Albert Einstein Healthcare Network

From: [redacted] < [redacted] >Date: Mon, Jun 1, at 4:PMSubject: ID# [redacted] To: [redacted] Hi [redacted] , I was unable to locate the attached patient in our systemCan you please obtain additional information from the patient, so I can investigate the account accordingly? Patient's name on the account Date of Birth Address Possible account# Date of Service If you need additional information, please let me know Thank you, [redacted] Billing SupervisorEinstein Practice Plan, Inc.Phone ###-###-#### XFax ###-###-####

August 25, 2016To Whom It May Concern,Thank you for reaching out to Einstein Healthcare Network so we may satisfy any questions or concerns [redacted] s father hasAll of [redacted] 's account information is listed above[redacted] stated that he believes that there should not be two co-pays because the x-ray was done in the same clinic, the same building on the same date by DrB [redacted] , all of that is accurate.I am glad to report to the Revdex.com that the patient, [redacted] has good insurance with [redacted] ***, and per the contract that Einstein Healthcare Network has with [redacted] we are permitted to charge two co-pays, one for the physician's cost of reading the x-ray and having a consultation with the patient after the x-ray was completed to discuss the results, and the second co-pay is due to the fact that the x-ray was taken in a hospital/clinic setting and not in a doctor's officeBoth of these charges are in keeping within the confines of the contract, as said earlier, and the insurance commissionerBecause of the excellent insurance coverage the patient has, the following charges were written off without any cost to [redacted] :Invoice [redacted] -- MR -date of services 6/28/- total charge $ 273,00- the physician had to write off this charge due to the hospital contract agreement with [redacted] iInvoice [redacted] - 4X-Rays of the Knee of service 6/23/16- total charge $84,00-physician again had to write this off per our contract Invoice [redacted] - US Extrmity Non Vasc- date of service 6/6/16-total charge $56.00-physician had to write this off per our contractThis is a total of $that the physicians had to write off at no cost to the patient,It is important to point out that the doctor did not count the visits as two visits, all billing is documented correctly and accuratelyThere are just two separate co-pays, one for the hospital, because of the use of the equipment like the x-ray machine, and the other is the co-pay for the physician who read the X-rays and met with the patient and her family.I have attached a copy of the EOB's (Explanation of Benefits) for the physician and the hospital showing the charge of two separate co-pays is correct.I hope this answers all of [redacted] 's questionsI realize that healthcare is very confusing anymore and It is getting harder and harder for the patients to understand who pays what and what their cost will be, if [redacted] has any further questions, please ask him to give me a call and I will be happy to answer any questions he has.Thank you for your time and concern.Sincerely,Chris SManager of Customer Service

From: Katrina B [redacted] < [redacted] @einstein.edu>Date: Fri, Feb 10, at 9:AMSubject: REF# [redacted] To: " [redacted] @myRevdex.com.org" < [redacted] @myRevdex.com.org>Cc: [redacted] < [redacted] @einstein.edu>Hi [redacted] ,I received your letter regarding [redacted] ***'s complaintHowever, there was no children information listed in this letterDue to the lack of information provided, I was unable to review the account/sWhen you get a chance, can you please contact [redacted] and provide me with his children information, so I can proceed in the investigation? If you have any questions, please feel free contact me.Thank you,Katrina B [redacted] Customer Service SupervisorEinstein Medical CenterPhone ###-###-####Fax ###-###-####

Thank you for taking the time to contact Einstein Medical Center regarding the above account.Einstein fully investigated the patient's account and realized that [redacted] Health Plan East processed the claims as a Specialist visit, instead of a Primary care visitUpon our investigation, we placed each of the following date of services on hold to be reviewed and reprocessed by the insurance company[redacted] 06/27/ [redacted] 05/10/ [redacted] 03/16/ [redacted] 02/03/ [redacted] 02/01/We also received and posted the patient's $payments that were paid time of serviceHowever, the patient paid an additional $10,more for date of Service 02/01/& 02/03/16, which resulted in a $credit.To finalize the account, we set up a refund in the amount of $The patient should receive a refund check in the mail within 4-weeks of the refund request date.If you have any questions, please feel free to contact meSincerely, Katrina B [redacted] Billing Supervisor

