To Whom It May Concern: This is in response to the complaint filed by Mr. [redacted] regarding his balance. Upon review of our documents and efforts made by our office, I'm sure you will find the complaint unwarranted.Ms. [redacted] came to our office on August 22, 2016 and presented the insurance card and...
completed the patient information demographics sheet (see attached). Please note the paragraph on the bottom of our demographic sheet. Additionally, she signed the Financial Responsibility Form (see a ttached) which also states we do not verify coverage at the time of an appointment. At no time does any of our office staff verify benefits for an office visit. The card and information provided by Ms. [redacted] at the time of her office visit, was scanned in and she was told that we were in network and contracted with the card given t o us.Ms [redacted] was seen on October 24, 2016 and she was presented with a balance statement from her first visit which showed a deductible amount. She paid her balance with no questions, and did not pay a co-pay.On October 26, 2016 our Prior Authorization department called [redacted] to see if Ms [redacted] insurance covered Allergy Testing. We were told that it was a covered service with a $60 co pay. No prior authorization is required for Allergy Testing. The insurance company asked if we are contracted, in which we responded "yes" as we were calling off the card in which Ms. [redacted] had given us. No prior authorization is required for allergy testing, therefore, the insurance does not look to see if we are in-network or out-of-network.Ms. [redacted] had her Allergy Testing on December 21, 2016 at which time, surgery was recommended. A surgery packet was generated and forwarded to our Prior Authorization department. As the surgery schedule was full for the remainder of the year, the surgery packet was held until after January 151 to call for prior authorization as benefits change at beginning of year.On December 27,2016 we received an Explanation of Benefits from [redacted] for a Zero (O} pay as they applied the Allergy Testing to deductible. A statement for the allergy testing in the amount of $372.58 was sent to Ms. [redacted] on 01/16/2017, 2/13/2017 and 3/13/2017.On January 6, 2017, the Prior Authorization called for benefits and prior authorization for the surgery. The surgery packet had been generated in December 21, 2016 with the card information the patient had given us. In speaking with [redacted], prior authorization was informed that her insurance had changed and we were out-of-network and no prior authorization could be obtained. I took this to our biller who also verified that the insurance information given to us was out-of-network.On January 6, 2017,I called Ms. [redacted] to review what we were told by [redacted]. Ms [redacted] then asked about her Allergy Testing. I explained that no prior authorization is required for Allergy Testing, we had just asked if she had the benefits and they gave us the information of the $60 copay. I explained to Ms. [redacted] that she had not told us her insurance had changed on August 1,2016. Ms. [redacted] stated she was going to call her insurance and find an ENT physician within the Banner Network. I told her to let us know and we would transfer all her records for continuity of care. She thanked me for all the information and the call ended.On March 15, 2017 we received a letter from Ms. [redacted] (see attached} stating she wanted us to take her bill off her account as she was given incorrect information from us.{Due to our biller being out of office for family emergency, she did not respond to her Jetter until March 31, 2017.}On March 31, 2017 our billing office called and spoke with Ms. [redacted]. Our biller explained that the card she had presented and the information given on the demographic sheet was not the correct insurance. Ms [redacted] stated that they never received any new insurance cards and as far as she knew their insurance had not changed and was still the PPO. Our biller reviewed everything from the beginning of her office visits and what had happened. Ms [redacted] stated she was never told about the deductible. Billing reviewed that they collected her deductible when she came in for office visits and there was never a question from her. Ms [redacted] stated that she was going to call her insurance company and research further about her plan changing and not receiving new cards.On April 14, 2017 the account was over 90 days old and a collection letter was sent.'On May 1, 2017, Mr. [redacted] called and spoke with billing to dispute the bill. He stated that we had given them incorrect information about being in-network and contracted. Billing tried to explain to him that what she had presented to us was in-network, and we would have no way of knowing that their plan had changed on August 1,2016. He stated that it was just hear say on our part and it was our job to check the insurance to know if they were in-network or out-of network. He asked to speak to the supervisor as he wanted to file a complaint against the biller. On May 1, 2017 at 11:13 a.m.,I received a voice message from Mr. [redacted] wanting to dispute his bill,to please call him back.On May 1, 2017 at 11:38 a.m.,I received another voice message from Mr. [redacted] stating he was not going to pay the bill and if we did not write the bill off,he was going to file a consumer fraud complaint as we were fraudulently billing and he was going to turn us into the Revdex.com so we would be investigated. I did not respond as the voice mail was threatening.It is unfortunate that when the employer changed their insurance plan, that new cards were not distributed to them. However, the patient has a responsibility when presenting insurance cards and information to their physicians,that they are giving the correct and current information.We billed in accordance to the information given to us by Ms. [redacted]. The billing for the Allergy Testing is correct and appropriate. The Allergy Testing had expenses to our facility for the 60 units of serum used and for the appointment which requires 1.5 hours with a tester and the physician. Therefore, the bill is due and payable. Thank you for the opportunity to respond to this complaint and present the facts.
