Anesthesia Associates of Lancaster LTD

November 20,2017We are in receipt of your letter dated November 9thYour request for a written response within the next days would make the due date todayWe will need an extension of time since responding to this complaint is far from straight forward, First of all, the insurance company involved is one where we do not participate in all of their productsSecondly, the network reported on their Explanation of Benefits is one we do not participate in but they have processed the claim as if we are participatingThirdly our billing company that we have hired to do our billing seems to have had some problems with properly adjudicating this claim and getting to the bottom of the patient’s questionsThese three factors combined with the short time frame that you have provided us will not result in a final conclusion todayI would expect that I will be able to have a definitive answer by December 1,At that time, we will send you a complete response in regal’d to this complaint.Please expect further correspondence from me on this matter no later than December 2017.Thank you,Edward RAdministrative Director

November 29, 2017Dear [redacted] ,Our response is as follows;Dear [redacted] :We are in receipt of the complaint that was submitted to the Revdex.com regarding your account with Anesthesia Associates of LancasterWe regret any inconvenience you have experienced due to the poor performance of our contracted billing company (***, Inc.)Following your complaint, we believe the matter will be resolved, if and when your insurance company pays the claim properly.We have reviewed your account and determined the following:•The initial information presented to us from UMR as well as subsequent reports indicates that your claim was processed through United Healthcare; which we do not participate withHowever, the payment from UMR was not consistent with our non-par status with that carrierAfter repeated attempts to clarify the inconsistency and your complaint, we received confirmation from UMR that your claim was processed under the Health America network which we do participate withPlease see the claim breakdown below:o CPT Code: [redacted] - Repair of ruptured musculotendinous cuff (eg, rotator cuff) open; acute Provider: Sean S [redacted] MD Total charge: $Total insurance payment: $Total contractual adjustment: $Balance: $0.00o CPT Code: [redacted] - Repair of ruptured musculotendinous cuff (eg, rotator cuff) open; acute Provider: Jacqueline S***, CRNA Total charge: $Total insurance payment: $Total patient payment: $Total contractual adjustment: $Balance: $0,00• UMR denied the code below.o CPT code: *** - Injection, anesthetic agent; brachial plexus, single Provider: Sean S [redacted] , MD Total charge: $776,00Our billing office has contacted UMR and they are currently reprocessing this claim since this code is payable under your Health America benefitThey have been instructed to allow approximately business days for completion and we will follwith UMR on 12/7/If it is not paid, further follor billing to you may be required.Your current account balance is zero, pending UMR payment for the injection (CPT code ***).We appreciate your bringing this to our attentionWe will further evaluate how we can prevent this problem from occurring in the futureYou may also want to make a complaint to UMR regarding their ongoing error in identifying payment under an incorrect networkHad this been done upfront by UMR, it is likely you would have had cause to complain,Please accept our apology for any inconvenience this may have caused you.Sincerely,Edward RAdministrative Director

We outsource or billing to a third partyI have received the following feedback.1.Claim billed to *** ** Keystone.2.*** ** Keystone paid patient,3.Patient remitted $to AALRemaining balance at this point in time was patient responsibility,5.Patient
called in with secondary insurance information.6.Claim submitted to *** *** 5/24/16.7.Followed up with *** *** 6/30/16, claim not on file,8.Verified that *** *** does not accept faxed claims.9.Mailed claim 6/30/by Certified Mail to ensure receiptWill follow up with carrierWill call patient to discuss,Spoke with patient 7-1-Explained that claim sent via Certified Mail on 6/and will verify that the Carrier has received the claim next weekApologized for any inconvenience and assured her that follow up with the carrier will occur and will communicate all findingsPatient appears to be satisfied with the progressI will continue to monitor the progress on this issueIf either the Revdex.com or MsEckerd have any further questions, please feel free to contact meThank youEdward FR***Administrative Director

