Ashley Chiropractic

Unfortunately Mrs [redacted] visited our office for Chiropractic care and utilized her insurance coverage for her visitIt was her understanding that her co-pay was $and thus paid $for her visit on the date of serviceShe later received an Explanation of Benefits (EOB) from her insurance company which stated that her co-pay was in fact $as opposed to the $that she believed it to beShe contacted our office and did speak with [redacted] , our office manager regarding the discrepancyShe was told that it would be looked into and that upon receiving the information she would be contacted, which she wasAt the time of her contact with our office, our office billing company had not received the EOB from her insurance company as is procedure with the insurance company to send the EOB to the patient before sending to the providing physicianAs soon our billing service received her EOB, [redacted] contacted them to find out about the discrepancyThey informed [redacted] that Mrs [redacted] was correct and her co-pay was $They were then authorized to submit a $reimbursement for Overpayment of her claimThat reimbursement will be received by the patient, Mrs [redacted] shortly Our office is governed by our insurance contract when we see a patient who are using insurance coverage for their visitsUnder our contract we accept the co-pay that the patient is aware of, which Mrs [redacted] stated to be $We are unable to review her insurance contract, as her insurance contract is only visible to herIn honoring our contract we accept her co-pay and wait for the EOB and insurance payment for the visitWe were unable to verify her insurance co-pay or the amount of her co-pay until we received the EOBAs soon as it was received the situation was dealt with and a reimbursement check was issuedThis process has taken approximately days from the DOS which is customary with the insurance company and is in no way a fault of our office We do hope that every patient who comes into our office has an excellent experience, however we have to go by what their stated co-pay is and follow our insurance contract as far as payment and reimbursementThis patient was obviously mistaken about her co-pay, per her own admittance and we were unable to reimburse any monies or change anything in our system until we had receipt of the EOB from the insurance companyThis complaint is not a worthy complaint per our following of our insurance contract and in doing so this complaint constitutes a deformation complaint that we leave open the option to fileIt is my belief that as with any patient with insurance coverage that she learn her own coverage and benefits as to not have this situation in the futureShe has full access to her coverage unlike our office and at any time prior to the visit was capable of verifying her co-pay amountI do hope that she has great future experiences with medical and chiropractic care Dr [redacted] Chiropractic Physician

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID [redacted], and have determined that this proposed action would not resolve my complaint.  For your reference, details of the offer I reviewed appear below.
She states it will take 90 days.  I paid this in December I have not received a check for $10.00. So it has been 120 days since I paid this bill.  The reason I found out I over paid was because they sent me a bill.  Nothing to do with my insurance.  If she is going to lie about this, how can I trust her on sending me a check.  [redacted] said nothing to me as to what she states.  He took my address and told me they would be mailing the check out.  Nothing about having to wait for the insurance company.  My insurance company is a pretty common insurance [redacted] why they did not know my copay is beyond me.   I do not trust this company, they have lied and been very unprofessional.  I will not be happy with this complaint until I get the $10.00.  Thank You
Regards,
[redacted]

Unfortunately Mrs. [redacted] visited our office for Chiropractic care and utilized her insurance coverage for her visit. It was her understanding that her co-pay was $25 and thus paid $25 for her visit on the date of service. She later received an Explanation of Benefits (EOB) from her insurance company...

which stated that her co-pay was in fact $15 as opposed to the $25 that she believed it to be. She contacted our office and did speak with [redacted], our office manager regarding the discrepancy. She was told that it would be looked into and that upon receiving the information she would be contacted, which she was. At the time of her contact with our office, our office billing company had not received the EOB from her insurance company as is procedure with the insurance company to send the EOB to the patient before sending to the providing physician. As soon our billing service received her EOB, [redacted] contacted them to find out about the discrepancy. They informed [redacted] that Mrs. [redacted] was correct and her co-pay was $15. They were then authorized to submit a $10 reimbursement for Overpayment of her claim. That reimbursement will be received by the patient, Mrs. [redacted] shortly. 
Our office is governed by our insurance contract when we see a patient who are using insurance coverage for their visits. Under our contract we accept the co-pay that the patient is aware of, which Mrs. [redacted] stated to be $25. We are unable to review her insurance contract, as her insurance contract is only visible to her. In honoring our contract we accept her co-pay and wait for the EOB and insurance payment for the visit. We were unable to verify her insurance co-pay or the amount of her co-pay until we received the EOB. As soon as it was received the situation was dealt with and a reimbursement check was issued. This process has taken approximately 90 days from the DOS which is customary with the insurance company and is in no way a fault of our office.
We do hope that every patient who comes into our office has an excellent experience, however we have to go by what their stated co-pay is and follow our insurance contract as far as payment and reimbursement. This patient was obviously mistaken about her co-pay, per her own admittance and we were unable to reimburse any monies or change anything in our system until we had receipt of the EOB from the insurance company. This complaint is not a worthy complaint per our following of our insurance contract and in doing so this complaint constitutes a deformation complaint that we leave open the option to file. It is my belief that as with any patient with insurance coverage that she learn her own coverage and benefits as to not have this situation in the future. She has full access to her coverage unlike our office and at any time prior to the visit was capable of verifying her co-pay amount. I do hope that she has great future experiences with medical and chiropractic care. 
Dr. [redacted]
Chiropractic Physician

