Allergy Institute

Initial Business Response /* (1000, 8, 2015/08/07) */
Please consider this a response to your letter of 7/30/regarding a complaint identified by the above case numberThis complaint was related to medical treatment provided to a member of the complainant's family
Services were initiated in
March of and at that time billing was sent to the patient's primary insurance, which paid in full for the first few visitsStarting in April the patient's primary insurance was no longer covering the visits and procedures in fullThe patient's mother was informed by our billing department that we were having issues receiving payment from the primary insuranceThe patient's secondary insurance was then billedAt that time it was believed that the secondary insurance was MediCal, as that had been the.information provided by the referring physician, as well as on the card that had been presented at the time of the initial visitIt did take several billing cycles before MediCal notified our office that the patient did not have regular Medical, but did have Blue Cross MediCal, Our office is not contracted with BlueCross MediCal and so we were unable to bill them for the services providedStatements were sent out to the address given at the start of careThese statements did indicate the balance on the accountStatements were sent in July, August and September of 2014, as well as in March and April of We have notations regarding several telephone conversations with the patient's mother and father in our attempts to collect the balance on the accountWe have offered payment options but these have been declined by the complainant
As the complainant indicated he and his wife both signed our "Policies" indicating that they would be responsible if insurance did not cover the costs incurred
We would have been pleased to have an amicable solution to this issue, however, despite multiple attempts to reach a billing agreement with the complainant we felt compelled to turn this matter over to the Fresno Credit Bureau
We thank you for the opportunity to present our perspective on the issues involved and the complaint brought forthOur relationship with all of our patients is based on mutual trust and respect, although there are times such as this when discord arisesWe appreciate your efforts to evaluate both sides of the issue
Sincerely,
*** *** RN
Office Manager
Initial Consumer Rebuttal /* (3000, 10, 2015/08/14) */
(The consumer indicated he/she DID NOT accept the response from the business.)
Yes we signed your "Policies", but that was after receiving information from your office that you accepted our insuranceSigning the policy with the understanding that you accept our insurance is a much different story than signing it after receiving informationIt is your responsibility to know what insurance you accept and to accurately inform usAs your response indicated, your office believed you accepted our secondary insuranceHad we been correctly informed that you do not, we may have still signed the policy, however we would have known not to run up an out-of-pocket expenseWe qualified for Medical insurance because we are not in a position to pay such medical feesAfter being told that you accept our insurance we had the peace of mind to continue with the appointments
Also included in your "Policies" is this: "Co-pays are always due prior to your appointment." We were never asked to pay up front at any of the appointmentsHad we been, it would have clued us into the fact that we were incurring costsWhy were we not asked? I can only conclude that your office still believed it would collect these costs from insuranceSo did we
Your response mentions that three statements were sent out in indicating the balance on the account, however at the time our understanding was that this balance was still being billed to insuranceWe were not clearly notified that you do not have a contract with our secondary insurance until this year, after more than $had been incurred
You have offered two payment options: the first was to pay in full with monthly payments; the second was offering a 25% discountBoth of these are unacceptable, for in essence you are expecting us to pay for at least 75% of your mistake
The bottom line is this: your office mistakenly accepted an insurance you do not have a contract with, and after the fact you are coming back to us to collect these feesWe should have been properly notified before we started incurring costs, not $laterThis alone is principle enough to dispute the amount you say we owe, but I have some further complaints to add and more reasons to not pay your office anymore than we already have:
In almost every subsequent appointment after the first, he would spend only a couple of minutes with us and then tell us to keep doing what we are doing and come back in three monthsThese brief visits were not worth what they costAnd in one of the appointments, he took a split second look into our daughter's ear and apparently misdiagnosed an ear infectionWe had a doctor appointment the next day with a different doctor, and we were told our daughter did not have an ear infectionSo we started antibiotics when she didn't need them for her ear
Our primary insurance paid your office over $All things considered, I feel this more than covers the services we receivedHaving to pay anymore to the Allergy Institute feels like it would be a scam
Final Business Response /* (4000, 12, 2015/08/27) */
After review of the complainant's comments from 8/14/15, it would appear that we are at an impasse.The complaint has now expanded from the issue of charges to statements regarding the level of care that was providedWe believe that appropriate care was provided to the patientAs indicated in our first response we felt that after offering payment options, which were declined, we had no alternative but to turn this over to the Fresno Credit BureauThank you for attempting to facilitate resolution