Ambi Medical Associates PC

Review: My husband had sugery in the day op center located in Mineola back in March. [redacted] from Ambi Medical Associates was the Anesthesiologist for his surgery. After the surgery we received a bill from the Ambi Medical Associates and then were informed that they do not participate in our insurance - Blue Cross/Blue Shield. I investigated when he was advised of this - and have been told - most recently as of this morning - that nobody at Day Op will advise him that the Ambi Medical does not participate in insurance - any insurance - it is the patients responsibility to ask. I find that an unheard of practice and very misleading to the average patient not familiar with insurance. The physician and Day op Center all participate in the insurance - but no mention of the Anesthesiologist - I would imagine this is an issue with every patient as they are all recieving very large bills. In addition, there is no choice in using a participating Anesthesiologist - so the patient has no choice. I was told that on the day of surgery my husband should have asked the physician while he was lying on the table if she participated in BC/BS - really? I have appealed to BC/BS and they advised they cannot make any more payment and suggested the physician accept their assignement. Ambi Medical has agreed to split the difference but I feel that their practice of not informing the patient goes against the patients rights to be informed of all the medical information - PRIOR to surgery.Desired Settlement: I would like Ambi Medical associates to accept the payment from BC/BS as all the other physicians who participate in insurance do and also I believe they need to ammend their practice and ensrue that the patients are informed of the fact that they do not participate in insurance.

Business

Response:

Dear [redacted]:

Regarding complaint ID [redacted] ([redacted]), please be advised we have written off the balance on [redacted]'s account. From the outset we had advised [redacted] we would work with him regarding the balance but were insistent that he review the claim with his carrier, which is an out of area BS plan. Because of that fact, our office was not able to do the review on [redacted]'s behalf as we do on hundreds of other patient's accounts. Out of area BS plans typically insist that only the patient can request a reconsideration of the claim. Initially, [redacted] (designated by [redacted] to deal with our office on his behalf) refused to do any review. Office notes indicate she stated this fact at least three times. We did point out to her that the patient did sign documentation assuming responsibility for any amount remaining after insurance paid and that at the very least, they would need to initiate a review or be responsible for the balance. At some point later [redacted] made comments that she had called her carrier and they would not review. We advised it is her right to review and continued to insist she do so.

Shortly after receiving the complaint from the Revdex.com, the patient forwarded documentation verifying that the carrier had reviewed the claim and had denied additional payment. As we now had verifiable evidence that the patient did finally review the claim, we were able to arrive at the decision to write off the balance.

I would also point out that our group participates with Blue Shield effective 5/*/13 mid was in the process of negotiating our contract when services were rendered to [redacted].