Denver Integrated Imaging South

The payment by the insurance company is in review In cases like these the clinic collects the amount the insurance company instructs at time of service When payment is made in a different amount the case must be reviewed to confirm payment process Confirmation by the insurance company is important, because an audit at a later date could result in the insurance company recovering funds from the clinic if they deem an overpayment was made by the insurance carrier

The patient did pay the estimated $at the time of service as directed by the insurance company Since that time, the insurance company has contacted the Denver Integrated Imaging office and recovered $of the amount paid by insurance previouslyThe insurance company is still reviewing the account to adjust the amount paid The insurance has determined at least part of the payment made by the insurance company was an overpayment and as a result the insurance is in the process of recovering the amount they deem overpaidThis adjustment being performed by the insurance company has and will affect the amount the patient is ultimately responsible for The insurance company must review and confirm as final before we can issue a refund for overpayment

At time of service the insurance representative instructed [redacted] *** staff to collect $from the patient When the insurance company processed the claim at different benefit level, the clinic had to contact the insurance company for confirmation When that confirmation is received the clinic will know if a refund is due to the insurance company or to the patient and make the refund accordingly We expect an answer very soon

Final Consumer Response / [redacted] (2000, 6, 2015/10/02) */ After filing this complaint, a check dated September 25, was received this week for the full amount of the refund we expectedWe consider this issue closed satisfactorily at this point in time

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

Initial Business Response / [redacted] (1000, 9, 2015/09/25) */ This refund was processedThe investigation with insurance company took some time, but was finalized and refund sent to patient on 9/18/ Initial Consumer Rebuttal / [redacted] (2000, 12, 2015/09/30) */ (The consumer indicated he/she ACCEPTED the response from the business.) I know that my insurance company resolved the matter sooner than indicated but I am satisfied with the result

Initial Business Response / [redacted] (1000, 15, 2015/12/10) */ The insurance carrier confirmed the overpayment and assured no reprocessing or recovery of funds would be madeA refund was issued to the patient Initial Consumer Rebuttal / [redacted] (2000, 17, 2015/12/15) */ (The consumer indicated he/she ACCEPTED the response from the business.) I have received the money I was owed after monthsI feel that the only reason I received the money owed me is because I requested help from the Revdex.comI appreciate the help of the Revdex.com

The clinic was able to confirm with insurance carrier the overpay is to be refunded to the patient $will be processed as a refund and mailed to patient by 10/4/

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID ***, and find
that this resolution is partially satisfactory to me
Yesterday I did receive a check from them for the amount I paid minus my co-pay. I believe I was due at a minimum acknowledgement of the onerous process to get the money owed to me as well as interest on the amount they withheld. I find their business practices at a minimum unethical. I also note that my insurance company Cigna issued a check to them days after my MRI, for an amount greater than what they charged me as the total. It took them days and multiple phone calls over that time to refund
Sincerely,
*** ***

Prior to providing medical services our clinic contacts the appropriate insurance company to obtain eligibility and benefit information for the patient At that time the insurance company will tell us the estimated copay/co-insurance/ deductible amount to be paid by the patient In this
patient case the insurance company paid the claim using very different benefits than used at the time of service when they instructed the clinic to collect the amount at time of service from the patient Unfortunately insurance companies make incorrect payments If the payment made by the insurance company does not match the information given to the clinic at time of service, it must be fully researched In numerous cases the insurance carrier will return to the medical provider and recover payments made on a case months or even years old with instructions for the medical provider to collect additional payment from the patient The medical provider must obtain confirmation from the insurance provider regarding which amount the patient was actually responsible to pay This does take some time, but is a necessary step.The insurance company review has been completed and a refund check will be issued and sent to the patient by 12/12/

this took place in September of last yearThat was months agoMy insurance company has called you times to confirm that you received your payment and owed me a refundYour business practice is ridiculous as evident by all the other claims just like mineYou have had ample time to get this taken care of and my insurance company has verified that you owe me a refundI have called you times in the past two weeks and I'm told every time that it is on the accounts depts supervisors deskOne lady even said "this hasn't been taken care of yet, this has been going on for months"! I am to the point that paying a lawyer to handle it might just be what I have to do, regardless of the cost.
Complaint: ***
I am rejecting this response because:
Sincerely,
*** ***

The overpayment was confirmed to be patient funds and a refund check was issued last week

I apologize for the delay I was able to review your account yesterday afternoon I will talk to my CFO on Monday and resolve with our AP Department

The confirmation with the insurance company has been completed and the refund to the patient is being issued today Check # *** is being sent by the AP Department

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
Sincerely,
*** ***

Cases like this require confirmation with insurance carrier. Insurance carriers maintain the right to reveiw and audit old payments up to years after payments are made and recovering funds from medical providers - so confirmation is required. Our staff was able to obtain that
confirmation and the refund will be issued to patient within a few days

Initial Business Response /* (1000, 9, 2015/09/25) */
This refund was processed. The investigation with insurance company took some time, but was finalized and refund sent to patient on 9/18/15.
Initial Consumer Rebuttal /* (2000, 12, 2015/09/30) */
(The consumer indicated he/she ACCEPTED the...

response from the business.)
I know that my insurance company resolved the matter sooner than indicated but I am satisfied with the result.

The insurance company estimated the amount the patient was to pay during a telephone call by the clinic staff at the time the patient was seen.  The insurance company processed the claim differently upon receipt.  The clinic then needed to confirm from the insurance company the correct...

benefits and patient responsibility.  That was accomplished on 7/12/2017 and a refund was made to the patient via credit card.

The patient did pay the estimated $240.00 at the time of service as directed by the insurance company.  Since that time, the insurance company has contacted the Denver Integrated Imaging office and recovered $78.75 of the amount paid by insurance previously. The insurance company is still...

reviewing the account to adjust the amount paid.  The insurance has determined at least part of the payment made by the insurance company was an overpayment and as a result the insurance is in the process of recovering the amount they deem overpaid. This adjustment being performed by the insurance company has and will affect the amount the patient is ultimately responsible for.  The insurance company must review and confirm as final before we can issue a refund for overpayment.

The research was finalized and a refund was issued to the patient in the amount of $207.50 on 6/27/16.