Big Apple Chinese Buffet

RE: Creditor: ProScan Dublin Complainant: [redacted] Account No: [redacted] Revdex.com Case ID No: [redacted] Dear [redacted] ***:This letter is in response to your correspondence dated October 13, regarding the above-referenced Revdex.com Case ID NumberAfter further review of [redacted] ’s file and her response to our September communication, we understand that the delay in getting her report to her physician was an inconvenience, however, it did not change the outcome of her diagnosis Therefore, we are offering [redacted] a refund of $150.00, which is approximately 1/of the amount she is disputing

RE: Creditor: ProScan Imaging of Greenwood Consumer: [redacted] Revdex.com ID # [redacted] Dear [redacted] ***: This letter is in response to your correspondence received on September 29, regarding the above-referenced Revdex.com ID NumberWe have conducted a thorough review of [redacted] ’s account [redacted] ’s referring physician changed the original order to a Brain MRI with and without contrast from a Brain MRI without contrast The order information was updated in [redacted] ’s chart at the imaging center At the time of service the MRI tech at ProScan explained the procedure, including the administering of contrast, to [redacted] [redacted] was also provided with a consent form giving ProScan permission to administer the contrast as part of his Brain MRI scan [redacted] signed the consent for the contrast administration However, the additional cost of the study with contrast was not properly communicated to [redacted] at the time of service Because the additional cost associated with the study with contrast was not sufficiently communicated to [redacted] , we would like to offer [redacted] a refund in the amount of $280, which represents approximately half of the additional balance due on his accountWe apologize for any inconvenience or confusion that [redacted] may have experienced ProScan is committed to provide all of our patients with the highest standards of service

RE: Creditor: ProScan Pink Ribbon Center - Red Bank Complainant: [redacted] Account Number: [redacted] Revdex.com Case ID No: [redacted] This letter is in response to your correspondence received on August 31, regarding the above-referenced Revdex.com complaint After a thorough review of Ms [redacted] ’s account, the following is the summary of our findings: 6/29/– Ms [redacted] was provided an “Advance Beneficiary Notice” which identified a Bone Density Test (“DEXA”) as may not be medically necessary, which the patient signed and dated 6/29/– Ms [redacted] completed screening scans for Mammogram and DEXA performed at the ProScan Pink Ribbon Center – Red Bank location 7/3/– Ms [redacted] ’s claim was submitted to [redacted] with the diagnostic diagnosis identified in the conclusion of the radiologist report 7/18/– [redacted] allowed $towards the claim and applied $to the deductible 7/19/- A statement was sent to Ms [redacted] from ProScan for the balance on the account of $ 8/1/– Ms [redacted] called in to Customer Service with questions regarding the statement she received The call was transferred to a claims follrepresentative to research the issue 8/1/– The claims follrepresentative reviewed the claim and determined that Ms [redacted] received a statement because the DEXA was considered a diagnostic test which makes the claim subject to deductible and co-insurance 8/1/– A customer service representative called Ms [redacted] back, but was unable to reach her The customer service representative left a voice mail message for Ms [redacted] 8/2/– Ms [redacted] called back and spoke with a customer service representativeShe stated that her physician was supposed to send over new order for a screening DEXA The customer service representative attempted to explain that the new order had not yet been receivedMs [redacted] then stated ProScan was trying to scam her, so the call was transferred to the SrBilling Manager 8/2/– The SrBilling Manager spoke to Ms [redacted] and assured her that she would look into her claim further The SrBilling Manager then explained to Ms [redacted] that even though the physician order was written a for screening DEXA scan, ProScan is required to code the claim according to the radiologist’s findings/conclusion which may differ from the physician’s reason written on the order for the scan After researching, the SrBilling Manager confirmed that the original order was written for ZPost-Menopausal Screening DEXA, however the radiologist’s report listed in the findings/conclusion a diagnostic finding of MDisorder of bone unspecified 8/2/– Ms [redacted] called back and spoke with Customer Service stating her physician was resending the order for the DEXA scan 9/1/– ProScan submitted the claim reconsideration to [redacted] with the radiology report and order To clarify, [redacted] will not change the diagnostic code assigned; it would only allow us to add to the claim the ZPost-Menopausal Screening DEXA reason for scan with the findings code MDisorder of bone unspecified Once ProScan has a reconsideration response back from ***, we will act accordingly If [redacted] finds that the scan is classified/paid as screening DEXA, ProScan will immediately contact Mrs [redacted] to refund her $If [redacted] denies reconsideration for screening, then ProScan will abide by its contract with *** We apologize for any inconvenience that Ms [redacted] may have experiencedProScan is committed to provide all of our patients with the highest standards of service If you have any questions, please let me know Regards, PROSCAN IMAGING Nathan M [redacted] Director of Revenue Cycle

