our contract we are only permitted to bill a patient what their insurance carrier pushes as their responsibilityAttached you will find *** explanation of benefits showing the balance of $owed.After reaching out to the Mr***on 12/27/we sent three additional monthly statements (copies attached) and a pre-collections letter stating if he did not contact us to question his balance or set up a payment plan the account was in danger of going to collectionsOn 4/5/Mr***'s mother called again to question the balance,we apologized and explained we were not able to release information to herAfter the call we tried reaching Mr*** via phone and had to leave another voicemailThe account was sent to collections on 4/25/2016.in good faith we have removed the account from collectionsThis will have no negative impact on Mr***'s credit report at this timeMr*** has days to resolve the balance owed by either contacting his insurance carrier, setting up a payment plan or issuing paymentIf this is not resolved by 7/26/the account may be recommended to our collection agency again. Sincerely,Ashley Y*** Collections Manager

-------- Forwarded message ----------From: B***, RobertDate: Wed, May 18, at 1:PMSubject: FW: Patient Complaint Revdex.com - *** - ID ***To: "***@myRevdex.com.org" Here is our response.We are in receipt of your
letter and have been following up with the patient's spouse addressing the family's concerns. Since this situation involves protected health information, we are not permitted under the HIPAA rules to provide any more details in our response.Thank you.Bob B***Compliance OfficerSelect MedicalGettysburg RoadMechanicsburg, PA 17055Office: ###-###-####Mobile: ###-###-####Fax: ###-###-####

To whom it may concern:
This letter shall serve as confirmation that Select Medical, has received correspondence from the Revdex.com, in reference to complaint number, Revdex.com #***, regarding a patient that was treated at Kessler Rehabilitation Center
(“KRC).This patient was seen at KRC for an initial evaluation for hip painThe concerns of the patient have been reviewed previously and we have responded directly to this patient in writingSpecifically, KRC has interviewed the staff members present at the center on the day of his initial evaluation, and his medical record was reviewedBased upon our review of the schedule and the patient's medical record, we found that the patient was early for his appointmentAll new patients are asked to arrive a half hour prior to their treatment time in order to complete necessary paperworkHis treatment did begin at 9am, as scheduledThe centers have basic assistive devices for training purposes during therapyPatients are requested to bring their own assistive device to and from therapyUnfortunately, staff members are unable to routinely leave the center to assist patients to and from vehiclesPatients are advised to bring a caregiver if assistance is neededIn addition, the patient was offered the option of transferring to a neighboring location that would have been better equipped to meet his needs; he declinedFollowing KRC's review, we have reminded staff members to effectively communicate this process to patientsBased upon a review of the medical record, the patient's initial evaluation was conducted according to Kessler's standards and the patient received interventions consistent with his conditionThe patient was seen by a physical therapy student who was supervised by the center manager in accordance with our practicesAfter hearing about these concerns, the staff members were reminded to effectively introduce and explain student competency and Supervision to patientsSincerely,
Bill A***, President

November 22nd, 2016To whom it may concern,We have received *** ***'s complaint in regards to the refund due on her son, *** *** ***'s, account with usI would like to apologize to *** *** for any inconvenience and we hope that this letter will offer resolution to her son's
account.There were errors from the insurance at original verification; *** did give the patient accurate information that we were an in-network provider but the information given to us was incorrectWe did respond to the patient's inquiries in January and refunded the $that was Originally collected for two of the patient's December visitsThat refund of $200,had a check date of February 19, 2016, check number ***, and it was cashed by *** *** on April 12", A copy of the cashed check is included with this response.The remaining disputed amount by *** *** is the $collected towards the patient's splint charge of $on December 4, Once the insurance did process and pay the claim Correctly, a payment from *** of was received and credited to Albert's account on October 17, A contractual discount of $was applied and the claim was considered paid in full with a $credit from *** ***'s original payment made at time of servicePart of that payment, a total of $48.93, was moved from the December 4" visit, now paid in full, to satisfy the remaining $48,deductible balance on the patient's January 5, visitThe patient was liable for a total of $for the services rendered on January 5th, only $was collected upfront for that visit leaving the remaining $dueInstead of sending a separate bill, the $was offset from the $credit on December 4thA copy of the explanation of benefits from *** is included with this response to show the patient responsibility.With the balance for the splint and the January 5th visit now paid in full, we did initiate the process to refund the patient the remaining $90,A check was cut on November 10, and mailed out on November 15, The check number is ***As of the date of this response, November 22th, the check has yet to be cashed. Once the refund check for the final $is cashed by the patient, Select Physical Therapy will Consider this patient's account finalized.Again, I do apologize for the inconvenience and extended wait for the final refundSelect Physical Therapy always strives to provide exceptional customer service to all of our patients and I hope that with this Second refund and explanation, *** *** is satisfied with this final outcome.If you have any further questions, please feel free to contact me directly at the number below between the hours of am to pm EST.Respctfully,Theresa L., M.ACollections Manager

Yes, I received the check, which was an accountingor claim error on their part. They legally have to pay me that money. But I still expect to have resolution by an apology for dragging this out until I filed with the Revdex.com 11 months later. From their mishandling.

