Bacay Medical Associates

Review: I received a bill from your medical office stating that I owe you $73.00, according to my billing insurance payment statement, it says that the total charge was $93.00 minus the ppo discount of $39.65, which should be $53.35 and then the insurance paid you $8.13, so in reality I owe you $45.22

I included the statement from the insurance to the Revdex.comDesired Settlement: I want to have my account adjusted to the proper amount

Business

Response:

This letter is in response to the complaint assigned ID # [redacted].According to the notice we received from the patient’s health plan, the service in the amount of $73 was “not a benefit of the subscriber’s health plan”. The health plan statement also indicates “the subscriber is responsible only for deductible, co-payment amounts, and non-covered items”.After reviewing the documentation the patient himself presented as confirmation of his complaint; it clearly shows an amount of $73 under the heading of “Patient’s Portion”; just as our copy states. Our office does not bill patients for any amounts other than what their health plan indicates is their responsibility to pay. The patient’s Explanation of Benefits indicates that the “Patient’s Portion” is $73.00, and therefore, we are billing him for $73.00.Sincerely,[redacted], Billing Manager[redacted]

Consumer

Response:

I am rejecting this response because: it clearly shows a ppo discount on the billing statement! How do I still get charged $73 if it shows a discount?

Business

Response:

If you look at the [redacted] Explanation of Benefits that our office received, there are two (2) charges that represent the total amount of $93.00. Line one for $73.00 that has not been paid by the insurance. The reason given by the insurance is that this item is “not a benefit of the subscriber’s health plan. Line two is for $20.00 and was paid in the amount of $8.13, with a contractual adjustment on our part of $11.87. The notice states that the subscriber is responsible for “deductible, co-payment amounts, and non-covered services”. It appears the confusion is coming from the notice that the patient obtained from his insurance company. First, they have grouped two separate charges into one line item. Secondly, they have indicated that the “Patient Portion” is $73.00, but on the same line they have indicated an amount of $39.65 under the heading “PPO Discount”. It is very obvious that these figures do not match up. We have processed this account in accordance with the notice that the member’s health plan remittance we received; and billed the member for the amount of $73.00 for a “non covered benefit”. At this point, I would suggest the member dispute the differences in the amount owed with his insurance company. Since the discrepancy appears on the statement he obtained from them. Sincerely,[redacted] Billing Manager[redacted]

Consumer

Response:

I have paid you in full.