9-15-(prior to patient’s appointment of 9-21-2017), **/ [redacted] website confirmed patient had active coverage9-21-Patient’s mother called questioning balance on the bill, she did not understand why services were not covered, it was explained they were covered, but they had not yet met their deductibleShe stated she did not know they had a deductible and was going to call their insurance company In fact, services were covered as payment of the claim was made in the amount of $149.71; contractual adjustments were made in the amount of $leaving the subscriber a deductible responsibility of $Based on a phone call from Mr [redacted] on 10-5-2017, we did phone [redacted] (an electronic health records software program) amidst Mr [redacted] concern that as a former programmer he knows that “ [redacted] has a program that runs the night before that tells you patient responsibility.” I believe Mr [redacted] may be referring to a program that provides information on a patient’s deductible expense, however, we were never asked about their deductibleEvery patient is unique relative to their diagnosis, medical history and symptomsThere is no probability that our office staff would know a patient’s personal balance prior to a patient being seen as I believe Mr [redacted] suggests We would have no idea the amount of time spent with a patient, or procedures ordered by the provider prior to a visit, thereby we would not know of charges in advance**/ [redacted] will verify employers are issued a benefit statement for disbursement to their subscribers, as it is their contract with the insurance companyMr [redacted] is well versed in health care, therefore, he knows provider’s outside of the [redacted] ’s are subject to a deductible as in network, but a different level of plan (unless, of course, he never received the benefit literature from his employer plan sponsor) Large group employers have an advantage of choosing “ala carte plan/benefits” and inadvertently there may have been a gap of no specialists, such as allergists in his area, or of his choosing, thereby I would suggest he may have a valid reason to seek appeal He can use his circumstances and his knowledge to validate the need to reassess their benefit package for inclusion of all health care specialties and providers, particularly for a large employer who is in the business of health care Subscribers should be able to choose whom they wish to care for their life, by having a plan that is unrestricted welcoming any and all the patient seeks to receive care fromHe should start a forum and dialog with his benefits department before renewal of their next plan Mr [redacted] should put his passion where it is needed and communicate with those who are in charge of decision making in benefits, so the future plan benefit outcomes will be enhancedThis can help not only himself and his family, but the multitudes covered under the current planRegards, Asthma & Allergy Associates P.C
I have reviewed the response made by the business in reference to complaint ID ***, and have determined that this does not resolve my complaint. This medical practice uses an EHR called *** which has the ability to pull up what a patient would have to pay out of pocket. This practice either refuses to use it because it would eat into their profits or they do use it and they decide not to tell patients how much the procedure would cost out of pocket. Either way, this is unethical and not how most medical practices are run. When a patient calls in and wants to know if the practice takes their insurance they are not asking if the medical practice is on par with said insurer. They want to make sure that they aren't going to be billed excessive charges for visiting said medical practice. Regardless of whether or not you are on par with an insurance company it is the duty of the medical practice to know whether or not you are in network. This provider knew they weren't in network with the LARGEST HOSPITAL in Central NY but failed to tell that to the patients mother which caused these excessive charges. Again, this is unethical and is not standard for most medical practices in NY
Regards,
*** ***
9-15-17 (prior to patient’s appointment of 9-21-2017), **/** website confirmed patient had active coverage. 9-21-2017 Patient’s mother called questioning balance on the bill, she did not understand why services were not covered, it was explained they were covered, but they had not yet met their deductible. She stated she did not know they had a deductible and was going to call their insurance company. In fact, services were covered as payment of the claim was made in the amount of $149.71; contractual adjustments were made in the amount of $107.95 leaving the subscriber a deductible responsibility of $393.34. Based on a phone call from Mr. [redacted] on 10-5-2017, we did phone [redacted] (an electronic health records software program) amidst Mr. [redacted] concern that as a former programmer he knows that “[redacted] has a program that runs the night before that tells you patient responsibility.” I believe Mr. [redacted] may be referring to a program that provides information on a patient’s deductible expense, however, we were never asked about their deductible. Every patient is unique relative to their diagnosis, medical history and symptoms. There is no probability that our office staff would know a patient’s personal balance prior to a patient being seen as I believe Mr. [redacted] suggests. We would have no idea the amount of time spent with a patient, or procedures ordered by the provider prior to a visit, thereby we would not know of charges in advance. **/** will verify employers are issued a benefit statement for disbursement to their subscribers, as it is their contract with the insurance company. Mr. [redacted] is well versed in health care, therefore, he knows provider’s outside of the [redacted]’s are subject to a deductible as in network, but a different level of plan (unless, of course, he never received the benefit literature from his employer plan sponsor). Large group employers have an advantage of choosing “ala carte plan/benefits” and inadvertently there may have been a gap of no specialists, such as allergists in his area, or of his choosing, thereby I would suggest he may have a valid reason to seek appeal. He can use his circumstances and his knowledge to validate the need to reassess their benefit package for inclusion of all health care specialties and providers, particularly for a large employer who is in the business of health care. Subscribers should be able to choose whom they wish to care for their life, by having a plan that is unrestricted welcoming any and all the patient seeks to receive care from. He should start a forum and dialog with his benefits department before renewal of their next plan. Mr. [redacted] should put his passion where it is needed and communicate with those who are in charge of decision making in benefits, so the future plan benefit outcomes will be enhanced. This can help not only himself and his family, but the multitudes covered under the current plan. Regards, Asthma & Allergy Associates P.C.
