Blair Realty of New Bern, LLC

When Mr [redacted] called us the first time, we did an assessment with him over the phoneOver the phone, Mr [redacted] gave us the information of using [redacted] x 1-months daily, but when we did the nursing assessment inside the facility, Mr [redacted] gave us different information of using [redacted] only mg x one month, which is not a qualification for our detox programWe have written documentation of the nursing assessment to verify this informationWe gave Mr [redacted] Information about his coverage based on the information he had given us over the phone, the reason we had never made an insurance authorization for the client is because the information was inaccurate, and the bill was sent directly to Mr [redacted]

Complaint: ***
I am rejecting this response because:
re: ***This issue has not been resolved and I was not aware I had to respond assuchPlease reopen this complaint because this issue has most certainly notbeen resolved.*** ***
Regards,
*** ***

To Whom it May Concern: Regarding Complaint ID # *** I have researched the complaint in detail and apologize for any inconvenience that this matter has caused the customerIn an effort to resolve the matter, I have asked our internal Insurance Processing group to contact the Customer and
verify that we have accurate insurance information on fileOnce this is confirmed the Processing Group is instructed to file the requested claims on behalf of the customer and respond to any and all requests from the insurance company regarding the claimOnce the insurance company completes processing the claim and remits a check to us we will review the accompanying Explanation of Benefits for any potential customer responsibility (i.edeductible, co-insurance and copay) and forward any money that should be returned to the patient. Should you have any questions or require additional information regarding this matter I can be reached at *** Sincerely, *** ***A/R Manage

When Mr. [redacted] called us the first time, we did an assessment with him over the phone. Over the phone, Mr. [redacted] gave us the information of using [redacted] x 1-2 months daily, but when we did the nursing assessment inside the facility, Mr. [redacted] gave us different...

information of using [redacted] only 2 mg x one month, which is not a qualification for our detox program. We have written documentation of the nursing assessment to verify this information. We gave Mr. [redacted] Information about his coverage based on the information he had given us over the phone, the reason we had never made an insurance authorization for the client is because the information was inaccurate, and the bill was sent directly to Mr. [redacted].

Complaint: [redacted]
I am rejecting this response because: This a complete lie. I am completely unaware of this reaction. I was told "someone dropped the ball and we need you to go to another facility for a month (they suggested their facility in [redacted] - which I rejected) for this to be payable thru [redacted]." No mention was ever made to any other option - for any other reason. I have never been told anything like this - my memory is fine. Made up - a complete fabrication. I stand by my original statement.
Regards,
[redacted]

It is our practice to verify insurance benefits prior toadmission, and gather appropriate information to qualify the client for ourprogram.  The verification of benefits isnot a guarantee that the insurance will cover the stay,that is based on medicalnecessity and criteria. During Mr. [redacted]’s prescreen over the phone, hereported taking [redacted] daily for 1-2 months. A daily use of [redacted] would require our services and meet medicalnecessity, which is why we scheduled him for admission. Upon admission into the facility, Mr. [redacted] wasassessed by the medical staff. This is standard procedure and necessary inorder to properly treat our population. During his nursing assessment Mr.[redacted] revealed that he was taking 2mg of [redacted] once a month, not daily for1-2 months as he stated previously during prescreen.  We did not attempt to pre-cert Mr. [redacted]due to his reported use and the fact he did not meet medical necessity for thedetox level of care. Once he was evaluated and placed on an observationprotocol, the staff approached him to discuss his options. It was explained toMr. [redacted] that he did not meet criteria for a detox protocol, and that wecould work with him to set up aftercare. We typically recommend that clients follow up with aftercare once theyare cleared for discharge from our facility, the average length of stay in mostresidential/inpatient aftercare programs is typically 30 days.  Mr. [redacted] refused the aftercarerecommendation and signed off that he refused.  Additionally, it was explained that we wouldnot be attempting to pre-cert his case with his insurance company, and weattempted to collect payment. When Mr. [redacted] explained that he was unable topay at this time, we let him know he would receive a bill in the mail.  Additionally, when Mr. [redacted] voluntarilysigned himself into our facility, he signed the financial agreements whichstate that ultimately he is financially responsible for his stay.  [redacted] Executive Director Sunrise Detox Centers