Acupuncture & Natural Herbs Inc.

Response: Acupuncture & Natural Herbs Inc. is proud to provide comprehensive and compassionate care in the community  and takes treatment of its patients – and their privacy – seriously. Because federal privacy laws govern patients’ protected health information, it is not the policy of...

Acupuncture & Natural Herbs Inc. to substantively respond to negative reviews on “ratings” websites, even if they provide misleading, unfair or inaccurate information.  It is the policy of Acupuncture & Natural Herbs, Inc. to ensure that, prior to treatment, all patients whose treatment is covered in whole or in part by insurance understand and agree in writing  that they are responsible for the cost of any services delivered that are not paid for by insurance.  It is the policy and strict practice of Acupuncture & Natural Herbs, Inc. to bill insurance companies in accordance with the terms of our contracts.

[redacted] ###-###-#### February 27, 2017 [redacted] Trade Practice Consultant Revdex.com of NM 7007 Jefferson St NE, Ste A Albuquerque, NM 87109 RE: Complaint [redacted], Acupuncture & Natural Herbs, Inc. Dear [redacted], Sorry it took so long to get these documents to you. However, we had a water heater break and flood our house. I've been working on that in between trips for work and so had to put this on the back burner for a while. Enclosed are my EOBs from my United Healthcare account showing how much Dr. L[redacted] billed for each acupuncture session and what she was paid by UHC for each one. I also included two (2) invoices showing that her charges for each visit were to be $75 per visit. She did tell me that the initial (first) visit would be $85 and then each subsequent visit would be $75. As you can see, she inflated the amount she billed UHC and was greatly overpaid. Not only is she keeping the overpayment for each of those visits but also wants me to pay in addition to those extreme overpayments. I knew what my maximum benefits were ($1,000) and was being responsible to not go over that limit. Thereby, limited the number of visits with her to 10 visits which should have totaled $760. She also billed on several visits for some sort of "heat" or "light" therapy which I never had. So not only did she overcharge but she also charged for something I never had. I'm considering filing something with the insurance fraud organization in New Mexico also. I'd like to get all the insurance overpayments paid back either to me or my insurance company. But I guess I already stated in my original complaint to you that she can keep the overpayment if she doles out the $1,000 from my insurance to cover all my visits. I guess when I file a complaint with another organization, maybe they can make her repay what she was overpaid or fraudulently charged for. I also need to file a formal complaint with my insurance company for at least the "heat light therapy" that I did not get. Anyway, these documents should help clarify my position. Please call me anytime at the above number if you need further information. Sincerely,  [redacted]

In compliance with Federal laws governing patients privacy rights, Acupuncture & Natural Herbs Inc. does not substantively respond to negative reviews on “ratings” websites, even if they provide misleading, unfair or inaccurate information in order to protect the privacy of our patients.   As a part of delivering high quality care to all of our patients, it is the policy of Acupuncture & Natural Herbs Inc. to ensure that all patients understand and consent in writing to receive treatments that the doctor believes necessary to treat their condition.   It is also the policy of Acupuncture & Natural Herbs, Inc. to ensure that, prior to treatment, all patients whose treatment is covered in whole or in part by insurance understand and agree in writing  that they are responsible for the cost of any services delivered that are not paid for by insurance.  It is the policy and strict practice of Acupuncture & Natural Herbs, Inc. to bill insurance companies in accordance with the terms of our contracts.

Complaint: [redacted]
I am rejecting this response because:It does not address the issue of the rates quoted by the business to the patient at the initial consultation. Rates for services were quoted to patient at one rate and billed to patient's insurance company at a substantially higher rate thereby using up patient's insurance allotment in many fewer visits than expected by patient. Patient was never advised that insurance company was being billed at a much higher rate than was quoted to patient. Patient was also not advised of what services insurance company was being billed for (insurance company was being billed for services that patient was not aware of) in addition to accupuncture treatments which were to be at rate of $75 per treatment. Patient's insurance company paid well in excess of $75 for each accupuncture treatment. Just one treatment was paid out to Dr. L[redacted] in the amount of $149.50!!! That is double--nearly 100%--more than the $75 treatment cost quoted. Dr. L[redacted]'s recent explanation to me, the patient, was that the $75 quoted to me was reflecting a 15% discount for paying at the time of visit and that insurance is billed at a higher rate because she has to wait longer for her money. When I said that she was paid much more than 15% higher, she then said it could be 30% more. Well, $149.50 is a lot higher than 30% more than $75. It has nothing to do with patient confidentiality and everything to do with overbilling my insurance who is paying on my behalf. It has everything to do with not disclosing to the patient how much you are billing their insurance company so that the patient may keep track of their accounts and finances. I trusted her to help me with my problem with migraines from my open heart surgery. I did my part in finding out what my benefits were and was responsible in keeping track of the number of visits so that I wouldn't run out of benefits. This business was not forthcoming and honest in billing my insurance company and in disclosing information to the customer/patient so that I would be aware that I was out of insurance benefits. They also billed for heat therapy that I never received, thereby using insurance money for something I didn't need or receive. Is it their policy and practice to bill for services not rendered and to bill at double the rates quoted to patients at time of consultation???? This isn't regarding my "health information". This is regarding the rates quoted to me and the fact that they billed my insurance company an inflated amount thereby using up all of my benefits in far less visits than calculated according to the rates quoted. This is about the patient/customer now left being billed for visits at $75 per visit (the original contracted amount per visit) because this business inflated and overbilled insurance thereby using up patients benefits in far less visits. At $75 per visit ($85 for initial consultation), I should have been able to have 13 visits! I only had 8 covered by insurance benefits of $1,000 to Dr. L[redacted]. 
Regards,
[redacted] [To assist us in bringing this matter to a close, the consumer must give a reason why they are rejecting the response. If the consumer does not provide a reason the complaint will be closed Answered]