Dear [redacted] Thank you for taking the time to contact Einstein regarding the issues that occurred with this accountEinstein thoroughly investigated the above account and contacted [redacted] to verify chargesWe were informed the correct procedure codes were billed for the services rendered on that date of serviceWe then placed the account on hold for further investigation purposes with the insurance companyWe discovered [redacted] originally processed the claim incorrectly leaving the patient responsible for the well-baby visit (procedure ***)The account was later paid correctly by [redacted] , which resulted in a zero patient responsibilityWe apologize for the inconvenienceAttached is a copy of the patient's bill, showing a zero balance due, along with the original & corrected Explanation of Benefits received from [redacted] .If you have any questions, please feel free to contact meSincerely, Katrina B [redacted] Billing Supervisor Einstein Practice Plan, Inc

Thank you for taking the time to contact Einstein Medical Center regarding the above accountEinstein fully investigated the patient's account, According to the notes in our system, Ms [redacted] called our pre-collect/self-pay vendor (extension of Einstein), at ###-###-#### several times and spoke to a live person• On 3/2/15, Ms [redacted] stated she mailed in a credit card payment in February At that time, she was informed the payment was never posted to her account, because it was never receivedThe account was then placed on a two week hold, waiting for payment• On 3/31/15, Ms, [redacted] called back for a status and was informed the payment was never received, Ms [redacted] was requested to contact her credit card company to see if the payment was deducted from her account, Ms, [redacted] stated she didn’t feel as if she needed to do soUnfortunately, Einstein was not given the proper documentation to review the patient's paymentEinstein can only research missing payments, if the money was deducted from the patient’s account and if we were provided proof of deduction (such as bank statement or canceled check), In this event, the patient did not contact her credit card company to confirm the payment was deductedBased on the above information provided in this letter, the patient continued to receive a bill for $750,00, which her insurance company stated she is responsible for a co-pay amountThe patient recently made a payment of $750.00, which was posted to her account on 6/15/As of that date, the patient is no longer receiving a bill, nor is she due a refund.If you have any questions, please feel free to contact me.Sincerely, Katrina B [redacted] Billing Supervisor Einstein Practice Plan, Inc

Hi [redacted] , Please advise dad that the patient was seen for a hearing problem, which was billedHowever, the procedure and the diagnostic code needs to correspond with each other in order for the claim to be paid by the insurance companyIn this particular case, the procedure code did not point to the right diagnostic code, which resulted in a claim denialI was informed by the Practice Manager, Anita S [redacted] , that we need to link procedure code *** to diagnostic code [redacted] , which was not done in the beginning.We that said, the corrections were made and re-submitted back to the insurance company for paymentUnfortunately, it can take up to six weeks for Einstein to receive a response from the insurance companyI will follow up on this account periodically to make sure the claim is paid.If the patient has any other questions or concerns regarding this issue, dad may feel free to contact me directly at ###-###-####.Thank you, Katrina B [redacted] Customer Service Supervisor Einstein Medical Center Phone ###-###-#### Fax ###-###-####

Hi [redacted] , I received this same request from [redacted] at the Office of Attorney General, HCS# [redacted] However, I just faxed over my response almost an hour ago to themPlease see the following result which is the same letter I sent to the Office of Attorney General RE: [redacted] ***(Mrn# [redacted] , INV# [redacted] ), DOS 1/18/Thank you for taking the time to contact Einstein Medical Center regarding the above patient I’ve thoroughly investigated the patient’s account and according to our system, the patient’s secondary insurance “ [redacted] ***” was never billed for this particular date of service until 2/1/Our vendor, “ [redacted] /***”, has mailed several statements to the patient’s address on file, but didn’t receive a response from the patient’s guarantor until October 30thAfter reviewing this account with ***, I was informed that no one billed the patient’s secondary insurance due to our timely filing restrictionsEinstein has several ways of handling timely filing accounts based on a particular insurance carrier, which [redacted] was not aware of until todayAs of today, [redacted] has been made aware of how to handle this type of scenario moving forwardTo conclude with this account, based on my findings and expertise, I was able to make the necessary adjustments on the account resulting in a zero patient responsibilityPlease note that we no longer report our accounts to the Credit Bureau’s, so this will not have a negative impact on the patient’s credit Shall you or the [redacted] ***(guarantor) have any questions or concerns, please feel free to contact me Sincerely, Katrina B [redacted] Customer Service Einstein Medical Center P# ###-###-#### F# ###-###-####