After a thorough review of Mr. ***’s account, the following is the summary of our findings: 5/6/2016 – Anthem Insurance verified, effective 1/1/2016, 0.00 Co-Pay, 20% Co-Insurance equal 89.76, Allowable 448.81, deductible 200.00 at time of eligibility verification check before... insurance adjudicates claim. 5/11/2016 – Services were rendered to Mr. ***. During Mr. ***’s appointment, registration paperwork was provided to for his review and signature; these documents explain that these are estimates based on information from patient’s health insurance provder. Co-payment was collected at time of service; a receipt for the payment of $89.76 was provided. 6/21/2016 – After receiving a statement for the balance due on his account, Mr. [redacted] called into Customer Service and spoke with a Customer Service Rep. regarding the balance due on his account; he stated he paid at the time of service. The Customer Service Rep explained the remaining balance of $159.98 is the amount his insurance applied towards his deductible after they adjudicated the claim. Mr. [redacted] stated no deductible due was mentioned at the time of his visit. 6/24/2016 – Mr. [redacted] called back into Customer Service and spoke with a Customer Service Rep. regarding the balance on his account and again stated that he paid at time of service. At that time he requested to speak to the Manager. The call was then transferred to the Collections Manager. [redacted] July 6, 2016 Page Two 6/24/2016 – The Collection Manager spoke with Mr. [redacted] regarding the remaining balance on his account. Mr. [redacted] stated he thinks the balance associated with the deductible should be adjusted off, since no one told him he had a deductible on top of the $89.76 he paid at the time of service. Please note that standard practice by the insurance company is to provide an Explanation of Benefits statement to the patient at the time the claim is processed. The Explanation of Benefits that ProScan received reflects the balance due by patient was applied to the patient’s deductible; until the patient’s deductible is met, that amount becomes due and payable by the patient. We cannot routinely waive Co-Insurance and/or deductibles as that is part of the terms of our agreement with Mr. ***’s insurance provider. Documents provided to Mr. [redacted] at the time of his appointment explained that he is responsible for any additional amounts owed related to the deductible. Based on the circumstances we will split the balance owed of $159.98 with him. Therefore if he sends a check for $80.00 we will write of the remaining balance. We apologize for any inconvenience that Mr. Tim [redacted] may have experienced. ProScan is committed to provide all of our patients with the highest standards of service. If you have any questions, please let me know. Regards, PROSCAN IMAGING [redacted] Chief Operating Officer

Per our Revenue Cycle Manager, ***'s check in the amount of $cleared for payment posting 9/26/17. A refund request in the amount of $was sent to our finance department on 10/2/for processing, therefore Ms*** should receive her refund the week of 10/

I am willing to accept this so long as this is refunded to my credit card promptly
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.
Regards,
*** ***