This patient is unhappy due to her over payment of her co-pay which, as stated previously is her responsibility to know per her contract with her insurance carrier. We do accept payment from [redacted], which is her insurance provider and she was given that information. We, however have many patients with [redacted] as well as many other insurance companies and do not know each individuals insurance coverage, co pay or deductible amount. The responsibility to know the patient's contract is the patient. The check has been issued and received. The check was issued on 3/27/14 and the check number is [redacted] and was cashed and deposited on 4/14/14.

Unfortunately Mrs. [redacted] visited our office for Chiropractic care and utilized her insurance coverage for her visit. It was her understanding that her co-pay was $25 and thus paid $25 for her visit on the date of service. She later received an Explanation of Benefits (EOB) from her insurance company...

which stated that her co-pay was in fact $15 as opposed to the $25 that she believed it to be. She contacted our office and did speak with [redacted], our office manager regarding the discrepancy. She was told that it would be looked into and that upon receiving the information she would be contacted, which she was. At the time of her contact with our office, our office billing company had not received the EOB from her insurance company as is procedure with the insurance company to send the EOB to the patient before sending to the providing physician. As soon our billing service received her EOB, [redacted] contacted them to find out about the discrepancy. They informed [redacted] that Mrs. [redacted] was correct and her co-pay was $15. They were then authorized to submit a $10 reimbursement for Overpayment of her claim. That reimbursement will be received by the patient, Mrs. [redacted] shortly. 

Our office is governed by our insurance contract when we see a patient who are using insurance coverage for their visits. Under our contract we accept the co-pay that the patient is aware of, which Mrs. [redacted] stated to be $25. We are unable to review her insurance contract, as her insurance contract is only visible to her. In honoring our contract we accept her co-pay and wait for the EOB and insurance payment for the visit. We were unable to verify her insurance co-pay or the amount of her co-pay until we received the EOB. As soon as it was received the situation was dealt with and a reimbursement check was issued. This process has taken approximately 90 days from the DOS which is customary with the insurance company and is in no way a fault of our office.

We do hope that every patient who comes into our office has an excellent experience, however we have to go by what their stated co-pay is and follow our insurance contract as far as payment and reimbursement. This patient was obviously mistaken about her co-pay, per her own admittance and we were unable to reimburse any monies or change anything in our system until we had receipt of the EOB from the insurance company. This complaint is not a worthy complaint per our following of our insurance contract and in doing so this complaint constitutes a deformation complaint that we leave open the option to file. It is my belief that as with any patient with insurance coverage that she learn her own coverage and benefits as to not have this situation in the future. She has full access to her coverage unlike our office and at any time prior to the visit was capable of verifying her co-pay amount. I do hope that she has great future experiences with medical and chiropractic care. 

Dr. [redacted]

Chiropractic Physician

This patient is unhappy due to her over payment of her co-pay which, as stated previously is her responsibility to know per her contract with her insurance carrier. We do accept payment from [redacted], which is her insurance provider and she was given that information. We, however have many patients with [redacted] as well as many other insurance companies and do not know each individuals insurance coverage, co pay or deductible amount. The responsibility to know the patient's contract is the patient. The check has been issued and received. The check was issued on 3/27/14 and the check number is [redacted] and was cashed and deposited on 4/14/14.

I have reviewed the response made by the business in reference to complaint ID [redacted], and have determined that this proposed action would not resolve my complaint.  For your reference, details of the offer I reviewed appear below.

She states it will take 90 days.  I paid this in December I have not received a check for $10.00. So it has been 120 days since I paid this bill.  The reason I found out I over paid was because they sent me a bill.  Nothing to do with my insurance.  If she is going to lie about this, how can I trust her on sending me a check.  [redacted] said nothing to me as to what she states.  He took my address and told me they would be mailing the check out.  Nothing about having to wait for the insurance company.  My insurance company is a pretty common insurance [redacted] why they did not know my copay is beyond me.   I do not trust this company, they have lied and been very unprofessional.  I will not be happy with this complaint until I get the $10.00.  Thank You

Regards,