To whom it may concern,We have received the rejected response from Mr. [redacted] dated May 5", 2016. Again, we do apologize to him for any inconvenience and hope to be able to resolve his outstanding balance of $997.28 amicably.To address his continued concerns, the dates of service that he was seen with us for where his insurance did request additional documentation were resolved with no balance being billed to him. As a company, even though we felt that 30 of the therapy visits provided to Mr. [redacted] were medically necessary, with the insurance having denied them, 59,575.00 was written off in November 2015 with no Cost pushed to the patient. At this time, there is nothing further to provide the insurance company; the $997.28 balance is the patient's responsibility under their insurance carrier benefits through [redacted].AS for the phone Calls and verbal permission given to speak with his mother, verbal permission is only good for the day the Call is made and verbal permission from the patient granted. Every effort was made each time the patient's mother called in and the patient gave verbal permission to explain that we still needed documentation for any future communication with his mother. Multiple emails were sent t email address [redacted] and email address [redacted] with the documentation attached that the patient needed to complete and send back so his mother would be formally listed on the HIPAA compliant billing disclosure form, No response was ever received.We want to continue to try and work with Mr. [redacted] on this outstanding balance. Mr. [redacted] has 90 days to resolve the balance owed by setting up a monthly, interest-free, payment plan or issuing payment in full for the $997.28 outstanding, if this balance is not resolved by July 26, 2016, the account may be turned over to our collection agency.if you have any further questions, please feel free to contact me at the number below between the hours of 8am to 5 pm EST.Respectfully, Theresa M. L[redacted], M.A. Collections Manager

To whom it may concern:This letter shall serve as confirmation that Select Medical, has received correspondence from the Revdex.com, in reference to complaint number, Revdex.com #[redacted], regarding a patient that was treated at Kessler Rehabilitation Center (“KRC).This patient was seen at KRC for an initial evaluation for hip pain. The concerns of the patient have been reviewed previously and we have responded directly to this patient in writing. Specifically, KRC has interviewed the staff members present at the center on the day of his initial evaluation, and his medical record was reviewed.Based upon our review of the schedule and the patient's medical record, we found that the patient was early for his appointment. All new patients are asked to arrive a half hour prior to their treatment time in order to complete necessary paperwork. His treatment did begin at 9am, as scheduled.The centers have basic assistive devices for training purposes during therapy. Patients are requested to bring their own assistive device to and from therapy. Unfortunately, staff members are unable to routinely leave the center to assist patients to and from vehicles. Patients are advised to bring a caregiver if assistance is needed. In addition, the patient was offered the option of transferring to a neighboring location that would have been better equipped to meet his needs; he declined. Following KRC's review, we have reminded staff members to effectively communicate this process to patients.Based upon a review of the medical record, the patient's initial evaluation was conducted according to Kessler's standards and the patient received interventions consistent with his condition. The patient was seen by a physical therapy student who was supervised by the center manager in accordance with our practices. After hearing about these concerns, the staff members were reminded to effectively introduce and explain student competency and Supervision to patients.Sincerely,Bill A[redacted], President

[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 Administratively Resolved]
 Complaint: [redacted]
I am rejecting this response because: LIE #1.There was no written response to my complaint. The first written response that I saw is their letter responding to Revdex.com complaint. Someone did call but did not identify himself.        LIE #2 No one at Kessler told me to bring my own device or that I could no get help into the facility. If that had been the case I would never have gone in the first place.       LIE # 3 They never offered me the choice of transferring to a neighborhood location.       LIE #4  I was never " given interventions consistent with his condition".  They don't even know what my "condition" is! "Hip pain" is not a condition!How a supposedly reptutable company can act in this manner is hard to believe. Ask them to produce a copy of the letter or written communication that they supposedly sent to me. Alsoask them what neighborhood location they referred me to!
Regards,
[redacted]