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID ***, and have determined that this does not resolve my complaint. For your reference, details of the offer I reviewed appear below
As indicated in the email below, *** has stated they have sent notification to ProScan on September 15th, indicated the claim was reprocessed and ProScan received the $via an electronic fund transfer. According to MrM***, ProScan has not received the reprocessed amount.My calls to ProScan were on August 1st and 2nd I have yet to receive a call back from the Billing Supervisor, Gara (sp?). She said she would look into it in August and would call me back. Even MrM***'s summary shows I have not had any contact from ProScan after my 8/2/call. I've been left hanging with no reply, hence my seeking Revdex.com's assistance. ProScan had the original script from my doctor before I had the Dexa scan; the script indicated the Dexa Scan fell under preventive care; yet ProScan billed as diagnostic, which left me a balance. The ProScan rep, Navi, (sp?) on 8/2/2017, told me she could not make "Outbound" calls to her own internal department to verify the original script indicated the scan was preventive. Further, I was told because the scan came back with a finding, I would owe the $46.44. I was advised to call my doctor's office to get the original prescription refaxed. I had to call my doctor because ProScan "could not" make "Outbound" calls to their own internal department? I still wonder if it is true that the billing office cannot contact the department with the original script, which led me to ask if the $was a scam preying upon ignorant people, or people who give up since this is so incredibly time consuming and disturbing being told no "outbound" calls and no return call from Gara, the billing supervisor, contact the doctor's office to get script refaxed, or believe the erroneous information about the result of the scan dictated if a patient were charged for a scan originally ordered as preventive. They are all being paid for their time; I am not. Though I realize I cannot be compensated for my time, including the time it took me to get ***'s response below, a patient should not have to go through what I've been through. I wonder how many other patients have paid though in reality if billed correctly would also have had a zero balance or believed a rep who said if there is a finding, the patient owes the balanceOr who have given up. I am at that point. In August, I could have readily accepted ProScan contacting me back and
stating they refiled the claim after, perhaps emailing an internal contact, since no Outbound calls ere possible...to obtain the original script
or the billing department had received the refaxed script.It is now October 1st. My date of service was June 29th. We are talking about a measly $46.44, which has cost me a lot more in stress and time.I do thank Revdex.com for your helpWith your intervention, I am able to get some sort of reply from ProScan. And, except for some omissions, I do appreciate MrM*** summary. Further, I appreciate the level of care and dedication from the front staff, technicians, and radiologist at ProScan*** ***'s email:
From: Member Services
Dear *** ***:
Thank you for using the secure member website to contact ***To help protect
your confidential information, please continue to use the secure member website
to contact usThis online form provides greater security than standard Internet
e-mail
Your claim
This is in response to your claim for date of service 06/29/in the amount
of $from ProScan Women's Imaging Center
We have reprocessed your claim under your preventive benefitWe allowed $
as the contracted amount on this claimWe paid the provider in the amount of
$and the payment was issued to them on 09/15/through electronic fund
transfer (EFT)There is no patient responsibility on this claim
We have attached a copy of your member explanation of benefits (EOB) to this
messageA provider EOB was also sent to ProScan Women's Imaging Center on
09/15/
If you have additional questions, send us a 'Contact Us' message or call the
toll-free number on your member ID card, if applicable
Sincerely,
Internet Response Team
***
***

[A default letter is provided here which indicates your acceptance of the business's response.  If you wish, you may update it before sending it.  If you and the business have reached an agreement and compliance is set for a future date, we trust the business will comply.  Please contact us after that time if the matter is not resolved as agreed and we will review the complaint and proceed accordingly.]
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. 
Regards,
[redacted]

[A default letter is provided here which indicates your acceptance of the business's response.  If you wish, you may update it before sending it.  If you and the business have reached an agreement and compliance is set for a future date, we trust the business will comply.  Please contact us after that time if the matter is not resolved as agreed and we will review the complaint and proceed accordingly.]
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. 
Regards,
[redacted]

PROSCANimaging[redacted]One East Fourth, Suite 600Cincinnati, OH 45202Corporate Headquarters5400 Kennedy Avenue Cincinnati, Ohio 45213Phone: 513-281-3400 Fax. 513-281-3420 Web: www.proscan.comRe: Creditor: ProScan Dublin Complainant: [redacted] Account No  : [redacted] Revdex.com Case ID No:...

[redacted]September 15, 2017RE: Creditor: ProScan DublinComplainant: [redacted] Account No: [redacted]Revdex.com Case ID NO: [redacted]Dear [redacted]:This letter is in response to your correspondence dated August 7th, 2017 regarding the above-referenced Revdex.com Case ID Number.After a thorough review of [redacted]'s account [redacted], the following is the summary of our findings:5/11/17 - [redacted] was contacted before her appointment and informed of [redacted]'s estimated amount due for an MRI was: $0 copay, 20% coinsurance, and an estimated allowable amount of $463.75, and with ProScan's Prompt Payment discount of 10%, the estimated total due would be $417.38.5/16/2017 - At the time of her appointment, [redacted] was provided the registration documents for review and signature. The registration documents explain that the amounts provided are estimates from the patient's health insurance carrier. The estimated allowable amount minus the 10% prompt payment discount was collected at the time of service and a receipt for the payment of $417.38 was provided to [redacted].5/18/17 - It was discovered that a mistake was made in the Findings section of the radiology report; it stated "located to the right of midline measuring", but referenced left in the Conclusion. The report should state right in both the Findings and Conclusion.5/19/17 - [redacted] was billed; [redacted] applied $479.83 deductible towardsthe MRI of the Brain and applied $24.58 towards the contrast, bringing the total balance due from patient $504.41. After the patient's payment of$417.38 was subtracted from the total balance due of $504.41, it left a remaining balance of $35.59 due from the patient.7/24/2017 - Our system shows that the last faxed amended report sent to [redacted]'s referring physician concurs with the final amended report in our system.7/27/2017 - The date of service of 4/27/2017 for MRI of the Brain and MRA of the Head was billed to [redacted] 6/6/17 which was partial paid and denied, and re-denied on 7/26/17.8/4/17 - After processing all payments and refunds received from [redacted] it was determined that a refund was due to the patient. Therefore, a check inthe amount of $267.33 was sent to the patient on or around August 17, 2017. We apologize for any inconvenience that [redacted] may have experienced. ProScan is committed to provide all of our patients with thehighest standards of service. If you have any questions, please let me know. Regards, PROSCAN IMAGING  By:  [redacted]       Director of Revenue Cycle

