Avenues Health Center

Avenues Health Center-- - [redacted] , D.C[redacted] *** ***Response to complaint # [redacted] As stated in our previous response, on November 4, 2014, our office spoke with the patient who was in pain and accommodated him and the urgent need of treatment by scheduling him immediatelyThe care of our patients is always our first priorityWhen we spoke with the patient over the phone, the patient stated that his insurance policy was new and he had not met his deductibleThis led our staff to believe that the patient was aware of his benefitsIf a patient is concerned of whether a provider is innetwork or out-of-network, their insurer provides many ways to search in-network providers, including online or calling their insurance company directlyAlthough we do not agree that we were negligent, we do believe there was a miscommunication between the office staff and the patientIn light of this and in good faith effort to reconcile these differences, we would be happy to waive any remaining balance and consider our patient's account as paid in full

[redacted] [redacted] *** [redacted] Response to Complaint on 11/5/2014: On 11/4/the patient called and asked to schedule a chiropractic appointmentHe stated that he was in a lot of pain and needed to get in as soon as possibleWe gave the patient two time options to be seen the next dayWe were able to work around his other appointment schedule and scheduled him for an appointment that was convenient for himThe patient stated over the phone that his insurance was brand new and that he had not yet met his deductibleThis led our office staff to believe that the patient was aware of his benefits(It is not unusual for chiropractic benefits to be dependent on the deductible being met.) It was stated by the office staff when the patient arrived, we would call on his insurance to confirm his chiropractic benefitsThis is our procedure for all of our new patients When the patient arrived, our office made copies of his insurance card and called his insurance company while he was in for his treatmentThe insurance company stated that he had met $of his $1,deductible as of 11/5/They stated that after his deductible was met his insurance would cover 60% of all of his visits for visits per calendar year When the patient came out of his appointment, he was told what his insurance would cover and was given the option to pay $and we would submit his claim to insurance, which would apply to his deductible, or we would give him a cash pay price of $and not submit his claim to insuranceThe patient said he needed to call his wifeHis wife immediately began yelling at him on the phone (other patients in the waiting room could hear this taking place.) While his wife was yelling at him, he told the office staff that he didn't understand why his wife was able to go to her chiropractor and she only paid a co-payThe office staff told him that it may be possible that his wife's chiropractor is in-network and that the in-network and out-of-network benefits could be differentThe patient told his wife that we were out of the network and she began to yell more including foul languageHe handed the phone over to the office staffThe patient's wife continued to yell, but it was now directed at our staff and she proceeded to hang up the phone as the office staff was trying to converse about the situationThe patient stepped outside and returned to state that he still had not heard back from his wifeThe patient asked if it would be possible for us to take a partial payment that day since they were not aware of us being out-of-network(Our office requires that all services be paid the day of the treatment.) Our office staff felt this was a reasonable request due to the miscommunication, but wanted to get the approval of the office managerThe office manager agreed, and asked that the patient pay half of his total today, and set up a payment plan for the remainder of his billThe patient was very cooperative throughout his time in our office and seemed appreciative of the payment plan option and made a payment to his account Approximately minutes later, the patient's wife called upset and yelling againShe demanded to Avenues Health Center [redacted] , D.C [redacted] speak with the office managerOur office manager handled the situation very professionally, and was very understanding of the situation and stated that there was a miscommunication, but that we did set up a payment plan with her husbandThe office manager suggested that they contact their insurance company, since Wyoming is considered to be an underserved state, and they may give her the in-network benefitsThe patient's wife proceeded to hang up on the conversation again After dealing with our patient's hostile wife, we as an office, have made the decision that all staff will make sure that our out-of-network status is clear at the time of making appointment

Revdex.com:
I have reviewed the response made by the business, and find that this resolution is satisfactory to me
Regards,
*** ***