Re: Complaint #[redacted]This is in response to the additional concerns raised by the customer which we understand were provided to the Revdex.com on February 27, 2017. As noted in our response to the initial complaint, Acupuncture & Natural Herbs, Inc. is proud to provide comprehensive and compassionate care in the community and takes treatment of its patients – and their privacy – seriously. In conveying the concerns to us, the Revdex.com has stated “Please understand that the consumer’s complaint and your response may be publicly posted on the Revdex.com website.” Both federal and state law prohibit us from disclosing confidential information about our patients without written authorization to do so, except under limited circumstances not present here. We received your fax of 1/9/17 which appears to be an authorization from the customer allowing disclosure of “medical, payment or insurance records related to the complaint I filed with Revdex.com so that Revdex.com may, at my request, may assist in the resolution of my complaint;” the next portion of the authorization is illegible; the top and bottom of the next paragraph/section appear to be cut off and we cannot read the whole thing. I conferred with my lawyer and, based on the cut off and other illegible portions, we are uncertain whether there are any limitations on what may be disclosed. In addition, HIPAA regulations require that an authorization must include an expiration date to be valid. There is a partially legible sentence that may relate to expiration of the authorization, but we cannot determine if it is scratched out or what it says in its entirety. Because our patient’s privacy is important to us, we are concerned that the authorization we have may not be valid, especially given that you have advised that our response may be publicly posted on the Revdex.com website. The authorization appears to address publication of some research data, but does not address publication of this response. We are committed to attempting to resolve the customer’s concerns and will attempt to address her concerns here without disclosing confidential information.The customer raised two primary issues in her February 27, 2017 communication. First, the customer repeated previous allegations that we overbilled her insurance company and were overpaid for treatments. We expressly and adamantly deny doing so. Acupuncture & Natural Herbs, Inc. has a contract with the customer’s insurance company that has been in effect since 2009. Rates paid by that insurance company for all services we perform are set in the contract. All payments we received were in accordance with the contract. It should be noted that our records indicate that we have not received payment for some dates of service. We have learned in our investigation of the complaint that the insurer believes it has made payment for some of those dates. We will address that issue with the insurer.  Two of the dates are included on the invoice that the customer submitted to the Revdex.com on February 27. We have already submitted a revised invoice to the customer deleting those two charges. The customer’s second concern was that we had billed the insurance company for a service she does not recall receiving. Our records indicate that the service she claims not to have received was provided on three different occasions. We will show those records to the customer if she would like to see them. The records we have from the insurance company regarding payment for that specific service differ from the ones she provided to the Revdex.com. For one date, she provided a document that shows the specific service listed three separate times, once for twice the cost of the other two. The document we have from the insurer for the same date shows the service listed one time, at the lower cost, and that the insurer did not pay us for the service. Due to the federal and state privacy laws mentioned at the beginning of the response, we cannot provide a copy of what we have from the insurer to the Revdex.com at this time, because it contains confidential information, but we would be happy to show the customer. If you can provide us with a legible valid authorization from the customer authorizing release of the insurance records to the Revdex.com, we will provide you with a copy. Similarly, if we have a valid authorization from the patient authorizing release to Revdex.com of the portions of the medical records in which the service was documented, we will provide copies of those records. We are sorry that the customer is dissatisfied. As best we can determine, there may have been a misunderstanding about the difference in rates for patients who pay for their treatment themselves and patients who have insurance coverage that we must bill. We offer flat fee rates for various services to patients who pay out-of-pocket, in part because we do not incur administrative costs associated with billing insurance and because there is no delay in payment. There is a minimum flat fee that was quoted to the customer when she called to ask about fees before she had seen a provider or received any services. Actual fees are dependent on actual services provided, for all clients, and cannot be determined until the provider evaluates the patient and determines what services are necessary. Once services are provided, when a patient has insurance, we are contractually obligated to bill the insurance companies in accordance with our contracts with those companies. We did so in this case. In summary, we charged the customer’s insurance company for services provided to her and did so appropriately and in accordance with our contract with that insurer. We apologize for any misunderstanding about the differences between self-pay and insurance rates. We are willing to discuss the matter in more detail with the customer or, with valid written authorization from the customer, with Revdex.com.