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Behavioral Health and Eduacation Specialists, Inc

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Behavioral Health and Eduacation Specialists, Inc Reviews (1)

Initial Business Response /* (1000, 6, 2015/08/18) */
Contact Name and Title: [redacted], President
Contact Phone: XXX-XXX-XXXX
BHES is a behavioral health outpatient practice. When patients call for their first appointment, we tell them we will, as a courtesy, verify their insurance...

benefits. We also recommend they call their insurance and verify their benefits as it is ultimately the patient's responsibility to know their insurance benefits. When we verified this patient's insurance benefits, we were told the patient had a $35.00 copay and a $400.00 deductible (the amount of money the patient needs to pay for services prior to any insurance benefits being issued).
This patient had sessions dated 1/20/15, 1/27/15, 2/5/15, 2/19/15 and 3/10/15 and the patient made the $35.00 copay at the time of service for all of the sessions, except on 1/27/15 $30.00 was paid and on 2/5/15 $40.00 to make up for the $5.00 not paid the prior session.
Given that the patient had a $400.00 deductible, the insurance company did not make any payments to BHES for those five sessions as the patient had not yet met the policy deductible; that means the patient owed 100% of the allowed amount (the total amount BHES has agreed to accept as payment in-full for the session) for the sessions (copay + remainder of the allowed amount that went towards the patient's deductible).
Once the insurance company processes a claim, BHES is provided an Explanation of Benefits which itemizes the amount charged for the session, the allowed amount for the session, the amount of the charged amount that needs to be written off because the charged amount was over the allowed amount, the amount the insurance company paid for the session and the amount the patient owed for the session. It is only at that time that BHES learned that the patient owed more money because those sessions went toward her deductible. Since the patient had not yet met their deductible, the patient owed BHES the additional money. This is not a fee BHES created or decided to charge the patient pay. Rather, this is additional money the patient is responsible to pay BHES due to the insurance policy benefits.
In this instance, the patient owed BHES $100.00 to cover the additional costs related to the sessions going towards the patient's deductible; once the deductible is met, the insurance company covers the additional amount.
If additional information is needed on that part of the complaint, please contact me at the number listed in this response and I can address anything you may need.
As for this patient being told by our Billing Specialist the patient's account is going to be sent to our collection agency, it is accurate the patient was told that would happen if the account balance was not paid in full immediately. BHES' Behavioral Health Services Financial Policy states that all "balances are due 30 days from the billing date" and that when an "account balance has not been paid within 30 days of the office billing date and you have not contacted the office regarding your account, your account may be referred to an independent collection agency." The patient signed the BHES Behavioral Health Services Financial Policy dated 1/20/15.
In this case, BHES mailed this patient monthly statements for the outstanding patient responsibility dated 4/1/15, 5/4/15, 6/2/15, 7/7/15 and 8/3/15. The patient did not make a payment to BHES for the additional patient responsibility after receiving several monthly statements and we provided plenty of time for the patient to make a payment beyond the 30 days required per our Behavioral Health Financial Policy; we try to work as much as possible with our patients to given them the opportunity to meet their financial obligations to our practice.
Along with the 7/7/15 statement, a notice of Final Warning was mailed to the patient as well informing the patient the account would be turned over to collections if the outstanding balance was not paid within 10 business days. Again, we did not receive payment from this patient for the outstanding balance that had been owed since March 2015 (the patient would have been informed of this balance in the 4/1/15 statement).
Given the patient's non-payment of the outstanding balance, our practice's last resort to receive payment for the amount owed is to turn the account over to our collections agency. In this case it appeared that was going to be our final option since the patient had not made a payment for several months.
Even though the patient was informed the account would be turned over to our collections agency, the patient spoke with one of the owners about the outstanding balance and chose to pay the balance in full prior to the account actually being turned over to collections. So, in this instance the account was not turned over to our collection agency.
As for the complaint that BHES' Billing Specialist hung up on the patient, I have spoken with our Billing Specialist about the situation. She told me that after she had about a 30 minute conversation with the patient without being able to resolve the issue, the Billing Specialist told the patient she was ending the call and then hung up the phone. It is possible the patient did not hear the Billing Specialist say she was ending the call and therefore the patient may have thought our Billing Specialist simply hung up on the patient. I have spoken with our Billing Specialist about additional ways to go about ending a long call in a manner where it does not appear she simply hangs up on the patient. The Billing Specialist was quite responsive to the feedback.
As for the Billing Specialist not taking additional calls from the patient that day, that also seems to be accurate as the Billing Specialist wanted to speak with the owners prior to speaking again with the patient, The Billing Specialist did speak with the owners, and then an owner spoke with the patient and the patient agreed to make the payment in full. I have also spoken with the Billing Specialist about how to better handle such situations in the future so the patient realizes the steps BHES is taking to address the concern and understands the issue has not been ignored or dismissed.
It is unfortunate this case worked out this way. Insurance coverage can be confusing and I believe this whole situation resulted from confusion on multiple levels related to the patient's insurance benefits and financial responsibility.
I hope this helps explain the items addressed in the complaint. Again, feel free to reach out to me if there are any further questions.

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Address: 14953 S Van Dyke Rd, Plainfield, Illinois, United States, 60544-5804

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