The Emily Program

Our apologies to this client for her poor experience with The Emily Program client account teamAs requested we are sending a statement (to the address provided by Ms***) that indicates the $charge has been adjusted and there is no remaining balance.As noted, we retired an old billing systemThis challenge, coupled with a staff transition in the client account department resulted in an unacceptable response to this clientWe appreciate the opportunity to make it right

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID *** and find that this resolution is satisfactory to me

Initial Business Response /* (1000, 8, 2015/06/24) */
We sincerely apologize that you have not had a positive experience with The Emily Program's billing department and that you were not aware of your balance with us.
Unfortunately, we do not believe your insurance accurately quoted your...

benefits to you. According to our records, you have Aetna in WA. We are out of network for IOP with Aetna WA. We are in network for outpatient therapy services.
In order to ensure we've been sending statements to the correct address, we verified your address in our system is correct. According to our records, monthly statements have been mailed to you.
We spoke with you on 3/11/15 regarding your request for an itemized statement, which we mailed the same day. After not hearing from you regarding payment on your account, we sent a letter to you on 4/3/15 requesting that you contact our team to resolve your balance. On 4/22/15, you contacted us and requested that we waive 2 failed appointment charges, which we did. You also mentioned that claims in 2014 appeared to be processing incorrectly. On 4/27/15, we looked into whether your 11/6/14 date of service processed incorrectly out of network and resubmitted the claim. We were told by your insurance that your 11/6/14 claim did, in fact, process correctly and that all other claims for your IOP services processed correctly as well. On 5/19/15, we called you regarding your balance of $2,249.62. This amount does not include the dates of service that we looked into when you believed your insurance processed incorrectly. We asked you to contact us before close of business on 5/22/15 to setup a payment plan. We did not hear back from you by the 5/22/15 deadline. On 5/27/15, you called to request an itemized statement. At that time your account had already advanced to collections because we did not receive a response regarding paying your balance or setting up a payment plan.
We would be glad to pull your account out of collections and pay the significant fees to do so, if you call the Emily Program Client Account Team by July 15 to pay your balance in full.
Initial Consumer Rebuttal /* (3000, 10, 2015/06/25) */
(The consumer indicated he/she DID NOT accept the response from the business.)
Unfortunately, I believe that my insurance benefits were correctly quoted. I used the information and forms provided by The Emily Program, including the claim numbers that IOP treatment was filed under, to verify my coverage. IOP stands for Intensive Outpatient Programming. The Emily Program website groups Intensive Outpatient Programming as outpatient therapy services.
Additionally, the majority of my other claims went through and were paid without issue except for a co-pay. It is a handful of dates that appear to have been billed or processed incorrectly. The dates are as follows:
11/6/2014
11/13/2014
11/17/2014
11/28/2014
12/4/2014
12/9/2014
12/11/2014
12/11/2014
1/5/2015
1/6/2015
1/8/2015
As you can see by the dates, clearly I was in programming more than those few dates. On June 5th, I spoke in depth with my insurance to see if this was an issue on their part. I was told that for outpatient there was no deductible, and no responsibility, however on the problem dates it appeared that the claims had been submitted as inpatient and that was where the problem was. Upon further inspection on the part of the insurance agent I spoke with, she realized that the claims should have been exactly the same as numerous others, and I was told that I would owe nothing from those dates other than the $40 co-pay because I was already covered per deductible and co-pay insurance.
You also failed to note several occasions that I have called and left messages attempting to straighten this issue out only to leave a message and never receive a call back. One such call took place after receiving your letter on 4/3/25, the call was placed on 4/7/25 at 4pm. I left a message requesting a call back and never received one. This is not the first time this has happened. On at least one occasion when I left a message requesting a statement, I also requested a return call to try and discuss some of these issues. The statements arrived in the mail, but the phone call never did. It's extremely difficult to try and resolve this issue when no one is willing to get back to me regarding this issue.
