Advanced Pain Management, S.C.

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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,
Amanda [redacted]

After a thorough review and complete audit of the account we agree that there was confusion regarding the place of service for the procedure presented to the patient.   Due to the confusion regarding this encounter a onetime full refund will be granted to this account and all applicable...

payers will be contacted. We sincerely apologize for the misunderstanding caused during this encounter and the time spent by this patient in attempting resolution.

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 issue. It 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 control. We will work with them to the best of our ability.

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID [redacted], and have received a refund check from APM. I appreciate their apology and acknowledgment of the communication problems. I 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 refunds. In 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 error. Refunds 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]

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Better Business...

Bureau:
I have reviewed the response made by the business in reference to complaint ID [redacted], and find that this resolution is satisfactory to me.  They called me antd stated that a refund will be sent to me in the mail. If this does not happen within two weeks I will contact you again and other resources.
Regards,
[redacted]

After a complete review of all charges, co-pays and co-insurance amounts it was discovered that the patient has a $0.00 balance on the Advanced Pain Management account and an $8.00 balance on the Pain Centers of Wisconsin-Kenosha (PCW-K) account. There is a $3.00 co-pay for visits to PCW-K and the...

patient paid $1.00 at the 1/25/16 visit. $3.00 co-pay for the 2/7/16 and 2/22/16 visits were not paid at time of service leaving an $8.00 balance.We could not find any services that were charged for but not provided.Advanced Pain Management and Pain Centers of WI-Kenosha apologize for any confusion caused by the statements sent to the patient. Below are the results from an audit completed on the accountThe patient is being billed for 2016 dates of service for Pain Centers of WI Kenosha (PCW-K) Current balance is $8.00The patient did make a $9 payment to Advanced Pain Management (APM) on 3/28/16.  $3 was applied to date of service 2/8/16.$6 was applied to date of service 9/2/15 and later moved to date of service 10/19/15.There is not a date of service 9/15/15 as noted in the patient complaint.The patient is responsible for Medicaid copay’s on both APM and PCWK.The patient statement dated 12/13/15 in NextGen shows a balance of $9.00. This is for $3 Medicaid copays from dates of service 9/2/15, 9/8/15 and 9/21/15.On patient check #1563 for $18.00, the patient has written in the memo “for 9/2, 9/8, 9/21, 10/5, 10/19, 10/26”.Medicaid did not process the October dates of service until 2016.  It looks like the patient was anticipating her copays on the October dates of service were going to be $3.00 each.Dates of service 10/5 and 10/19 had a co-pay of $9.00 each and 10/26 did not have a copay. (Copay amounts are based on the type of service)

[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]

Revdex.com Case #  [redacted]
replyAdvanced Pain Management has done a thorough review of all
the issues Ms. [redacted] raises. First I would like to apologize for all the
calls and communication problems Ms. [redacted] encountered; that is not how APM
wishes our patients to be treated. APM has...

reprocessed all claims and have adjusted all the
accounts mentioned in the complaint. After receiving confirmation from the
numerous carriers and their representatives, which took an inordinate amount of
time, APM has processed the refund of $5,247.10. This was the refund amount
left after all the co-pays and co-insurance obligations, according to the
insurance carrier’s contracts, were met.This check was sent to Ms. [redacted] the week of October 12,
2015. Please accept APM’s deepest apologies for this problem.

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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]  I have no other choice other than to accept. MAPS put the blame on U-Care and U-Care puts the blame on MAPS! (Just can't win sometimes) Thank you to Wisconsin Revdex.com for their help in this matter.

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 6/2/2015 date of service, our primary insurance sent us an EOB on 2/11/2016 and stated they paid nothing.  Your billing department should have billed our secondary insurance in February 2016 (WPS) and Brian from your billing department submitted this claim to WPS on 6/16/2016.  Why did this get submitted 4 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 6/30/2016.  If this would have been submitted to WPS timely, they would have paid claim. On the 7/7/2016 date of service, our primary insurance sent us an EOB on 11/9/2015 and stated they paid nothing.  The same process should of happened.  Your billing department should have submitted this claim in November 2015 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]

We apologize for the extreme length of time this whole audit took. MAPS billing did an in-depth review of all 6 claims, the result of that investigative audit revealed that UCare claims were not processed accurately according to the terms of the UCare contact with MAPS. MAPS billing contacted UCare...

explained the errors that were found and requested that all 6 claims be reprocessed as they were not done consistently. U Care verified that the patient benefits had changed in 2014 but refused to reprocess the claims. If they would have reprocessed the claims the patient would have been responsible for those other three $100.00 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 due. UCare also said it was contacting the patient to explain their error. In regard to the employees mentioned in the complaint, neither employee is now employed by MAPS and we apologize for the confusion and dropped calls.

Business states they have requested approximately 7 times that the collection agency contact trans union. Another urgent request was made yesterday. They hope to hear back soon.

[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 received services at Waukesha Pain Center on three occasions.   On March 27, 2014, January 27, 2015 and January 20, 2016 the patient signed and dated the Patient Financial Statement of Information. That document clearly states it is the patient’s responsibility to verify with...

their insurance carrier the facilities in network or out of network designation. The document also states:     You may receive multiple bills for our services. If you are having a procedure at one of our Ambulatory Surgery Centers, you will receive one (1) bill for the physician (professional) services and one (1) bill for the Ambulatory Surgery Center (facility) fees. Your benefits for each of these may be different, so please check with your insurance carrier to understand your benefits. Patient payments can be applied to outstanding balances for professional services or for the facility fees, as determined by the organization.   The patient did not pay any portion of her patient responsibility for these dates of service, thus they were applied to bad debt on 1/9/2015 and sent to our collections agency.    Due to concerns raised by this patient, the balance was pulled out of bad debt on 9/6/16 for further review.   At this time the patient is responsible for the balance of $1420.38.   In the patient complaint she raised concern regarding payments being applied to bad debt.   At this time the organization does apply payments to outstanding bad debt.    Another concern raised by the patient is her co pay amount.  The patient’s insurance card states that copays for specialists are $60.00.   Typically, our organization is considered a specialist and that is the amount that front desk staff are trained to collect.   Upon review of this payer’s contract and discussion with a payer representative, the specialist copay should only be applied if the patient is seen by a physician.   When services are provided by an advanced practice provider (NP or PA) the $40 copay applies.  We apologize for this misinterpretation on our part. An alert has been placed in the patient record to indicate this.  The additional $20 that was paid on each date of service has been applied to coinsurance balances that were patient responsibility.   Thus,   no refund is indicated.  The $56.18 that the patient paid twice has been applied to the March 23, 2016 visit.   It was not applied to a 2015 date of service as one billing representative informed her.  We apologize for any misunderstandings the patient may have had with the complex nature of insurance billing.

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.
Please reopen this complaint. I am currently still working with the vendor for resolution. The improper negative items have been removed but my credit score has not recovered from the impact. We need to contact transunion to determine if it will recover from the incorrect items. We continue to see unexplainable bills from the company and are trying to get clarification. 
Regards,
[redacted]

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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.  I have made arrangements to pay this. variability for the dr. visit itself was in excess of $143. this is erroneous.
Regards,
Lisa [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.]
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]

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.

This will resolve my complaint if APM adjusts my account to show the $7 credit, instead of the $4 credit they now show. I have not heard anything back from APM that they have adjusted this, yet. Thanks

APM has started a complete audit of the account. Should there  be a refund due it will be processed per procedure.