Arise

December 23, Attn: *** *** Dispute Resolution Specialist Complaint ID *** We are responding to your letter received on De,:ember 18th in reference to complaint ID #: ***According to patient records, notes and care provider interviews the patient h,14:more than a mouth
swab: Tests Performed **
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*** *** The patient checked in at 9:AM and was seen by 10:AMThe patient's out of pocket was $that she never ultimately paid; the balance was written-off with no financial impact to the patientAt Arise Austin Medical Center, we pride ourse ves on providing the best patient experience in the Austin areaWe regret that the experience of *** *** was not to her sat sfactionOur system CEO is always available to discuss I he Arise Healthcare experience, great or not, directly with patients and family membersThank-you for bringing this to our attention and we are more than willing to discuss the issue with *** *** at her convenienceRespectfully, *** *** Arise Austin Medical Center *** Arise Austin Mediceil Center) Bee Caves Rd Austin TX ) 512-314-

December 23, Attn: [redacted]
Dispute Resolution Specialist Complaint ID [redacted] We are responding to your letter received on De,:ember 18th in reference to complaint ID #: [redacted]According to patient records, notes and care provider interviews the patient h,14:more than a mouth swab: Tests Performed **
[redacted] The patient checked in at 9:AM and was seen by 10:AMThe patient's out of pocket was $that she never ultimately paid; the balance was written-off with no financial impact to the patientAt Arise Austin Medical Center, we pride ourse ves on providing the best patient experience in the Austin areaWe regret that the experience of [redacted] was not to her sat sfactionOur system CEO is always available to discuss I he Arise Healthcare experience, great or not, directly with patients and family membersThank-you for bringing this to our attention and we are more than willing to discuss the issue with [redacted] at her convenienceRespectfully, [redacted] Arise Austin Medical Center [redacted]
Arise Austin Mediceil Center) Bee Caves Rd Austin TX ) 512-314-

Patient's procedure was performed on 2/9/2016 at [redacted]. The claim for the procedure was generated on 2/15/16. We received our first response from [redacted] on 5/31/16 with unlisted procedures that were not reimbursed. Claim was sent back for review. Our [redacted] contract states Cedar...

Park will be reimbursed for unlisted procedures. After multiple emails and calls with [redacted], Ms. [redacted] a [redacted] Representative provided an "Incidental List" on 1/24/2017 and the list was sent to our managed care department for review. It was determined that the unlisted procedures were on the incidental list and the patient was due a refund. A request for patient's refund was submitted on 2/8/17, entered into refund system on 2/16/17, reviewed and approved 2/17/17, check cut to patient 2/20/17 and check cleared on 2/28/17 (refund history snapshot below). in the timeline provided, the collector worked diligently with several different [redacted] representatives to resolve the contract discrepancy so we could refund our patient. We do understand the patient's frustration due to the length of time it took to get the documentation needed from [redacted] to issue the refund and sincerely apologize for any inconvenience this caused. Service excellence is something that we take very seriously and would never compromise under any circumstances. A solution is in place and preventable measures have been introduced. We take this opportunity to thank you for your feedback which allows us to serve our patients at the highest standard in the future. Please see our timeline below. (see attachment) 10/04/16 Batch of claims (Patient included) was sent to [redacted]'s Contract Mgr. [redacted] to review as our contract stated we should be reimbursed for unlisted procedures. There were conflicting claims, some paid the unlisted procedures and some did not.11/07/16 First call from patient inquiring about her refund. Advised there was an ongoing contractdispute that was being looked into by [redacted] as the EOB might be incorrect and she could possibly owe the money that she originally paid. Patient was fine with that.Contacted [redacted] the same day to ask if there was any determination. She advised she had forwarded these examples over for review and she would check status then get back to me.11/14/16-[redacted] requested copies of the UB 04's to send to claims dept. for review —sent requested documents to claims dept.12/01/16- Emailed Ms. [redacted] again asking for an update. Collector advised he had to call back some patients and update them on status. Ms. [redacted] responded that after she forwards the claims for review it can take up to 90 days for an answer. Collector advised her this was unacceptable as he had patients that were possibly due refunds and we need an answer on this ASAP.12/07/16-Received second call from patient asking about her refund. Advised patient an email was sent to [redacted] on 12/1 and the account was set to be followed up on 12/14. Patient was advised if collector didn't hear anything within a week he'd give her Ms [redacted] # to call and file a complaint on behalf of herself,January 2017- Patient had a [redacted] representative call collector (3 way call) regarding the patient's refund. The representative was looking at the patient's EOB stating that it was showing the patient was due a refund and we need to get this to the patient, Collector proceeded to tell her this was a contract issue and gave her the names of the [redacted] participants involved and advised her we cannot refund the patient until we get an answer, along with documentation showing that per our contract this was correct (as our contract stated otherwise). Collector advised there were contrasting claims where some codes paid and some did not. [redacted] rep stated she was going to call Ms. [redacted]. [redacted] representative called our collector again stating Ms, [redacted] had forwarded her to [redacted], a [redacted] internal claims consultant, and that she had advised her that Ms. [redacted] was due a refund. The collector stated we were advised the same, but Ms, [redacted] was supposed to provide us with a [redacted] "Incidental Code" list that was not provided to us when the contract was signed. Once, we were provided this, we could refund the patient. [redacted] rep never reached out to collector again. 01/23117-  Reached out to [redacted] again stating we need a copy of this list to refund the patients involved. She sent this over 01/24/17. 01/26/17-  Contacted managed care at Regional Billing Office to advise of the issue and to see if there was something they could do regarding [redacted] not providing us with this list when contract was signed. Managed Care working with [redacted] to prevent future contract issues. 02/08/17- Sent refund request to RBO. Allow 1-2 weeks for processing. 02/14/17- Received call from patient asking about her refund. Collector advised he sent request over on 02/08/17 and he'd contact for a status update. 02/16/17- Received email from cash apps stating she put into refund system 2/16/17. 02/17/2017 — refund approved for payment on 2/17/17 02/20/2017 — check was cut and paid on 2/20/17 — ck# [redacted] 02/27/17- Received call from patient stating she hasn't received refund check. RBO advised check was mailed 02/20/17. Called patient back and advised her of this. She stated if she didn't get it in a few days she'd be calling back. 02-27-2017 — Reached out to patient after receiving complaint from Revdex.com. Patient was unavailable and we left a message for a return call. 02/28/2017- -check cleared 2/28/17