Ashton Creek Health & Rehabilitation Center

Initial Business Response /* (1000, 5, 2017/03/20) */
1)Ashton Creek is not responsible to verify benefits with any provider other than Ashton Creek.
2)Ashton Creek is a contracted, in-network provider with United Healthcare and the benefits explained to him were his benefit coverage for Ashton...

Creek. It is clearly stated on several documents signed by the patient that the benefits stated by his insurance are NOT a guarantee of payment and rates and benefits are subject to change. It is standard policy for our Medical Director, or other licensed provider with ECS, to visit a patient upon admission and throughout their stay at the facility.
When the patient called the first time, he was directed to contact ECS as it is their billing, not ours. When the patient called a second time, he stated that they were telling him his insurance plan was out-of-network with them and this portion was his responsibility. I told him that seems odd since we have a number of UHC participants come through our building and I would've heard of more of these issues if that were the case with our UHC patients. I asked the patient to email me the statement from ECS so I could look into it further. The patient emailed me the ECS statement on 1/19/2017. On 1/25/17 I was able to contact ECS billing department and speak to a representative. She was the person who had spoken to the patient and said she told him that he has a specific private insurance plan with UHC that is out-of-network with them. She said it doesn't happen often, but UHC stated that was the out-of-network benefit and the [redacted] was the patient's responsibility. She stated that she had discussed with the patient payment arrangements and she was willing to accept any payment that he was able to present. On 1/27/17 I wrote the patient a letter stating I was sorry that he received this bill, but it was out of our hands. There were several documents signed upon admission stating the consent of treatment with our physicians and that their fees for treatment are not associated with the facility charges. I provided a copy of the signed agreement to the patient just as he was provided the same copy when he signed it upon admission each time.
I have included the attached documents:
1)February 2016 Admission Agreement that was signed by the patient at time of admission. I have starred the sections that apply to physician services where it clearly states, "The fees associated with physician services are not included in the Facility's charges." Also starred in the admission agreement is section 2.2 stating: "In addition to the Facility's charges, the Resident or the Resident's Legal Representative shall pay all fees and costs for goods or services furnished to or for the Resident by anyone other than the Facility, unless these charges are reimbursed through Medicare, Medicaid or some other authorized third party payor."
2)November 2016 Admission Agreement that was signed by the patient upon admission. The starred sections are the same as stated in attachment 1 documents.
3)Personal Consent/Acknowledgement form. The first subject line of this form is providing consent from the patient for our Medical Director, to provide treatment.
4)Notice of Medicare/Insurance Coverage Availability Form. These are the benefits the patient stated he was quoted upon admission. Once again, we are only responsible to quote the coverage from an insurance company for our facility. Even so, it clearly states on this form, "The above is stated by your insurance company and is NOT a guarantee of payment. This is only a phone verification of benefit coverage we provide as a COURTESY. These rates and benefits are subject to change."
Ashton Creek does not agree to pay these charges as we feel the patient was given plenty of documentation that clearly states his responsibility of charges his insurance does not cover.