To Whom It May Concern:
255);">I apologize in the delay for responding to this complaint, but today's email is the first notification that I have seen I need to update my physical address with you as we have recently movedIn reading her complaint, I cannot find any truth DrK*** doesn't discuss insurance filings Pre-determination for surgery takes anywhere from 30-days to hear back from insurance companies and patient's are advised of this in advance Never would he have told a patient that we would have known within a week
We send the pre-determination letters as a convenience to our patient's but ultimately, a patient's private medical insurance is their own policy They can call the insurance company themselves at any point in time for a status update Insurance delays have nothing to do with my office or staff There was absolutely no delay in speaking to the patient and at no point did she ever not receive a call back She was frustrated that we didn't have the information she was looking for, which is understandable, but again she needs to take this up with her insurance companyShe is upset that her surgery wasn't approved Insurance companies can be extremely difficult to deal with and this can happen for a variety of reasons Sometimes the codes aren't eligible in their plan, sometimes they want more information before making a decision, and sometimes they just don't feel the patient meets the medical criteria We do appeal any denials, but again, this has nothing to do with my office or staff Our billing department doesn't deny claims, only the insurance company With our Financial Policy that she signed, it clearly states that her insurance company is her responsibility and anything we file is as courtesyI'm not quite sure where she is seeing any type of *** *** code, but the patient never allowed me the opportunity to look into it for her Regardless, medical billing codes (*** codes and *** diagnosis codes) are the same for any procedure For example, a *** is an office visit -- it doesn't matter if it is a *** ***, private insurance, *** or even a cash paying client They are the EXACT same codes This was explained to herThe problem is that she was absolutely belligerent and degrading when she would speak to my staff She yelled and cussed at them, called them "screw ups" and an assortment of other names It was to the point that no one wanted to speak to her when she called, which makes it ultimately my responsibility I was never anything but polite and professional to her and tried explaining all of this to her I was told repeatedly to "shut my mouth" and let her speak, which I did I took all of the verbal abuse from her as I would never require my staff to be subjected to that NEVER did I hang up on her, she did that to me MULTIPLE times But I feel this is why there was never a resolution as I was unable to explain anything to this patient Personally, I don't feel she was looking for as much of a resolution as she was looking to vent her frustrationThere is a proper protocol for "firing" patients from a practice of which I have no authority to do so, nor did I HOWEVER at no point are we required to perform a surgery on a patient It is at the physician's discretion to determine whether a patient is suitable for surgery and mental instability is an extremely valid reason for deciding against performing a surgery Granted, I would NEVER tell a patient this, but instead I may say (like I told her) that "maybe there is another physician that is better suited for you." Physician-patient relationships are CRITICAL in the care of the patient Any breakdown in the relationship is a possible breakdown in care and we never want to see that happen We would rather refer the patient out to another physicianAdditionally, she has stated that I denied her medical records request but I have never received a medical records request from her By law, I cannot release these records without the proper release on file so she must come in and fill out the form If she doesn't want to come in, she can send her request in writing I gave her information for requesting her recordsShe has since gone on to post reviews online filled with these lies and defamation Now receiving this from the Revdex.com, there will be no response on my part other than contacting my attorney to draft a cease and desist as this situation has gotten far too out of hand I completely understand her frustration with having a surgery denied, but there is no reason for this and I will not tolerate these actions against our practice
Thank you,
Amber K***
To Whom It May Concern:
255);">I apologize in the delay for responding to this complaint, but today's email is the first notification that I have seen I need to update my physical address with you as we have recently movedIn reading her complaint, I cannot find any truth DrK*** doesn't discuss insurance filings Pre-determination for surgery takes anywhere from 30-days to hear back from insurance companies and patient's are advised of this in advance Never would he have told a patient that we would have known within a week
We send the pre-determination letters as a convenience to our patient's but ultimately, a patient's private medical insurance is their own policy They can call the insurance company themselves at any point in time for a status update Insurance delays have nothing to do with my office or staff There was absolutely no delay in speaking to the patient and at no point did she ever not receive a call back She was frustrated that we didn't have the information she was looking for, which is understandable, but again she needs to take this up with her insurance companyShe is upset that her surgery wasn't approved Insurance companies can be extremely difficult to deal with and this can happen for a variety of reasons Sometimes the codes aren't eligible in their plan, sometimes they want more information before making a decision, and sometimes they just don't feel the patient meets the medical criteria We do appeal any denials, but again, this has nothing to do with my office or staff Our billing department doesn't deny claims, only the insurance company With our Financial Policy that she signed, it clearly states that her insurance company is her responsibility and anything we file is as courtesyI'm not quite sure where she is seeing any type of *** *** code, but the patient never allowed me the opportunity to look into it for her Regardless, medical billing codes (*** codes and *** diagnosis codes) are the same for any procedure For example, a *** is an office visit -- it doesn't matter if it is a *** ***, private insurance, *** or even a cash paying client They are the EXACT same codes This was explained to herThe problem is that she was absolutely belligerent and degrading when she would speak to my staff She yelled and cussed at them, called them "screw ups" and an assortment of other names It was to the point that no one wanted to speak to her when she called, which makes it ultimately my responsibility I was never anything but polite and professional to her and tried explaining all of this to her I was told repeatedly to "shut my mouth" and let her speak, which I did I took all of the verbal abuse from her as I would never require my staff to be subjected to that NEVER did I hang up on her, she did that to me MULTIPLE times But I feel this is why there was never a resolution as I was unable to explain anything to this patient Personally, I don't feel she was looking for as much of a resolution as she was looking to vent her frustrationThere is a proper protocol for "firing" patients from a practice of which I have no authority to do so, nor did I HOWEVER at no point are we required to perform a surgery on a patient It is at the physician's discretion to determine whether a patient is suitable for surgery and mental instability is an extremely valid reason for deciding against performing a surgery Granted, I would NEVER tell a patient this, but instead I may say (like I told her) that "maybe there is another physician that is better suited for you." Physician-patient relationships are CRITICAL in the care of the patient Any breakdown in the relationship is a possible breakdown in care and we never want to see that happen We would rather refer the patient out to another physicianAdditionally, she has stated that I denied her medical records request but I have never received a medical records request from her By law, I cannot release these records without the proper release on file so she must come in and fill out the form If she doesn't want to come in, she can send her request in writing I gave her information for requesting her recordsShe has since gone on to post reviews online filled with these lies and defamation Now receiving this from the Revdex.com, there will be no response on my part other than contacting my attorney to draft a cease and desist as this situation has gotten far too out of hand I completely understand her frustration with having a surgery denied, but there is no reason for this and I will not tolerate these actions against our practice
Thank you,
Amber K***