[To assist us in bringing this matter to a close, you must give us a reason why you are rejecting the responseIf no reason is received your complaint will be closed Administratively Resolved]
Complaint: ***
I am rejecting this response because: I want to escalate this complaint, because I feel that the service that was supposed to be provided, was not providedI feel that the process from beginning to end was misrepresented
Regards,
*** ***

November 5, 2015To Whom it May Concern:Customer has agreed to pay $adjusted the customer's bill to reflect what he has agreed to payCustomer will receive a new bill showing $553.00.DrE*** sent report to customer as requested.Any questions please feel free to contact me at
###-###-####.SincerelyEthel L., Manager *** Rehab Billing

[To assist us in bringing this matter to a close, you must give us a reason why you are rejecting the responseIf no reason is received your complaint will be closed Administratively Resolved]
Complaint: ***
I am rejecting this response because:The business requested more information; who do I supply that to? The Revdex.com message said not to reply; am I supposed to contact the company I complained about directly? Or do I give it to the Revdex.com? How?
If Revdex.com is supposed to provide the follow up info to the company, I was a patient there under *** Caton (my maiden name) and DOB 9/6/77, and it was a patient stay from 12/10/14- 12/13/14
Regards,
*** ***

--------- Forwarded message ----------
sans-serif;">From: Katrina B***Date: Fri, Feb 19, at 3:PMSubject: ref*To: ***@myRevdex.com.org
Hi ***,
Thank you for taking the time to contact Einstein Medical Center regarding the following account
I would like to inform you that the patient's refund was successfully completed. Check#*** was mailed to the patient on 2/18/
*** *** *** -----Revdex.com reference #***
I would greatly appreciate if you can respond back to this email confirming you received it
If you have any questions, please feel free to contact me
Thank you,
Katrina B***
Billing SupervisorEinstein Practice Plan, Inc.Phone ###-###-#### X***
Fax ###-###-####

[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 ***, and find that this resolution is satisfactory to me.
Regards,
*** ***

Hi ***, Thank you for contacting Einstein Medical Center regarding the following account.I reviewed the patient's account and released a previous date of service was billed with the same procedure code and was paid by the patient's *** insuranceAs of now, I have no idea why the insurance
company did not pay the claim at 100%In the meantime, I placed the invoice on hold to avoid phone calls and correspondences until the issue is resolvedI also requested someone to contact the insurance company to review the claim with the insurance companyAs soon as I hear back, I will update you on this account. ***,*** MRN: *** Invoice #: *** Date of Service: 1/6/17If you have any questions, please feel free to contact me.Thank you,Katrina B*** Customer Service Supervisor***

Hi [redacted], I received this same request from [redacted] at the Office of Attorney General, HCS#[redacted]. However, I just faxed over my response almost an hour ago to them. Please see the following result which is the same letter I sent to the Office of Attorney...

General.              RE: [redacted](Mrn#[redacted], INV#[redacted]), DOS 1/18/2017 Thank you for taking the time to contact Einstein Medical Center regarding the above patient.  I’ve thoroughly investigated the patient’s account and according to our system, the patient’s secondary insurance “[redacted]” was never billed for this particular date of service until 2/1/18. Our vendor, “[redacted]”, has mailed several statements to the patient’s address on file, but didn’t receive a response from the patient’s guarantor until October 30th. After reviewing this account with [redacted], I was informed that no one billed the patient’s secondary insurance due to our timely filing restrictions. Einstein has several ways of handling timely filing accounts based on a particular insurance carrier, which [redacted] was not aware of until today. As of today, [redacted] has been made aware of how to handle this type of scenario moving forward. To conclude with this account, based on my findings and expertise, I was able to make the necessary adjustments on the account resulting in a zero patient responsibility. Please note that we no longer report our accounts to the Credit Bureau’s, so this will not have a negative impact on the patient’s credit.  Shall you or the [redacted](guarantor) have any questions or concerns, please feel free to contact me.             Sincerely,              Katrina B[redacted]            Customer Service             Einstein Medical Center.             P# ###-###-####            F# ###-###-####

