We apologize for the extreme length of time this whole audit tookMAPS billing did an in-depth review of all claims, the result of that investigative audit revealed that UCare claims were not processed accurately according to the terms of the UCare contact with MAPSMAPS billing contacted UCare explained the errors that were found and requested that all claims be reprocessed as they were not done consistentlyU Care verified that the patient benefits had changed in but refused to reprocess the claimsIf they would have reprocessed the claims the patient would have been responsible for those other three $co-pay amounts, per the contract with UCare, because they refused the patient has a zero balance, as the co-pays were never collected no refund is dueUCare also said it was contacting the patient to explain their errorIn regard to the employees mentioned in the complaint, neither employee is now employed by MAPS and we apologize for the confusion and dropped calls
Revdex.com: I have reviewed the response made by the business in reference to complaint ID [redacted] , and have received a refund check from APMI appreciate their apology and acknowledgment of the communication problemsI hope that management at APM will review their policies regarding refund of patient overpayments so that in the future other patients do not have the same negative experience of a 9+ month delay in processing and issuing refundsIn situations such as mine, where there was no question of insurance coverage and where APM was solely responsible for delays in timely claims filing, the patient should not be penalized for APM's errorRefunds should be issued promptly when it is determined that payment was collected for covered services and insurance coverage was fully in force.Thank you for your assistance in resolving my complaint Regards, [redacted]
The contested charges for Date of service 6/2/were electronically sent to the primary insurance carrier on separate occasions in and June, August, October and JanuaryEach time the carrier denied receiving the charges so they were resubmittedWe cannot send to the secondary carrier until the primary insurance processes the claim After the four attempts of submission to your primary insurance it has finally be processed and thus it has been submitted to the secondary insuranceThe secondary payer originally denied and is currently in appeal with this carrier For the July 7, date of service a similar situation occurred This claim also is still out with the secondary payer, Auxiant We are holding all billings to the patient until all appeals are exhausted At this time there is no patient responsibility until the secondary insurances complete processing their claims We apologize for this delay which was caused by the processing timeline of the primary insurance With regard to the address for patients concerns, please address all concerns to our corporate office: Advanced Pain Management W Loomis Road Suite Greenfield, WI Attention: Compliance Department
Revdex.com: I have reviewed the response made by the business in reference to complaint ID [redacted] , and have determined that this does not resolve my complaint For your reference, details of the offer I reviewed appear below.Medicaid is not at fault for APM not being billed until APM was billing incorrectlyAlso, according to Medicaid, my copay to PCW, for 2015, is $I can't be billed for copays, that PCW was not allowed to bill for in Please contact [redacted] at Forward Health to correct this1-608-421-My payment on 3/28/was meant to go to PCW, but I was told that the office was not allowed to put payments towards PCW, they could only put it towards APM and APM would transfer the money to PCW, which was obviously not doneI spoke to billing on 5/17/16, and was told I had a credit of $on APM and that they would transfer it to PCWBut, I was then told by someone else that they probably wouldn't transfer it, and to make a payment to PCW, even though I don't owe them anything, because it won't get fixedI am not paying money I do not owe, because APM will not correct my billAlso, why is $of my payment made on 3/28/going to APM service dates of 9/2/and 10/19/when I paid those dates on check #1563? My copay for APM can't be more than $according to Forward HealthMy payments this year have been APM $on 1/18/16, 1/25/16, 3/28/16, 4/19/16, 5/10/16, and $on 2/22/I paid $on 3/28/that was supposed to go to PCWI also paid Access $on 4/19/and 5/10/Where are all these payments going, that I somehow still owe money from service dates?I spoke to [redacted] from Forward Health on 12/20/to find out what I owed for copays for [redacted] listed my copays as:9/2/$for APM, $for PCW ($paid on check #1563)9/8/$for APM, $for Access ($paid to APM on check #1563, $paid to Access on check #1562)9/21/$for APM, $for PCW ($paid to APM on check #1563)10/5/APM insurance payment denied because of billing issues, $for PCW ($paid to APM on check #1563)10/19/APM insurance payment denied because of billing issues, $for PCW ($paid to APM on check #1563)10/26/APM insurance payment denied because of billing issues, $for PCW ($paid to APM on check #1563)I left a message for [redacted] on 5/17/16, to go through my copays for Regards, [redacted]
[redacted] was owed $for service provided 9/8/2015, this transaction occurred 10/30/$was owwed to [redacted] for service provided on 7/29/2015, this transaction occurred 9/22/