Thank you for reaching out to our office for details in explanation of a complaint you received, which is unprecedented for our practice. The patient's mother phoned our office and inquired if we were in network with their insurance plan, which we relayed to her, we were. Patient's mother did not...
understand why the claims were not paid, and we explained they were subject to their policy's deductible. Patient's mother stated she was not aware they had a deductible on their insurance plan was going to call her insurance company and set up a payment plan. Therefore, subject to the subscriber's contract with the insurance company, charges were submitted to the insurance company, contractual adjustments were deducted, and the insurance company allocated the balance of the account to the responsibility of the subscriber. The father slates he works for a large medical practice, I can only assume, therefore, he is familiar with health insurance, and a deductible. I can appreciate his comments regarding his workplace, but they are inconsequential to our practice. There are a multitude of insurance plans in the industry and the contract is between the subscriber and insurance company to verify their benefits. A patient always has the option to delay a procedure until they perform the necessary verification with their insurance company who has knowledge of their policy. If you need further information, please do not hesitate to contact our office. Sincerely yours, Asthma & Allergy Associates P.C. Elliot R., M.D.
9-15-(prior to patient’s appointment of 9-21-2017), **/ [redacted] website confirmed patient had active coverage9-21-Patient’s mother called questioning balance on the bill, she did not understand why services were not covered, it was explained they were covered, but they had not yet met their deductibleShe stated she did not know they had a deductible and was going to call their insurance company In fact, services were covered as payment of the claim was made in the amount of $149.71; contractual adjustments were made in the amount of $leaving the subscriber a deductible responsibility of $Based on a phone call from Mr [redacted] on 10-5-2017, we did phone [redacted] (an electronic health records software program) amidst Mr [redacted] concern that as a former programmer he knows that “ [redacted] has a program that runs the night before that tells you patient responsibility.” I believe Mr [redacted] may be referring to a program that provides information on a patient’s deductible expense, however, we were never asked about their deductibleEvery patient is unique relative to their diagnosis, medical history and symptomsThere is no probability that our office staff would know a patient’s personal balance prior to a patient being seen as I believe Mr [redacted] suggests We would have no idea the amount of time spent with a patient, or procedures ordered by the provider prior to a visit, thereby we would not know of charges in advance**/ [redacted] will verify employers are issued a benefit statement for disbursement to their subscribers, as it is their contract with the insurance companyMr [redacted] is well versed in health care, therefore, he knows provider’s outside of the [redacted] ’s are subject to a deductible as in network, but a different level of plan (unless, of course, he never received the benefit literature from his employer plan sponsor) Large group employers have an advantage of choosing “ala carte plan/benefits” and inadvertently there may have been a gap of no specialists, such as allergists in his area, or of his choosing, thereby I would suggest he may have a valid reason to seek appeal He can use his circumstances and his knowledge to validate the need to reassess their benefit package for inclusion of all health care specialties and providers, particularly for a large employer who is in the business of health care Subscribers should be able to choose whom they wish to care for their life, by having a plan that is unrestricted welcoming any and all the patient seeks to receive care fromHe should start a forum and dialog with his benefits department before renewal of their next plan Mr [redacted] should put his passion where it is needed and communicate with those who are in charge of decision making in benefits, so the future plan benefit outcomes will be enhancedThis can help not only himself and his family, but the multitudes covered under the current planRegards, Asthma & Allergy Associates P.C
I have reviewed the response made by the business in reference to complaint ID ***, and have determined that this does not resolve my complaint. This medical practice uses an EHR called *** which has the ability to pull up what a patient would have to pay out of pocket. This practice either refuses to use it because it would eat into their profits or they do use it and they decide not to tell patients how much the procedure would cost out of pocket. Either way, this is unethical and not how most medical practices are run. When a patient calls in and wants to know if the practice takes their insurance they are not asking if the medical practice is on par with said insurer. They want to make sure that they aren't going to be billed excessive charges for visiting said medical practice. Regardless of whether or not you are on par with an insurance company it is the duty of the medical practice to know whether or not you are in network. This provider knew they weren't in network with the LARGEST HOSPITAL in Central NY but failed to tell that to the patients mother which caused these excessive charges. Again, this is unethical and is not standard for most medical practices in NY