Complaint: ***
I am rejecting this response because: The office manager admitted to being completely aware of the fact that their staff should have notified whether they were in or out of network The office manager admitted that the staff was negligent in doing soIf they were at fault and admitted they need to change how they were dealing informing customers of insurance, then they should reimburse and take the payment they received as payment in full
Regards,
*** ***

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Response to Complaint on 11/5/2014: 
On 11/4/2014 the patient called and asked to schedule a...

chiropractic appointment. He stated that he was in a lot of pain and needed to get in as soon as possible. We gave the patient two time options to be seen the next day. We were able to work around his other appointment schedule and scheduled him for an appointment that was convenient for him. The patient stated over the phone that his insurance was brand new and that he had not yet met his deductible. This led our office staff to believe that the patient was aware of his benefits. (It is not unusual for chiropractic benefits to be dependent on the deductible being met.) It was stated by the office staff when the patient arrived, we would call on his insurance to confirm his chiropractic benefits. This is our procedure for all of our new patients. 
When the patient arrived, our office made copies of his insurance card and called his insurance 
company while he was in for his treatment. The insurance company stated that he had met $0.00 of his $1,000 deductible as of 11/5/2014. They stated that after his deductible was met his insurance would cover 60% of all of his visits for 60 visits per calendar year. 
When the patient came out of his appointment, he was told what his insurance would cover and was given the option to pay $150 and we would submit his claim to insurance, which would apply to his deductible, or we would give him a cash pay price of $105 and not submit his claim to insurance. The patient said he needed to call his wife. His wife immediately began yelling at him on the phone (other patients in the waiting room could hear this taking place.) While his wife was yelling at him, he told the office staff that he didn't understand why his wife was able to go to her chiropractor and she only paid a co-pay. The office staff told him that it may be possible that his wife's chiropractor is in-network and that the in-network and out-of-network benefits could be different. The patient told his wife that we were out of the network and she began to yell more including foul language. He handed the phone over to the office staff. The patient's wife continued to yell, but it was now directed at our staff and she proceeded to hang up the phone as the office staff was trying to converse about the situation. The 
patient stepped outside and returned to state that he still had not heard back from his wife. The patient asked if it would be possible for us to take a partial payment that day since they were not aware of us being out-of-network. (Our office requires that all services be paid the day of the treatment.) Our office staff felt this was a reasonable request due to the miscommunication, but wanted to get the approval of the office manager. The office manager agreed, and asked that the patient pay half of his total today, and set up a payment plan for the remainder of his bill. The patient was very cooperative throughout his time in our office and seemed appreciative of the payment plan option and made a payment to his account. 
Approximately 20 minutes later, the patient's wife called upset and yelling again. She demanded to 
Avenues Health Center [redacted], D.C. [redacted] 
speak with the office manager. Our office manager handled the situation very professionally, and was very understanding of the situation and stated that there was a miscommunication, but that we did set up a payment plan with her husband. The office manager suggested that they contact their insurance company, since Wyoming is considered to be an underserved state, and they may give her the in-network benefits. The patient's wife proceeded to hang up on the conversation again. 
After dealing with our patient's hostile wife, we as an office, have made the decision that all staff will make sure that our out-of-network status is clear at the time of making appointment.

Avenues Health Center-- - [redacted], D.C.[redacted]Response to complaint #[redacted] As stated in our previous response, on November 4, 2014, our office spoke with the patient who was in pain and accommodated him and the urgent need of treatment by scheduling him immediately. The care of our patients is always our first priority. When we spoke with the patient over the phone, the patient stated that his insurance policy was new and he had not met his deductible. This led our staff to believe that the patient was aware of his benefits. If a patient is concerned of whether a provider is innetwork or out-of-network, their insurer provides many ways to search in-network providers, including online or calling their insurance company directly. Although we do not agree that we were negligent, we do believe there was a miscommunication between the office staff and the patient. In light of this and in good faith effort to reconcile these differences, we would be happy to waive any remaining balance and consider our patient's account as paid in full.