RE:          Creditor: ProScan Imaging of Greenwood Consumer: [redacted]                 Revdex.com ID #[redacted]   Dear [redacted]:   This letter is in response to your...

correspondence received on September 29, 2017 regarding the above-referenced Revdex.com ID Number. We have conducted a thorough review of [redacted]’s account.  [redacted]’s referring physician changed the original order to a Brain MRI with and without contrast from a Brain MRI without contrast.  The order information was updated in [redacted]’s chart at the imaging center.  At the time of service the MRI tech at ProScan explained the procedure, including the administering of contrast, to [redacted].  [redacted] was also provided with a consent form giving ProScan permission to administer the contrast as part of his Brain MRI scan.   [redacted] signed the consent for the contrast administration.  However, the additional cost of the study with contrast was not properly communicated to [redacted] at the time of service.  Because the additional cost associated with the study with contrast was not sufficiently communicated to [redacted], we would like to offer [redacted] a refund in the amount of $280, which represents approximately  half of the additional balance due on his account. We apologize for any inconvenience or confusion that [redacted] may have experienced.    ProScan is committed to provide all of our patients with the highest standards of service.

After a thorough review of Mr. [redacted]’s account, the following is the summary of our findings:   5/6/2016 – Anthem Insurance verified, effective 1/1/2016, 0.00 Co-Pay, 20% Co-Insurance equal 89.76, Allowable 448.81, deductible 200.00 at time of eligibility verification check before...

insurance adjudicates claim.   5/11/2016 – Services were rendered to Mr. [redacted].  During Mr. [redacted]’s appointment, registration paperwork was provided to for his review and signature; these documents explain that these are estimates based on information from patient’s health insurance provder. Co-payment was collected at time of service; a receipt for the payment of $89.76 was provided.   6/21/2016 – After receiving a statement for the balance due on his account, Mr. [redacted] called into Customer Service and spoke with a Customer Service Rep. regarding the balance due on his account; he stated he paid at the time of service. The Customer Service Rep explained the remaining balance of $159.98 is the amount his insurance applied towards his deductible after they adjudicated the claim. Mr. [redacted] stated no deductible due was mentioned at the time of his visit.   6/24/2016 – Mr. [redacted] called back into Customer Service and spoke with a Customer Service Rep. regarding the balance on his account and again stated that he paid at time of service.  At that time he requested to speak to the Manager. The call was then transferred to the Collections Manager.     [redacted] July 6, 2016 Page Two     6/24/2016 – The Collection Manager spoke with Mr. [redacted] regarding the remaining balance on his account.  Mr. [redacted] stated he thinks the balance associated with the deductible should be adjusted off, since no one told him he had a deductible on top of the $89.76 he paid at the time of service.   Please note that standard practice by the insurance company is to provide an Explanation of Benefits statement to the patient at the time the claim is processed.  The Explanation of Benefits that ProScan received reflects the balance due by patient was applied to the patient’s deductible; until the patient’s deductible is met, that amount becomes due and payable by the patient.  We cannot routinely waive Co-Insurance and/or deductibles as that is part of the terms of our agreement with Mr. [redacted]’s insurance provider. Documents provided to Mr. [redacted] at the time of his appointment explained that he is responsible for any additional amounts owed related to the deductible.   Based on the circumstances we will split the balance owed of $159.98 with him. Therefore if he sends a check for $80.00 we will write of the remaining balance.   We apologize for any inconvenience that Mr. Tim [redacted] may have experienced.  ProScan is committed to provide all of our patients with the highest standards of service.   If you have any questions, please let me know.                                           ...⇄ Regards,                                           ...⇄ PROSCAN IMAGING                                         ...⇄                                     [redacted]                                         ...⇄ Chief Operating Officer

[A default letter is provided here which indicates your acceptance of the business's response.  If you wish, you may update it before sending it.  If you and the business have reached an agreement and compliance is set for a future date, we trust the business will comply.  Please contact us after that time if the matter is not resolved as agreed and we will review the complaint and proceed accordingly.]
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.  The payment of $80 should be received by 7/14/16
Regards,
[redacted]

RE:       Creditor:                     ProScan Dublin Complainant:             [redacted] Account No:               [redacted]Revdex.com Case ID No:         [redacted]   Dear [redacted]:This letter is in response to your correspondence dated October 13, 2017 regarding the above-referenced Revdex.com Case ID Number. After further review of [redacted]’s file and her response to our September communication, we understand that the delay in getting her report to her physician was an inconvenience, however, it did not change the outcome of her diagnosis.  Therefore, we are offering [redacted] a refund of $150.00, which is approximately 1/3 of the amount she is disputing.

