Sheridan Children's Healthcare Services

Please be advised after thorough review of the account, I can confirm that the account was in fact removed from collections. However, it can take 30-60 business days for the credit bureaus to remove the account from the patients credit history. Please note that the appeal was filed to the patients insurance along with the records & proof of timely filing they require. As an out of network provider we have exhausted all possible avenues that we can to attempt to obtain payment for both of the remaining balance from the insurance. At this point the responsible party on the account will have to contact their insurance and request they review the medical records we have already provided to the insurance and reconsider the denial. In the interim we have removed the account from collections and notified NRS. They have closed the account on their end and it is now being handled entirely by our office. Please note though we understand your frustration, we have made every attempt possible to obtain payment from the insurance and have them reprocess the claims. If you would like to reach out to your insurance and request they assist please feel free to contact them directly.

Please note the account history shows the account was removed from collections and the balance was returned to our office on 5/13/2020. However, I have contacted the collection agency again and requested they close the account out on their end and remove it from the responsible parties credit history. We have received the response from NRS confirming the account is closed on their end and they are working diligently to have it removed from the credit history. I have also asked that if this has already been done on their end that they respond to us with confirmation and the date it was done for our records. Please note we are not claiming out of network benefits with your insurance. The insurance processed the claim as out of network and we then submitted an appeal. The insurance then advised they would process as in network but chose to deny the claim stating no authorization and untimely filing (both of which are incorrect) at which point we provided the insurance not only with proof of our timely filing but also the medical records which show no need for authorization. As we have previously stated, we have made every attempt to obtain payment from your insurance and thus far have been unsuccessful. We have exhausted all of our options and would suggest you contact the insurance and have them process our most recent appeal which includes documents we provided confirming there is no need for authorization and the claim was submitted on time.

Please be advised those documents are provided directly to the insurance. We are not authorized to release copies of claims we send to the insurances and EOB's sent to us from the insurances to anyone other than the insurances themselves. However, a copy of those documents was provided directly to the insurance itself and they should be able to provide you with copies of the documents they have on record pertaining to claims submitted on your behalf by a providers. Please understand as providers, we have exhausted every option we have available to us. We understand your frustration however, it is the insurance that is not processing the claims and citing incorrect reasons for rejections.

Please be advised that the claims have been submitted properly to the insurance however, the reason for which the insurance is denying the claim is incorrect, there is no authorization required and the initial claim which was also incorrectly denied was filed in a timely manner. As providers we cannot force an insurance to pay a claim, we can only submit our appeals and evidence supporting our claim for payment which we have done. As previously stated, I have confirmed with NRS that the account has been closed out on their end at our request and we are currently handling the account in our office. We are continuing to work on getting the claim reprocessed by the insurance. In the interim, please feel free to contact us anytime if you have any questions or concerns, regarding this account.

Please note our response pertains to an account that is billed under a different billing provider that the one selected on this complaint. If you feel this is not the correct account or this information is incorrect, please respond with the information pertaining to the account you are referring to in this complaint.

Please be advised as previously stated the account we located is being handled by CAPIO. For assistance with this account please contact CAPIO at X-XXX-XXX-XXXX.

Please be advised after thorough review of the account we confirmed that on 9/16/2019, the patient contacted our office regarding the bill for the anesthesia services rendered by our clinician. At which time the patient was advised that the original rate offered was a prepayment rate which was dependent on the payment for the anesthesia services being made to us within a specific timeframe, as is explained to each patient when they are initially given the prepayment rate (discounted rate). After which the rate for the anesthesia would no longer be discounted. By the time the patient called us on 9/16/2019, the window of eligibility for the discounted rate had passed.When this was explained to the patient he disconnected the call. The balance on the account is correct. For assistance with the balance please contact Frost Arnett as their office is now handling the account.