To whom it may concern:This letter shall serve as confirmation that Select Medical, has received correspondence from the Revdex.com, in reference to complaint number, Revdex.com #[redacted], regarding a patient that was treated at Kessler Rehabilitation Center (“KRC).
This patient was seen at KRC for an initial evaluation for hip pain. The concerns of the patient have been reviewed previously and we have responded directly to this patient in writing. Specifically, KRC has interviewed the staff members present at the center on the day of his initial evaluation, and his medical record was reviewed.
Based upon our review of the schedule and the patient's medical record, we found that the patient was early for his appointment. All new patients are asked to arrive a half hour prior to their treatment time in order to complete necessary paperwork. His treatment did begin at 9am, as scheduled.
The centers have basic assistive devices for training purposes during therapy. Patients are requested to bring their own assistive device to and from therapy. Unfortunately, staff members are unable to routinely leave the center to assist patients to and from vehicles. Patients are advised to bring a caregiver if assistance is needed. In addition, the patient was offered the option of transferring to a neighboring location that would have been better equipped to meet his needs; he declined. Following KRC's review, we have reminded staff members to effectively communicate this process to patients.
Based upon a review of the medical record, the patient's initial evaluation was conducted according to Kessler's standards and the patient received interventions consistent with his condition. The patient was seen by a physical therapy student who was supervised by the center manager in accordance with our practices. After hearing about these concerns, the staff members were reminded to effectively introduce and explain student competency and Supervision to patients.
Sincerely,
Bill A[redacted], President

This letter is in response to above online compliant and case number. First and foremost Select Medical would like to apologize to Mr. [redacted] for any inconveniences this matter has caused.Mr. [redacted] was referred to Rehab Clinics for Physical Therapy to treat for his knee, he...

treated from 10/10/2012 through 2/15/2013, a total of 53 visits. We received notification in August 2014 from his insurance carrier [redacted] that 30 of his visits denied for medical necessity. This was after consistent monthly follow-ups with them asking for claim status. After the medical necessity denial was received the treating therapist wrote the attached 19 page Medical Necessity Letter and submitted it to the insurance in hopes of overturning their denial. Our Regional Care Coordinator also reviewed the letter and medical notes and felt the treatment was necessary. In October 2014 we received notification from [redacted] stating they reviewed our Letter of Medical Necessity and they determined their denial was upheid. Mr. [redacted] never received a statement for these 30 visits. Even though we felt the treatment was necessary the total charges totaling $9,575.00 were written off in November 2015. We are hopefully that this Summary and attached documents shows sufficient documentation was submitted and communicated properly to the insurance carrier.?in regards to Mr. [redacted] complaint regarding the balance of $997.28, this balance is what [redacted] shows as the patient's responsibility. Mr. [redacted] was advised during his initial evaluation that his insurance carrier would only cover at 100% until a certain dollar amount of treatment was reached then [redacted] would only cover 80% pushing the remaining balances to patient responsibility. Mr. [redacted] acknowledges this in his letter.
 We consistently billed the patient monthly from August 2014 to March 2016. We did agree to place the account on hold from going to collections until the medical necessity issue was resolved but our account notes do not show we agreed to stop billing the patient for the visits that processed and paid.
On 12/17/15 Mr. [redacted]'s mother called into our customer service department inquiry about this balance. Unfortunately we were unable to answer her questions because she is not listed on Mr. [redacted]'s billing disclosure. We explained releasing information to a party not listed on the disclosure is a HIPAA violation. In good faith, after her call we immediately tried reaching Mr. [redacted] to make sure all of his inquiries were answered. Unfortunately we were unable to reach him, a voicemail was left. We followed up with a letter explaining that we were unable to reach him, why he was being billed, if he felt the balances were incorrect to contact [redacted] and provided him with the direct contact information of the Select Medical representative handling his account if he had any additional questions. Attached is a copy of the letter. We never received a response from Mr. [redacted]. We have contacted [redacted] on numerous occasions and they have assured us the balance being billed to the Mr. [redacted] is correct. Per our contract we are only permitted to bill a patient what their insurance carrier pushes as their responsibility. Attached you will find [redacted] explanation of benefits showing the balance of $997.28 owed.
After reaching out to the Mr. [redacted]on 12/27/2016 we sent three additional monthly statements (copies attached) and a pre-collections letter stating if he did not contact us to question his balance or set up a payment plan the account was in danger of going to collections. On 4/5/2016 Mr. [redacted]'s mother called again to question the balance,we apologized  and explained we were not able to release information to her. After the call we tried reaching Mr. [redacted] via phone and had to leave another voicemail. The account was sent to collections on 4/25/2016.in good faith we have removed the account from collections. This will have no negative impact on Mr. [redacted]'s credit report at this time. Mr. [redacted] has 90 days to resolve the balance owed by either contacting his insurance carrier, setting up a payment plan or issuing payment. If this is not resolved by 7/26/2016 the account may be recommended to our collection agency again.
 Sincerely,
Ashley Y[redacted] Collections Manager