Revdex.com: I have reviewed the response made by the business in reference to complaint ID [redacted] , and have determined that this does not resolve my complaint For your reference, details of the offer I reviewed appear below On the 6/2/date of service, our primary insurance sent us an EOB on 2/11/and stated they paid nothing Your billing department should have billed our secondary insurance in February (WPS) and Brian from your billing department submitted this claim to WPS on 6/16/ Why did this get submitted months after our primary insurance paid nothing? WPS declined the claim because of untimely billing My wifes employer and WPS had a contract to pay any claims until 6/30/ If this would have been submitted to WPS timely, they would have paid claimOn the 7/7/date of service, our primary insurance sent us an EOB on 11/9/and stated they paid nothing The same process should of happened Your billing department should have submitted this claim in November to Auxiant.It is not my fault that these claims have not been paid by my secondary insurance companies (WPS & Auxiant) Your billing department is incompentent to bill the insurance companies on a timely basis I refuse to pay these claims Your billing department needs to be accountable for their actions Regards, [redacted]
This will resolve my complaint if APM adjusts my account to show the $credit, instead of the $credit they now showI have not heard anything back from APM that they have adjusted this, yetThanks
As stated in the previous response, these claims are currently with the secondary insurance carrier We apologize regarding the length of time that this claim has taken to process If the secondary insurances deny paying for these dates of service, APM will cancel all charges and ensure that there is no balance incurred to the patient because of this delayed process We apologize for this misunderstanding
[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.] 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] ***
The patient was seen in our Burlington office and at that visit was scheduled for a urine drug screen per policyThe patient signed the release that clearly stated responsibility is the patients should insurance not cover the expenseThe CDC Guidelines call for routine unscheduled urine samples to verify compliance with the medication regime the patient is currently onUnfortunately the patients insurance does not cover that particular testSpecific examinations and evaluations carry different coding and charge amountsWe have audited all charges for the visits in question and find the coding and charging to be correct
As mentioned in our previous response, all office visits were audited and charges were correct for the services rendered At times different services and assessments are completed at an office visit which can result in charge variability from one visit to the next In addition, at one visit a urine drug test was performed which currently is not being paid for by Ms [redacted] ’s insurance We have alerted Ms [redacted] ’s insurance carrier of the issueIt is our hope that Ms [redacted] ’s carrier comes to an equitable resolution quickly However, the carrier’s process for review is outside of our controlWe will work with them to the best of our ability
We apologize for the extreme length of time this whole audit tookMAPS billing did an in-depth review of all claims, the result of that investigative audit revealed that UCare claims were not processed accurately according to the terms of the UCare contact with MAPSMAPS billing contacted UCare explained the errors that were found and requested that all claims be reprocessed as they were not done consistentlyU Care verified that the patient benefits had changed in but refused to reprocess the claimsIf they would have reprocessed the claims the patient would have been responsible for those other three $co-pay amounts, per the contract with UCare, because they refused the patient has a zero balance, as the co-pays were never collected no refund is dueUCare also said it was contacting the patient to explain their errorIn regard to the employees mentioned in the complaint, neither employee is now employed by MAPS and we apologize for the confusion and dropped calls
Revdex.com: I have reviewed the response made by the business in reference to complaint ID [redacted] , and have received a refund check from APMI appreciate their apology and acknowledgment of the communication problemsI hope that management at APM will review their policies regarding refund of patient overpayments so that in the future other patients do not have the same negative experience of a 9+ month delay in processing and issuing refundsIn situations such as mine, where there was no question of insurance coverage and where APM was solely responsible for delays in timely claims filing, the patient should not be penalized for APM's errorRefunds should be issued promptly when it is determined that payment was collected for covered services and insurance coverage was fully in force.Thank you for your assistance in resolving my complaint Regards, [redacted]
The contested charges for Date of service 6/2/were electronically sent to the primary insurance carrier on separate occasions in and June, August, October and JanuaryEach time the carrier denied receiving the charges so they were resubmittedWe cannot send to the secondary carrier until the primary insurance processes the claim After the four attempts of submission to your primary insurance it has finally be processed and thus it has been submitted to the secondary insuranceThe secondary payer originally denied and is currently in appeal with this carrier For the July 7, date of service a similar situation occurred This claim also is still out with the secondary payer, Auxiant We are holding all billings to the patient until all appeals are exhausted At this time there is no patient responsibility until the secondary insurances complete processing their claims We apologize for this delay which was caused by the processing timeline of the primary insurance With regard to the address for patients concerns, please address all concerns to our corporate office: Advanced Pain Management W Loomis Road Suite Greenfield, WI Attention: Compliance Department