RE:          Creditor:                              ProScan
Pink Ribbon Center - Red Bank Complainant:                    [redacted]
                Account Number:            [redacted]
                Revdex.com Case ID No:                [redacted]
This letter
is in response to your correspondence received on August 31, 2017 regarding the
above-referenced Revdex.com complaint.
After a
thorough review of Ms. [redacted]’s account, the following is the summary of our
findings:
6/29/17 – Ms.
[redacted] was provided an “Advance Beneficiary Notice” which identified a Bone
Density Test (“DEXA”) as may not be medically necessary, which the patient
signed and dated.
6/29/17 – Ms.
[redacted] completed screening scans for Mammogram and DEXA performed at the ProScan
Pink Ribbon Center – Red Bank location.
7/3/17 – Ms.
[redacted]’s claim was submitted to [redacted] with the diagnostic diagnosis
identified in the conclusion of the radiologist report.
7/18/17 –
[redacted] allowed $46.44 towards the claim and applied $46.44 to the deductible.
7/19/2017 - A
statement was sent to Ms. [redacted] from ProScan for the balance on the account
of $46.44.
8/1/17 – Ms.
[redacted] called in to Customer Service with questions regarding the statement
she received.  The call was transferred to
a claims follow-up representative to research the issue.
8/1/17 – The
claims follow-up representative reviewed the claim and determined that Ms.
[redacted] received a statement because the DEXA was considered a diagnostic
test which makes the claim subject to deductible and co-insurance.
8/1/17 – A customer
service representative called Ms. [redacted] back, but was unable to reach
her.  The customer service representative
left a voice mail message for Ms. [redacted].
8/2/17 – Ms.
[redacted] called back and spoke with a customer service representative. She stated
that her physician was supposed to send over new order for a screening DEXA.
The customer service representative attempted to explain that the new order had
not yet been received. Ms. [redacted] then stated ProScan was trying to scam
her, so the call was transferred to the Sr. Billing Manager.
8/2/17 – The
Sr. Billing Manager spoke to Ms. [redacted] and assured her that she would look
into her claim further.  The Sr. Billing Manager then explained to Ms.
[redacted] that even though the physician order was written a for screening DEXA
scan, ProScan is required to code the claim according to the radiologist’s
findings/conclusion which may differ from the physician’s reason written on the
order for the scan.
After
researching, the Sr. Billing Manager confirmed that the original order was
written for Z78.0 Post-Menopausal Screening DEXA, however the radiologist’s report
listed in the findings/conclusion a diagnostic finding of M89.9 Disorder of
bone unspecified.
8/2/17 – Ms. [redacted]
called back and spoke with Customer Service stating her physician was resending
the order for the DEXA scan.
9/1/17 – ProScan
submitted the claim reconsideration to [redacted] with the radiology report and order.
To clarify,
[redacted] will not change the diagnostic code assigned; it would only allow us to
add to the claim the Z78.0 Post-Menopausal Screening DEXA reason for scan with
the findings code M89.9 Disorder of bone unspecified.
Once ProScan
has a reconsideration response back from [redacted], we will act accordingly.  If [redacted] finds that the scan is
classified/paid as screening DEXA, ProScan will immediately contact Mrs.
[redacted] to refund her $46.44. If [redacted] denies reconsideration for screening,
then ProScan will abide by its contract with [redacted].
We apologize
for any inconvenience that Ms. [redacted] may have experienced. ProScan is committed to provide all of our
patients with the highest standards of service.
If you have
any questions, please let me know.
Regards,
PROSCAN IMAGING
Nathan M[redacted]Director
of Revenue Cycle

Thank you, [redacted].  I did get a statement in the mail showing a zero balance.   They adjusted the invoice to show I should not have owed any money. Getting my refund will be the last step. (I paid the invoice while I worked through your office and the insurance company and...

Proscan.) Thank you, again, for all your help. [redacted]