To Whom It May Concern: This is in response to the complaint filed by Mr. [redacted] regarding his balance. Upon review of our documents and efforts made by our office, I'm sure you will find the complaint unwarranted.Ms. [redacted] came to our office on August 22, 2016 and presented the insurance card and...
completed the patient information demographics sheet (see attached). Please note the paragraph on the bottom of our demographic sheet. Additionally, she signed the Financial Responsibility Form (see a ttached) which also states we do not verify coverage at the time of an appointment. At no time does any of our office staff verify benefits for an office visit. The card and information provided by Ms. [redacted] at the time of her office visit, was scanned in and she was told that we were in network and contracted with the card given t o us.Ms [redacted] was seen on October 24, 2016 and she was presented with a balance statement from her first visit which showed a deductible amount. She paid her balance with no questions, and did not pay a co-pay.On October 26, 2016 our Prior Authorization department called [redacted] to see if Ms [redacted] insurance covered Allergy Testing. We were told that it was a covered service with a $60 co pay. No prior authorization is required for Allergy Testing. The insurance company asked if we are contracted, in which we responded "yes" as we were calling off the card in which Ms. [redacted] had given us. No prior authorization is required for allergy testing, therefore, the insurance does not look to see if we are in-network or out-of-network.Ms. [redacted] had her Allergy Testing on December 21, 2016 at which time, surgery was recommended. A surgery packet was generated and forwarded to our Prior Authorization department. As the surgery schedule was full for the remainder of the year, the surgery packet was held until after January 151 to call for prior authorization as benefits change at beginning of year.On December 27,2016 we received an Explanation of Benefits from [redacted] for a Zero (O} pay as they applied the Allergy Testing to deductible. A statement for the allergy testing in the amount of $372.58 was sent to Ms. [redacted] on 01/16/2017, 2/13/2017 and 3/13/2017.On January 6, 2017, the Prior Authorization called for benefits and prior authorization for the surgery. The surgery packet had been generated in December 21, 2016 with the card information the patient had given us. In speaking with [redacted], prior authorization was informed that her insurance had changed and we were out-of-network and no prior authorization could be obtained. I took this to our biller who also verified that the insurance information given to us was out-of-network.On January 6, 2017,I called Ms. [redacted] to review what we were told by [redacted]. Ms [redacted] then asked about her Allergy Testing. I explained that no prior authorization is required for Allergy Testing, we had just asked if she had the benefits and they gave us the information of the $60 copay. I explained to Ms. [redacted] that she had not told us her insurance had changed on August 1,2016. Ms. [redacted] stated she was going to call her insurance and find an ENT physician within the Banner Network. I told her to let us know and we would transfer all her records for continuity of care. She thanked me for all the information and the call ended.On March 15, 2017 we received a letter from Ms. [redacted] (see attached} stating she wanted us to take her bill off her account as she was given incorrect information from us.{Due to our biller being out of office for family emergency, she did not respond to her Jetter until March 31, 2017.}On March 31, 2017 our billing office called and spoke with Ms. [redacted]. Our biller explained that the card she had presented and the information given on the demographic sheet was not the correct insurance. Ms [redacted] stated that they never received any new insurance cards and as far as she knew their insurance had not changed and was still the PPO. Our biller reviewed everything from the beginning of her office visits and what had happened. Ms [redacted] stated she was never told about the deductible. Billing reviewed that they collected her deductible when she came in for office visits and there was never a question from her. Ms [redacted] stated that she was going to call her insurance company and research further about her plan changing and not receiving new cards.On April 14, 2017 the account was over 90 days old and a collection letter was sent.'On May 1, 2017, Mr. [redacted] called and spoke with billing to dispute the bill. He stated that we had given them incorrect information about being in-network and contracted. Billing tried to explain to him that what she had presented to us was in-network, and we would have no way of knowing that their plan had changed on August 1,2016. He stated that it was just hear say on our part and it was our job to check the insurance to know if they were in-network or out-of network. He asked to speak to the supervisor as he wanted to file a complaint against the biller. On May 1, 2017 at 11:13 a.m.,I received a voice message from Mr. [redacted] wanting to dispute his bill,to please call him back.On May 1, 2017 at 11:38 a.m.,I received another voice message from Mr. [redacted] stating he was not going to pay the bill and if we did not write the bill off,he was going to file a consumer fraud complaint as we were fraudulently billing and he was going to turn us into the Revdex.com so we would be investigated. I did not respond as the voice mail was threatening.It is unfortunate that when the employer changed their insurance plan, that new cards were not distributed to them. However, the patient has a responsibility when presenting insurance cards and information to their physicians,that they are giving the correct and current information.We billed in accordance to the information given to us by Ms. [redacted]. The billing for the Allergy Testing is correct and appropriate. The Allergy Testing had expenses to our facility for the 60 units of serum used and for the appointment which requires 1.5 hours with a tester and the physician. Therefore, the bill is due and payable. Thank you for the opportunity to respond to this complaint and present the facts.