Aurora Behavioral Health System

RE: ID#: *** To Whom It May Concern, In response to your letter dated May 2, and received at Aurora Behavioral Health Systems East on May 8, 2017, I am providing you with the following information. This patient received care, treatment and services at Aurora Behavioral
Healthcare Tempe in our outpatient program from March 30, through May 21, At the start of treatment, insurance benefits were verified and insurance informed there was a $copay per session Copay amounts were paid in fullBelow is a time line of events following completion of the program. 5/28/15- Insurance paid full amount of $2743.006/25/15- Insurance recouped payment of $2743.006/25/15- Insurance paid $2743.008/20/15- Insurance recouped payment of $2743.0011/10/15- Upon notification from insurance that they recouped payments due to a diagnosis exclusion on the policy, Aurora reached out to legal guardian/parent to discuss self-pay prices A message was left.11/11/15- Parent called requesting clinical information for her daughter’s treatmentShe was informed that the payments were recouped due to the diagnosis exclusion on her policy Self-pay prices were discussed with her at this time Parent stated she would like to appeal the denial decision with her insurance company Information to obtain medical records for the appeal was provided to her A letter was sent to parent for payment or payment arrangement. This account went into collections as no payment was receivedUpon receipt of the letter from Revdex.com on May 8th, 2017, Aurora contacted the insurance company and spoke with a claims supervisor that confirmed the claims were denied correctly Claims Supervisor reported that the claims were denied due to the diagnosis exclusion on this policyShe did confirm the claims have not been reprocessed after 11/11/ The appeals department was then contacted to confirm whether an appeal was initiated on this denialThe appeals department confirmed that there has not been an appeal filed by the parent in 2015, or 2017. Aurora did contact the insurance company to determine the reason the payment was recouped and this information was provided to the policy holderAt that time, the policy holder could have filed an appeal with the insurance company to dispute this denial and policy holder verbalized intent to do soAurora billed at adjusted self-pay rates for the service provided Policy holder did not file an appeal to the insurance company and did not provide payment to Aurora for the services provided. If you have any questions, or if I may be of further assistance in this matter, please do not hesitate to contact me at the number or e-mail listed below. Sincerely,Becky K***

I was advised by Aurora (and *** referred me to them as they were an in-network provider) the services were covered by insurance and I would be required to pay a $copay per session. Aurora requested a credit card to remain on file and they would charge $to the credit card per week for approximately eight weeks. Aurora’s Business Office was contacted by myself upon contacting *** regarding the claim. I left a message stating *** advised me Aurora needs to rebill them under a covered diagnosis. I inquired about the appeal process to get this claim covered and I was advised by *** due their contract with Aurora I would only be responsible for the copay and nothing more. The provider would need to work out the details of the claim directly with my insurance provider. This information was provided to Aurora’s Business Office. I fulfilled my obligation to Aurora by paying the $copay per session. I did not receive additional correspondence from Aurora. I only learned of the collection notice when I received a credit alert stating my credit score dropped. I was under the impression this issue was resolved on my part and Aurora would contact insurance to further discuss and/or file an appeal on their own as I previously shared this information with their Business Office.Attached is the Provider Explanation of Benefits from *** for your review. Page two clearly states “CLAIM TOTAL PATIENT RESPONSIBILITY $195.00”. I’ve fulfilled my obligation of the claim. The provider also has the option to file an appeal, the member does not have to initiate the appeal. I only received the two pages of the Provider Explanation of Benefits. If the other pages are required I’ll contact *** to request the remaining pages.Thank you,*** *** ***
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