Regarding monthly statements, unfortunately, I have no way to corroborate my side, I cannot prove a lack of statements. I know that early this year is the first time that I started receiving semi-regular statements at all from The Emily Program. Also, in the time this initial complaint was filed, my latest request for an itemized statement was received, however the address was incorrect. My street address was correct, but instead of Des Moines, Washington, it was addressed to Des Moines, Iowa. Obviously you can understand how this is extremely troubling to me, and makes me wonder if other mail to me has been addressed such and has actually not made it to me and has been sent out to someone in Iowa. I have kept the envelope for my records and can send a copy at your request.
Regarding the 4/22 call and forgiven charges, in the most recent statement I received, those charges are actually still there. I was told that charges from 11/20, 12/8, and 12/19 would all be forgiven, and in the most current statement, only 12/19 was forgiven. I have the previous and most recent summaries and my notes from that conversation as well if you desire copies.
Finally, on 5/7/2015, I received a certified letter dated 5/22 notifying me that The Emily Program was discontinuing services and that my account was in collections. After the aforementioned discussion with my insurance company on 6/7/15, I called the collections agency, whose information was provided on the letter, and spoke to a collector by the name of [redacted] and was told that there was no record of my bill. He searched by my phone number, account number, and name, and no information was found. I then called The Emily Program with a request for a call back to give them the information I had found out and figure out exactly where my account is, and to date, have yet to receive a response.
I would love nothing more than to set this matter to rest and set up a payment plan, however I will not do so until my account reflects an accurate balance, and all of these unsettled charges have been clarified.
Final Business Response /* (4000, 12, 2015/07/08) */
Thank you for your response.
I'm glad to hear that you utilized our insurance verification tool. Unfortunately, we believe your insurer is misquoting your benefits and coverage with us. The Emily Program is not in-network with Aetna WA for Intensive Outpatient Programming (IOP). We are in-network with your insurer for Outpatient Therapy Services. I, personally, worked to secure our Aetna WA contract and IOP is not part of our agreement for Outpatient Therapy Services. IOP is a higher level of care in eating disorder treatment and billed differently than Outpatient Services. We billed for IOP on a UB-04 form using revenue code 0905, as is industry standard for billing this level of care. We will not change our billing form or code used, as this would be out of compliance with health care billing and coding standards in WA. Although your insurer is communicating that you are in-network, they processed the claims you dispute as out-of-network. Therefore, they are validating through their claim processing procedure that these services are out-of-network at The Emily Program. We invite you to contact your insurer to discuss how they decided to process these claims - as well as your belief that the majority of other claims went through and were paid without issue. If this is the case, your insurer should be able to explain why they are processing claims for the same services differently.
I'm sorry to hear that you haven't experienced our team to be responsive to your needs. We have made every attempt to promptly return your calls. According to our records, we returned your 4/7/15 message on 4/8/15 and left a message. We returned your 4/15/15 voicemail same day and left a message for you.
We sincerely apologize that we sent a letter to the incorrect address. We have verified that we have the correct address in our system currently.
As a courtesy to you, we have waived the fees for 4 of at least 8 times you cancelled appointments without proper notice. On 4/22/15, you requested that 2 late cancellations for 2014 be waived. On that date, we waived late cancellation fees for 12/19/14 and 12/31/14. Also on 4/22/15, we waived late cancellation fees for 1/23/15 and 1/27/15. On your account, you still have late cancellation fees for the following dates of service: 4/28/15, 5/5/15, 5/19/15, 5/26/15.
On 5/27/15, you contacted us to request an itemized statement. We returned your call to let you know that we mailed an itemized statement and your account was referred to a collections agency. We contacted the collection agency on 7/7/15 and spoke with [redacted]. She confirmed that your account is on file.
We appreciate that you would like to take care of your balance and hope that you choose to do so. I hope this information allows you to proceed with settling your account.
Your account balance, as sent to collections, is $4,000.43. This reflects an accurate balance, pending any additional charges that may still result from insurance processing. (Unfortunately, we cannot control or influence the amount of time it takes for insurance providers to process claims.) We would still be glad to pull your account out of collections and pay the significant fees to do so, if you call The Emily Program Client Account Team by July 15 to pay this balance in full.

