New Mexico Medical

RE: ID [redacted] To Whom It May Concern: We are in receipt of the above referenced complaintOn September 26, 2016, [redacted] had two lesions removed in our Edgewood office by John P***, PA-CAfter these lesions were removed, they were sent off to our pathology company, Pathology Consultants of New Mexico (PCNM), for testingThe claim for the services rendered in our office was sent to her insurance company, PresbyterianOn November 20, 2016, we received payment from PresbyterianThe Explanation of Payment indicated that $was patient responsibility as the patient had not yet met her deductibleIn her complaint, Ms [redacted] indicated that she had received bills totaling $I contacted PCNM to see if this patient had a bill with themI spoke with a billing specialist named [redacted] and she indicated that the patient's balance with them was $ [redacted] reviewed the claim and indicated that even though the patient had already been billed, the claim was not processed correctly and she was going to resubmit the claim to Presbyterian for further reviewShe has also placed the patient's account on hold until she receives a response from Presbyterian, at which time the patient's account will be reviewed and potentially changedMs [redacted] also indicated in her complaint that she was assured that this was covered by her insuranceThis procedure is a covered benefit on her insurance plan, however, Ms [redacted] had not yet met her $deductible at the time of service so she was responsible for 100% of the allowed chargesThank you for your time in this matterTracey P*** Billing Manager New Mexico Medical

RE: ID [redacted] To Whom It May Concern:  We are in receipt of the above referenced complaint. On September 26, 2016, [redacted] had two lesions removed in our Edgewood office by John P[redacted], PA-C. After these lesions were removed, they were sent off to our pathology company,...

Pathology Consultants of New Mexico (PCNM), for testing. The claim for the services rendered in our office was sent to her insurance company, Presbyterian. On November 20, 2016, we received payment from Presbyterian. The Explanation of Payment indicated that $94.48 was patient responsibility as the patient had not yet met her deductible. In her complaint, Ms. [redacted] indicated that she had received bills totaling $600. I contacted PCNM to see if this patient had a bill with them. I spoke with a billing specialist named [redacted] and she indicated that the patient's balance with them was $516.14. [redacted] reviewed the claim and indicated that even though the patient had already been billed, the claim was not processed correctly and she was going to resubmit the claim to Presbyterian for further review. She has also placed the patient's account on hold until she receives a response from Presbyterian, at which time the patient's account will be reviewed and potentially changed. Ms. [redacted] also indicated in her complaint that she was assured that this was covered by her insurance. This procedure is a covered benefit on her insurance plan, however, Ms. [redacted] had not yet met her $3250 deductible at the time of service so she was responsible for 100% of the allowed charges. Thank you for your time in this matter. Tracey P[redacted] Billing Manager New Mexico Medical