Regards,
*** ***
9-15-17 (prior to patient’s appointment of 9-21-2017), **/** website confirmed patient had active coverage. 9-21-2017 Patient’s mother called questioning balance on the bill, she did not understand why services were not covered, it was explained they were covered, but they had not yet met their deductible. She stated she did not know they had a deductible and was going to call their insurance company. In fact, services were covered as payment of the claim was made in the amount of $149.71; contractual adjustments were made in the amount of $107.95 leaving the subscriber a deductible responsibility of $393.34. Based on a phone call from Mr. [redacted] on 10-5-2017, we did phone [redacted] (an electronic health records software program) amidst Mr. [redacted] concern that as a former programmer he knows that “[redacted] has a program that runs the night before that tells you patient responsibility.” I believe Mr. [redacted] may be referring to a program that provides information on a patient’s deductible expense, however, we were never asked about their deductible. Every patient is unique relative to their diagnosis, medical history and symptoms. There is no probability that our office staff would know a patient’s personal balance prior to a patient being seen as I believe Mr. [redacted] suggests. We would have no idea the amount of time spent with a patient, or procedures ordered by the provider prior to a visit, thereby we would not know of charges in advance. **/** will verify employers are issued a benefit statement for disbursement to their subscribers, as it is their contract with the insurance company. Mr. [redacted] is well versed in health care, therefore, he knows provider’s outside of the [redacted]’s are subject to a deductible as in network, but a different level of plan (unless, of course, he never received the benefit literature from his employer plan sponsor). Large group employers have an advantage of choosing “ala carte plan/benefits” and inadvertently there may have been a gap of no specialists, such as allergists in his area, or of his choosing, thereby I would suggest he may have a valid reason to seek appeal. He can use his circumstances and his knowledge to validate the need to reassess their benefit package for inclusion of all health care specialties and providers, particularly for a large employer who is in the business of health care. Subscribers should be able to choose whom they wish to care for their life, by having a plan that is unrestricted welcoming any and all the patient seeks to receive care from. He should start a forum and dialog with his benefits department before renewal of their next plan. Mr. [redacted] should put his passion where it is needed and communicate with those who are in charge of decision making in benefits, so the future plan benefit outcomes will be enhanced. This can help not only himself and his family, but the multitudes covered under the current plan. Regards, Asthma & Allergy Associates P.C.
Thank you for reaching out to our office for details in explanation of a complaint you received, which is unprecedented for our practice. The patient's mother phoned our office and inquired if we were in network with their insurance plan, which we relayed to her, we were. Patient's mother did not...
understand why the claims were not paid, and we explained they were subject to their policy's deductible. Patient's mother stated she was not aware they had a deductible on their insurance plan was going to call her insurance company and set up a payment plan. Therefore, subject to the subscriber's contract with the insurance company, charges were submitted to the insurance company, contractual adjustments were deducted, and the insurance company allocated the balance of the account to the responsibility of the subscriber. The father slates he works for a large medical practice, I can only assume, therefore, he is familiar with health insurance, and a deductible. I can appreciate his comments regarding his workplace, but they are inconsequential to our practice. There are a multitude of insurance plans in the industry and the contract is between the subscriber and insurance company to verify their benefits. A patient always has the option to delay a procedure until they perform the necessary verification with their insurance company who has knowledge of their policy. If you need further information, please do not hesitate to contact our office. Sincerely yours, Asthma & Allergy Associates P.C. Elliot R., M.D.