Initial Business Response /* (1000, 8, 2016/02/24) */
It is our understanding that the client's mother does not dispute our record of failed appointments, but contends the family should not be responsible for late fees assessed as a result of those failed appointments.
Our records confirm that The...

Emily Program made numerous attempts to clarify our attendance policy, to confirm the family understood expectations around that policy and to discuss the consequences of late cancellations and missed appointments.
Therapist Kasey [redacted] has a record of numerous dates when she spoke with the father regarding a pattern of missed appointments. Kasey recognized the missed appointment fees were a source of stress for the family and tried to help problem solve with the father and offer ideas around scheduling. He did not respond to those ideas. The therapist also called the client's mom and left a message regarding concerns with missed appointments. The mother did not return the call.
Most recently, on Aug. 10, Kasey spoke again with the father regarding the many no shows, the accumulation of late fees and moving the client to a one-session-at-a-time schedule. The therapist also gave the father her direct line and card and said he could call her directly if he needed to cancel a session. She again clearly discussed the 24-hour cancellation policy. (The client missed 3 appointments between Aug. 10 and 24.)
As noted, our therapist was very clear about our policies and our office manager confirms there was no verbal agreement that late fees would be waived - beyond the 3 courtesy adjustments we offer all clients each rolling 12-month period.
Payments have been inconsistent on this account. The last payment was received in July. The family was notified in September by letter that the account was under financial review. The family did not respond to the letter and numerous attempts to talk with the father failed (calls were made Sept. 4, 9 and 29th).
The client's mother called on Nov. 23 to discuss the failed appointment charges after receiving a letter for discontinuation of services. A payment plan was offered. Subsequent communication follows:
Nov. 30: Mother calls to say she was working with a credit institute to pay the bill. She was advised we would need to hear from her by Dec. 4, 2015.
Dec. 14: Jodi at American Financial Solutions called regarding the client's account and was advised on payment arrangement offers.
Dec. 15: The Emily Program was notified that the insurance reimbursement for services went directly to the client.
Dec. 21: Jodi from American Financial Solutions called to report that the client's mother did not call them back regarding our offers for payment arrangements
Dec. 31: Account was referred to collections.
The preceding outline of communications illustrates that The Emily Program made every reasonable effort to communicate with the client's family about policy regarding late cancellation fees.
Our goal remains, that the client receives the care she needs. To do so, the client must be present for scheduled appointments.
In the spirit of resolution, we have contacted the collections service to inform them that we are willing to waive the accrued $1,020 in late fees provided the remaining balance of $2,039.74 is paid in full by March 25, 2016.
If the family wishes to continue treatment with The Emily Program after the balance is paid, they will be required to sign an attendance policy agreement with the understanding that there will be no exceptions to the policy. The client also will be on scheduling restriction for a period of time to ensure appointments are kept. (Restriction means that only one appointment can be scheduled at a time.)
Initial Consumer Rebuttal /* (3000, 10, 2016/02/29) */
(The consumer indicated he/she DID NOT accept the response from the business.)
This response is not true on several accounts.
1. We had a verbal agreement with Erin on our first visit. We expressed our concern about the 24 hour notice on the first date and were told they would work with us. I had no idea they were charging us late fees every time my husband got sick. They did Not EVER mention that we would be able to cancel three appointments within a year and not be charged and that we would be charged for all other issues. If they had told us this would apply to us in our unique situation we would never have agreed to sending out daughter here as we would NEVER be able to comply with this due to the fact that our daughter is only 12 at the time and cannot drive herself to Seattle and my husband is disabled.
2. We received insurance checks and were told by our insurance company not to cash them as they were paying the company directly. We did not cash or use any of those checks. We still have them in our Emily program file. As far as I know Emily program received payments directly from our insurance company and these checks should not be given to the Emily program. We would be happy to give them the Emily program but I don't think we are supposed to. Again, they were NOT CASHED.
3. Every time I had a message from the Emily program I called them back. It was very difficult and inconvenient to try to get in touch with them as you cannot call a central number and get a reliable response. If you leave a message they will tell you that they didn't get it.....it was unclear as to the steps to take to get the "work with you" because of your husbands health issues. Basically I feel lied to and manipulated instead of supported as a family struggling with multiple health crises.
4. We would have paid on time if they had been clear about how the payments worked, we didn't have a clear bill. ever. It was very confusing, not timely, and didn't reflect what actually needed to be paid. We asked repeatedly about co-pay etc. and while we were told we didn't need to make payments at each session my husband made payments anyway.
5. My husband was very ill during this time and could not always get my daughter to her appointments. We left messages that the program didn't receive because of their difficult phone system.
6. Emily program dropped us from service without notice, I was informed by phone when I contacted them to work on understanding my bill. They told me they sent a registered notice demanding payment by a certain date, I received the notice after this date.
7. I did have frequent contact with American financial solutions, they reported having trouble getting in touch with the EMILY PROGRAM. When I let the Emily program know that I was working with a financial counselor to get all of our bills paid I was told they would wait for this before sending our account to collections. A few days later I was informed that they did not, again, hold true to their word. They sent our account to collections despite agreeing to wait to hear from AFS. I was able to proceed with a American Financial Solutions very easily with ALL of my other accounts. Only the Emily program would not work with us in a timely and responsible matter to resolve our bill.
Final Business Response /* (4000, 12, 2016/03/11) */
The Emily Program has met (and exceeded) Ms. [redacted] desired resolution as stated in her original complaint.
She asked us to remove late fees which were incurred as the result of numerous late cancellations and missed appointments. We removed those fees.
Ms. [redacted] said that once the late fees were removed, she would be 'happy' to pay the balance owed. We are confused as to why she has taken no action to do so.
We stand by our previous response: The Emily Program will waive a total of $1,020 in late fees provided the remaining balance of $2,039.74 is paid in full by March 25.

Our apologies to this client for her poor experience with The Emily Program client account team. As requested we are sending a statement (to the address provided by Ms. [redacted]) that indicates the $79.28 charge has been adjusted and there is no remaining balance.As noted, we retired an old billing...

system. This challenge, coupled with a staff transition in the client account department resulted in an unacceptable response to this client. We appreciate the opportunity to make it right.