Please be advised we have again reviewed the account and confirmed that on 9/5/19 the Doctors office did contact us and spoke with our prepayment department. The doctors office confirmed they advised the patient of the anesthesia services prior to the surgery and advised that the rate given is a Prepayment rate and that it must be paid prior to the surgery for the rate to be honored. We have reviewed the records on the account and confirmed the time and units for the anesthesia have been billed correctly. As a courtesy we have removed the account from collections and the patient will now be billed directly by us for the balance on the account. However, the patient must contact us to submit payment or set up a payment arrangement or the account will again go to collections after 3 or more statements go out to the patient without payment in full being received or a payment arrangement being setup on the account.

After a thorough review of the account including all charges, credits & adjustments on the account we were able to confirm that a claim was filed on 8/12/2015 to Cigna. On 8/19/2015 we received a payment from Cigna which posted to the account for $88.57. At which time we also applied a contractual adjustment to the account of $358.91. As per the Explanation of Benefits we received from the patients insurance the patients had a $1,000 deductible which had not been at the time services were rendered by our anesthesiologist. The EOB also reflected a $29.52 as coinsurance which made the total patient responsibility for the services rendered by our anesthesiologist $1,029.52. We made numerous attempts to contact the patient by mailing statements to the address on the account on 9/30/2015, 10/29/2015, 11/11/2015, 12/09/2015 & 1/6/2016. After repeated unanswered attempts to contact the patient via mailed statements, the account was referred to A.R.R. for collections until it was ultimately transferred entirely to CAPIO Partners for handling. Since this account was referred for collections after numerous unsuccessful attempts to contact the patient by our office and ultimately transferred to CAPIO after ARR was unable to obtain payment on the account, moving forward any further payment options and/or credit reporting related matters must be discussed directly with CAPIO at X-XXX-XXX-XXXX.

After thorough review of the account referenced in this complaint we were unable to find any record of having spoken with the patient in March. However, as per the conversation we had with the patient on 4/24/18 when they called in and spoke with our Customer Service Dept. at which time we initially offered a $50 a month payment plan. When the patient requested a further reduction in the monthly payment we complied and advised the lowest we could offer would be a $40 a month payment plan. The patient was advised they must make a $40 payment that day in order to have the account removed from collections and set up on the payment plan. Since the patient did make the payment for $40 as instructed the account has been removed from collections and there is now a payment plan on the account. The patient must make sure to make their $40 payment every 30 days to avoid the account being sent to collections again for non-payment.

We are unable to negotiate payment terms via this complaint. However, if the patient would like to discuss any options regarding the account balance which may be available, please contact our customer service department and they will gladly inform him of the options available.

We received the complaint on 5/15/2018 and have been trying to reach the patient on the following days: 5/15 5/16 and 5/21/2018. we left several messages for her to call back but as of today 5/21/2018 we have not received a call back. At this time we are going to adjust patient balance. leaving the patient responsibility zero. We have confirm the patient was never turn over to collections.

After thorough review of the account reference in this complaint we have found that the charges billed for the Anesthesia services rendered are valid and the balance is ultimately the responsibility of the patient. After submitting our Claim to the patients insurance *** we applied the $2,858.86 payment we received from *** along with a contractual adjustment of $1,627.92 to the account. As per *** the remaining balance is the responsibility of the patient as part of their Co-Insurance. The charges billed on this account are for Anesthesia services which are billed in units of time. Although the patient may additional anesthesia services were required and rendered during this particular procedure or if the patients insurance advises the remaining balance is the responsibility of patient due to the terms of their coverage with their carrier then the remaining balance is to be paid by the patient. We applied the $422.00 payment we received to this account however at no point did we agree to accept it as payment in full on this account. The remaining $803.22 will continue to be due until payment in full for that amount is received. If the patient would like to contact our offices to make a payment arrangement for the remaining amount we will gladly assist. A copy of the patients EOB we received from *** confirming the remaining balance is the responsibility of the patient has been uploaded to this response.

Please be advised the letter received from ***, was sent by *** the same day we notified the agency we have adjusted the balance to $0 and requested the account removed from collections. With regards to the call received, I will again contact *** and inquire what occurred and confirm that this account must be closed on their end.