We outsource or billing to a third partyI have received the following feedback.1.Claim billed to *** ** Keystone.2.*** ** Keystone paid patient,3.Patient remitted $to AALRemaining balance at this point in time was patient responsibility,5.Patient called in with secondary
insurance information.6.Claim submitted to *** *** 5/24/16.7.Followed up with *** *** 6/30/16, claim not on file,8.Verified that *** *** does not accept faxed claims.9.Mailed claim 6/30/by Certified Mail to ensure receiptWill follow up with carrierWill call patient to discuss,Spoke with patient 7-1-Explained that claim sent via Certified Mail on 6/and will verify that the Carrier has received the claim next weekApologized for any inconvenience and assured her that follow up with the carrier will occur and will communicate all findingsPatient appears to be satisfied with the progress.I will continue to monitor the progress on this issueIf either the Revdex.com or MsEckerd have any further questions, please feel free to contact meThank you.Edward FR***Administrative Director

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID [redacted], and await clarification between [redacted] and Anesthesia Assoc of Lancaster...and await the resolution of payment. Areas of concern remain how the company (Anesthesia Assoc of Lancaster) could issue note dated April 18th 2017 that no balance due with subsequent letter indicating money due...I am concerned about reference to Health America! I was not enrolled under them, it was always with [redacted].The ongoing issue with multiple attempts to resolve the payment concern with Anesthesia Assoc of Lancaster has been a trying, stressful period as unable to reach them and explain concern including on multiple attempts with representative of [redacted] together on call and in response threatening notices from them.
Regards,
[redacted]

November 29, 2017Dear [redacted],Our response is as follows;Dear [redacted]:We are in receipt of the complaint that was submitted to the Revdex.com regarding your account with Anesthesia Associates of Lancaster. We regret any inconvenience you have experienced due to the poor performance of our contracted billing company ([redacted], Inc.). Following your complaint, we believe the matter will be resolved, if and when your insurance company pays the claim properly.We have reviewed your account and determined the following:•The initial information presented to us from UMR as well as subsequent reports indicates that your claim was processed through United Healthcare; which we do not participate with. However, the payment from UMR was not consistent with our non-par status with that carrier. After repeated attempts to clarify the inconsistency and your complaint, we received confirmation from UMR that your claim was processed under the Health America network which we do participate with. Please see the claim breakdown below:o CPT Code: [redacted] - Repair of ruptured musculotendinous cuff (eg, rotator cuff) open; acute Provider: Sean S[redacted] MD Total charge: $600.00 Total insurance payment: $311.52 Total contractual adjustment: $288.48 Balance: $0.00o CPT Code: [redacted] - Repair of ruptured musculotendinous cuff (eg, rotator cuff) open; acute Provider: Jacqueline S[redacted], CRNA Total charge: $600.00 Total insurance payment: $280.37 Total patient payment: $31.15 Total contractual adjustment: $288.48 Balance: $0,00• UMR denied the code below.o CPT code: [redacted] - Injection, anesthetic agent; brachial plexus, single Provider: Sean S[redacted], MD Total charge: $776,00Our billing office has contacted UMR and they are currently reprocessing this claim since this code is payable under your Health America benefit. They have been instructed to allow approximately 15 business days for completion and we will follow-up with UMR on 12/7/2017. If it is not paid, further follow-up or billing to you may be required.Your current account balance is zero, pending UMR payment for the injection (CPT code [redacted]).We appreciate your bringing this to our attention. We will further evaluate how we can prevent this problem from occurring in the future. You may also want to make a complaint to UMR regarding their ongoing error in identifying payment under an incorrect network. Had this been done upfront by UMR, it is likely you would have had cause to complain,Please accept our apology for any inconvenience this may have caused you.Sincerely,Edward R. Administrative Director

November 20,2017We are in receipt of your letter dated November 9th. Your request for a written response within the next 10 days would make the due date today. We will need an extension of time since responding to this complaint is far from straight forward, First of all, the insurance company...

involved is one where we do not participate in all of their products. Secondly, the network reported on their Explanation of Benefits is one we do not participate in but they have processed the claim as if we are participating. Thirdly our billing company that we have hired to do our billing seems to have had some problems with properly adjudicating this claim and getting to the bottom of the patient’s questions. These three factors combined with the short time frame that you have provided us will not result in a final conclusion today. I would expect that I will be able to have a definitive answer by December 1,2017. At that time, we will send you a complete response in regal’d to this complaint.Please expect further correspondence from me on this matter no later than December 13 2017.Thank you,Edward R. Administrative Director