Advanced Integrative Medicine, P.C.

Initial Business Response /* *** ** *** */
July 6,
Revdex.com - Denver/Boulder
EFlorida Ave
Suite
Denver, CO XXXXX
CASE ID: XXXXXXXX
Dear Denver/Boulder Revdex.com -
This letter is in response to the above referenced case IDThe complaint states that
we ignored requests from Cigna for informationThis was not the case as we were notified by Cigna that the additional information was needed from the claimant/patient in regards to questions of another provider being involved with her carePlease see the attached time line of events along with copies of correspondence between the providers billing office and Cigna as well as with the patient (aka the claimant)This documentation shows that we were informed that request from anther provider was not receivedPlease note we were not able to supply this information, it had to come from either the patient or the patient's other medical provider
We communicated with the claimant via statements and phone calls and provided details as to why Cigna stated they were not able to process her claimsThe attached shows the claimant was given notice on February 5, and February 19, that her account was going to be referred to an outside collection agency if the claim was not resolvedOn February 20, a phone call with the billing staff and the claimant took place where the claimant was again notified that the account was going to be referred to a collection agency if no further action was takenWe specifically mentioned that this action could be avoided if she could provide information (such as a reference number) that her insurance company was still working on the claimThe last communication we had from Cigna was that the claim was closedThe claimant did not provide this information
Two months lapsed providing ample time for resolution before the account was referred to an outside collection agency on April 29, After account was sent to collections we continued to try to work with the claimantOn May 18, 2015, we spoke with the claimant and offered to do a conference call with the claimant and CignaThe claimant stated she would contact them herself and then call us back with a reference number and name of a person at Cigna that was handling the requestHowever, we never received a call back with this information until mid-June
On June 16, 2015, the claimant called the office to inform us that Cigna was paying the claims in questionOn June 19, we received payment from CignaWe promptly (that same day) notified the collection agency and asked them to remove the negative item from the credit bureau reportingWe then called the claimant and advised her that collection agency was notified to cancel reporting with the credit bureausWe further advised her the collection agency indicated it would take 30-days (per collection agency) for reporting to be cancelled
We will continue to work with the collection agency to have the negative item removedThis should satisfy the claimant's request to correct the credit report
Please note, that we followed our procedure and continued to notify the patient of the current situationWe feel we made every attempt to provide resolution as well as several opportunities to avoid the referral to the collection agency and then once referred, to avoid escalationIf we had been informed earlier that Cigna was finally going to process the claim for payments, we could have avoided the reporting of the negative item to collection bureaus
Please let us know if you have any questions or need the attached documentation clarified in any wayWe are happy to provide any additional information you may request
As of 07/07/we received update call from collection company that this is not appearing on patient/claimant credit report
Thank you,
*** ***
Director of Revenue Cycle Management
On behalf of Advanced Integrative Medicine, PC

Initial Business Response /* (1000, 5, 2015/06/10) */
First of all, we are very grateful to work in such a thriving medical officeWe are very fortunate to have wonderful patients, who appreciate the hard work and dedication that goes into healing and taking care of their loved onesThis was
the case with this familyThe patient scheduled a physical not realizing that it was one month too soon for her insurance to cover a yearly physicalThe patient and her husband were roomed and the provider caught her mistake and informed her of thisThe patient and her husband, at no time asked the provider or medical assistant to leave and not be seenInstead the patient had several medical complaints of chest pain, sleep apnea, high cholesterol and wanting to discuss her labs that were drawn from an outside Health FairBy the end of her office visit, the patient and her husband expressed to the provider and her medical assistant that they "liked her better" than their current providers and wanted to switch their care to her in the futureThe husband thanked the provider for being so thorough and aggressive in treating his wife's cholesterolThe provider and the couple then spoke about fly fishing and while leaving the husband expressed gratitude to the provider for her military service as well
As they were leaving our office, both expressed their satisfaction with her office visit, to the front receptionistsThe husband asked to have a copy of the financial responsibility form that the patient signed when coming in and then left with the prescription for the brand name medication they personally requested from the provider
Three hours later, the husband came back into the office very loudly asking for a full refund of their partial payment of her visitHe was very rude to the front and when they tried to calm him down, by stating he left satisfied that his wife had been seen, his anger increasedHe was making a scene in front of other patients by screaming demanding his money backThe receptionist was frightened by this and called the office manager to handle the situationWhen the office manager spoke with him, he stated " He didn't realize the medication they asked for would cost over $200", and because of this, he wanted his partial payment for the visit returnedThe office manager tried to explain, that his wife was seen for a medical visit and we needed to be paid for services rendered and this had nothing to do with the cost of the medicationHe then became more and more verbally abusive and confusedFor some reason he couldn't comprehend the connection of paying for services that his wife receivedHe continued to point out the cost of the medication that they requested as being too expensive and that in a month a physical would be freeThe office manager reiterated that, it was unreasonable for him to ask for his money backHis visible anger escalated and he continued to verbally insult the office manager and the officeThe office manager felt so uncomfortable with the level of anger coming from the husband, she asked for him to leaveHe refused until he received his money backThe office manager again asked for him to leave or she would have to call the policeThe situation was so evident in our small office that another provider stepped in to try and calm him down, but he seemed only more confused and angry with what he was sayingAt no time did the provider ever threaten verbally or physically the husbandThe police were called, with this action the husband finally left
We thankfully do not typically see this kind of behavior in our office from patients or their family membersWe feel, like any business, that we have to be paid for our services to continue serving our patients, irrespective of the cost of medication requested by patients
We liken it to someone going into a restaurant and ordering a mealRaving about the dinner to the waiter and chefThey order a dessert that happens to cost $50, when they get the bill the customers yell and scream how horrible the entire experience has been at the restaurant and demand a free dinner