Revdex.com: I have reviewed the response made by the business in reference to complaint ID [redacted] , and have determined that this does not resolve my complaint For your reference, details of the offer I reviewed appear below.Medicaid is not at fault for APM not being billed until APM was billing incorrectlyAlso, according to Medicaid, my copay to PCW, for 2015, is $I can't be billed for copays, that PCW was not allowed to bill for in Please contact [redacted] at Forward Health to correct this1-608-421-My payment on 3/28/was meant to go to PCW, but I was told that the office was not allowed to put payments towards PCW, they could only put it towards APM and APM would transfer the money to PCW, which was obviously not doneI spoke to billing on 5/17/16, and was told I had a credit of $on APM and that they would transfer it to PCWBut, I was then told by someone else that they probably wouldn't transfer it, and to make a payment to PCW, even though I don't owe them anything, because it won't get fixedI am not paying money I do not owe, because APM will not correct my billAlso, why is $of my payment made on 3/28/going to APM service dates of 9/2/and 10/19/when I paid those dates on check #1563? My copay for APM can't be more than $according to Forward HealthMy payments this year have been APM $on 1/18/16, 1/25/16, 3/28/16, 4/19/16, 5/10/16, and $on 2/22/I paid $on 3/28/that was supposed to go to PCWI also paid Access $on 4/19/and 5/10/Where are all these payments going, that I somehow still owe money from service dates?I spoke to [redacted] from Forward Health on 12/20/to find out what I owed for copays for [redacted] listed my copays as:9/2/$for APM, $for PCW ($paid on check #1563)9/8/$for APM, $for Access ($paid to APM on check #1563, $paid to Access on check #1562)9/21/$for APM, $for PCW ($paid to APM on check #1563)10/5/APM insurance payment denied because of billing issues, $for PCW ($paid to APM on check #1563)10/19/APM insurance payment denied because of billing issues, $for PCW ($paid to APM on check #1563)10/26/APM insurance payment denied because of billing issues, $for PCW ($paid to APM on check #1563)I left a message for [redacted] on 5/17/16, to go through my copays for Regards, [redacted]
[redacted] was owed $for service provided 9/8/2015, this transaction occurred 10/30/$was owwed to [redacted] for service provided on 7/29/2015, this transaction occurred 9/22/
Revdex.com: I have reviewed the response made by the business in reference to complaint ID [redacted] , and have determined that this does not resolve my complaint For your reference, details of the offer I reviewed appear below On the 6/2/date of service, our primary insurance sent us an EOB on 2/11/and stated they paid nothing Your billing department should have billed our secondary insurance in February (WPS) and Brian from your billing department submitted this claim to WPS on 6/16/ Why did this get submitted months after our primary insurance paid nothing? WPS declined the claim because of untimely billing My wifes employer and WPS had a contract to pay any claims until 6/30/ If this would have been submitted to WPS timely, they would have paid claimOn the 7/7/date of service, our primary insurance sent us an EOB on 11/9/and stated they paid nothing The same process should of happened Your billing department should have submitted this claim in November to Auxiant.It is not my fault that these claims have not been paid by my secondary insurance companies (WPS & Auxiant) Your billing department is incompentent to bill the insurance companies on a timely basis I refuse to pay these claims Your billing department needs to be accountable for their actions Regards, [redacted]
This will resolve my complaint if APM adjusts my account to show the $credit, instead of the $credit they now showI have not heard anything back from APM that they have adjusted this, yetThanks
As stated in the previous response, these claims are currently with the secondary insurance carrier We apologize regarding the length of time that this claim has taken to process If the secondary insurances deny paying for these dates of service, APM will cancel all charges and ensure that there is no balance incurred to the patient because of this delayed process We apologize for this misunderstanding
[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.] 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] ***
The patient was seen in our Burlington office and at that visit was scheduled for a urine drug screen per policyThe patient signed the release that clearly stated responsibility is the patients should insurance not cover the expenseThe CDC Guidelines call for routine unscheduled urine samples to verify compliance with the medication regime the patient is currently onUnfortunately the patients insurance does not cover that particular testSpecific examinations and evaluations carry different coding and charge amountsWe have audited all charges for the visits in question and find the coding and charging to be correct
As mentioned in our previous response, all office visits were audited and charges were correct for the services rendered At times different services and assessments are completed at an office visit which can result in charge variability from one visit to the next In addition, at one visit a urine drug test was performed which currently is not being paid for by Ms [redacted] ’s insurance We have alerted Ms [redacted] ’s insurance carrier of the issueIt is our hope that Ms [redacted] ’s carrier comes to an equitable resolution quickly However, the carrier’s process for review is outside of our controlWe will work with them to the best of our ability