[To assist us in bringing this matter to a close, you must give us a reason why you are rejecting the response. If no reason is received your complaint will be closed as Answered]
 Complaint: [redacted]
I am rejecting this response because:
The healthcare provider did not accept their mistake. Let me try to explain it in a very simple way and I hope they understand. My insurance, [redacted], covers annual check-up one time per calendar year. The hearing test and the vision test are included in the annual check-up. The office should have submitted the claim under the routine code because the visit on October 4, 2016 was an annual check-up. The same patient ([redacted]) had a sick visit to the same office ([redacted]) on February 1, 2017 for hearing problem. I paid a copay of $30 for that sick visit. Instead of submitting the claim under the diagnostic code, the office submitted the claim under the routine code. I called my insurance and my insurance told me that the office submitted the wrong code.  If my child comes to the office on a sick visit for hearing problem then the office should submit the claim under the diagnostic code. The copay for the sick visit is $30 and the copay for the annual check-up is $0. There is no way that I should be billed for over $30. To summarize it, the office visit on October 4, 2016 was an annual check-up and the routine code should be used while the office visit on February 1, 2017 was a sick visit and the diagnostic code should be used.
Regards,
[redacted]

From: Katrina B[redacted]<[redacted]@einstein.edu>Date: Fri, Feb 10, 2017 at 9:07 AMSubject: REF#[redacted]To: "[redacted]@myRevdex.com.org" <[redacted]@myRevdex.com.org>Cc: [redacted] <[redacted]@einstein.edu>Hi [redacted],I received your letter regarding [redacted]'s complaint. However, there was no...

children information listed in this letter. Due to the lack of information provided, I was unable to review the account/s. When you get a chance, can you please contact [redacted] and provide me with his children information, so I can proceed in the investigation? If you have any questions, please feel free contact me.Thank you,Katrina B[redacted]Customer Service SupervisorEinstein Medical CenterPhone ###-###-####Fax ###-###-####

Thank you for taking the time to contact Einstein Medical Center regarding the above account.Einstein fully investigated the patient's account and realized that [redacted] Health Plan East processed the claims as a Specialist visit, instead of a Primary care visit. Upon our investigation, we placed...

each of the following date of services on hold to be reviewed and reprocessed by the insurance company.[redacted] 06/27/16 [redacted] 05/10/16 [redacted] 03/16/16 [redacted] 02/03/16 [redacted] 02/01/16We also received and posted the patient's $10.00 payments that were paid time of service. However, the patient paid an additional $10,00 more for date of Service 02/01/16 & 02/03/16, which resulted in a $20.00 credit.To finalize the account, we set up a refund in the amount of $20.00. The patient should receive a refund check in the mail within 4-6 weeks of the refund request date.If you have any questions, please feel free to contact me.Sincerely,Katrina B[redacted] Billing Supervisor

Thank you for taking the time to contact Einstein Medical Center regarding the above account.Einstein fully investigated the patient's account and realized that [redacted] Health Plan East processed the claims as a Specialist visit, instead of a Primary care visit. Upon our...

investigation, we placed each of the following date of services on hold to be reviewed and reprocessed by the insurance company.[redacted] 06/27/16
[redacted] 05/10/16
[redacted] 03/16/16
[redacted] 02/03/16
[redacted] 02/01/16
We also received and posted the patient's $10.00 payments that were paid time of service. However, the patient paid an additional $10,00 more for date of Service 02/01/16 & 02/03/16, which resulted in a $20.00 credit.To finalize the account, we set up a refund in the amount of $20.00. The patient should receive a refund check in the mail within 4-6 weeks of the refund request date.If you have any questions, please feel free to contact me.
Sincerely,
Katrina B[redacted] Billing Supervisor

Dear [redacted]
Thank you for taking the time to contact Einstein regarding the issues that occurred with this account.
Einstein thoroughly investigated the above account and contacted [redacted] to verify charges. We were informed the correct procedure codes were...

billed for the services rendered on that date of service. We then placed the account on hold for further investigation purposes with the insurance company. We discovered [redacted] originally processed the claim incorrectly leaving the patient responsible for the well-baby visit (procedure [redacted]). The account was later paid correctly by [redacted], which resulted in a zero patient responsibility. We apologize for the inconvenience. Attached is a copy of the patient's bill, showing a zero balance due, along with the original & corrected Explanation of Benefits received from [redacted].If you have any questions, please feel free to contact me.
Sincerely,
Katrina B[redacted]
Billing Supervisor
Einstein Practice Plan, Inc.