Brain N Sync

September 14, 2014
 
Dear [redacted],
            This letter is in response to complaint ID# [redacted].
Brain N Sync, LLC provides Neurofeedback for people with diverse mental disorders. I did start seeing the claimant’s son on...

February 2, 2014. I called [redacted] to verify their insurance. [redacted] at customer service verified I was a provider. [redacted] informed me that “benefits are not guaranteed until claims are filed”. This is a standard response from every insurance company.  The claimant’s wife also informed me that she had called [redacted] and verified I was a provider with them. After six sessions, I filed the proper [redacted] form to the [redacted] for claims on March 10, 2014. I only filed one claim in March because there was no sense in filing another claim just to have it denied.
            On March 26, 2014, I received a denial letter from them stating I was not a provider for them. At my client’s next session, I informed the claimant’s wife that the insurance company denied the claim. I informed her that I would call to see what was going on. I have documentation showing I called every week until April 20, 2014 to get this fixed. I faxed proper paperwork to [redacted] four times (I also have documentation showing the fax dates and times). I kept getting referred to different departments at the insurance company. Throughout this whole time, I kept the claimant’s wife informed of the status and what the insurance was saying.
            [redacted] took over from [redacted] to process the claims for [redacted] in April 2013. When I took over Brain N Sync in June 2013, I was informed I was an active, non network provider.  Throughout the month of April while attempting to straighten this out, I found out that when the files were transferred from [redacted] to [redacted], the credentialing department did not receive the update with my new address and status. I had sent my new address and certification to them in July 2013 two times.  [redacted] computer system was not correct with my information.
            On April 20, 2014, I received a letter from [redacted] stating they had decided not to include me in their list of providers at this time.  I immediately informed the claimant’s wife about it and they still kept two more appointments with me.  At that time, I asked if she wanted to stop the sessions because they were unable to complete the other sessions with the counselor and she said yes. The claimant’s wife told me that she would use her credit card to pay the bill.
            I discounted my rate to my cash rate for them. I offered to make payment arrangements as well. I mailed them three bills to which I received no reply. On the last bill that was mailed, I made a note stating that if the bill was not paid within 30 days the account would be sent to collections.  After no response, my collection agent contacted them several times for payment.  On August 21, 2014 they paid the bill, which was 6 months after the services were rendered.
            When the client started service, the claimant’s wife signed Brain N Sync’s Informed Consent. She signed the informed consent and initialed besides the insurance statement: “It is my responsibility to know if the services rendered are covered by insurance, if there is a deductible and/or co-pay, and agree to pay remaining charges”. 
At no time did I lie or deceive the claimant. I was up front with the insurance issue from March 26th on.  The claimant’s wife was aware of what I was doing with the insurance. I kept her updated every week. The claimant could have stopped treatment at any time.    
Most insurance companies will reimburse their beneficiaries for services rendered by a non provider, usually at a discounted rate. The claimant can contact [redacted] to find out how to submit a claim for reimbursement themselves. If they need a superbill to submit to the insurance company, I would be happy to provide one for them.   [redacted]’s form is [redacted] DoD/[redacted] MEDICAL CLAIM PATIENT'S REQUEST FOR MEDICAL PAYMENT, ** Form[redacted]. It is on [redacted]’s website under medical forms.
Since it took them over 6 months to pay for the services that were rendered from February to April, discounted the rate to my cash rate for them,   and waived the collection fee, Brain N Sync, LLC will not be refunding any money to the claimant.
Sincerely,
[redacted]
Owner
Brain N Sync, LLC

September 14, 2014

 

Dear [redacted],

            This letter is in response to complaint ID# [redacted].

Brain N Sync, LLC provides Neurofeedback for people with diverse mental disorders. I did start seeing the claimant’s son on...

February 2, 2014. I called [redacted] to verify their insurance. [redacted] at customer service verified I was a provider. [redacted] informed me that “benefits are not guaranteed until claims are filed”. This is a standard response from every insurance company.  The claimant’s wife also informed me that she had called [redacted] and verified I was a provider with them. After six sessions, I filed the proper [redacted] form to the [redacted] for claims on March 10, 2014. I only filed one claim in March because there was no sense in filing another claim just to have it denied.

            On March 26, 2014, I received a denial letter from them stating I was not a provider for them. At my client’s next session, I informed the claimant’s wife that the insurance company denied the claim. I informed her that I would call to see what was going on. I have documentation showing I called every week until April 20, 2014 to get this fixed. I faxed proper paperwork to [redacted] four times (I also have documentation showing the fax dates and times). I kept getting referred to different departments at the insurance company. Throughout this whole time, I kept the claimant’s wife informed of the status and what the insurance was saying.

            [redacted] took over from [redacted] to process the claims for [redacted] in April 2013. When I took over Brain N Sync in June 2013, I was informed I was an active, non network provider.  Throughout the month of April while attempting to straighten this out, I found out that when the files were transferred from [redacted] to [redacted], the credentialing department did not receive the update with my new address and status. I had sent my new address and certification to them in July 2013 two times.  [redacted] computer system was not correct with my information.

            On April 20, 2014, I received a letter from [redacted] stating they had decided not to include me in their list of providers at this time.  I immediately informed the claimant’s wife about it and they still kept two more appointments with me.  At that time, I asked if she wanted to stop the sessions because they were unable to complete the other sessions with the counselor and she said yes. The claimant’s wife told me that she would use her credit card to pay the bill.

            I discounted my rate to my cash rate for them. I offered to make payment arrangements as well. I mailed them three bills to which I received no reply. On the last bill that was mailed, I made a note stating that if the bill was not paid within 30 days the account would be sent to collections.  After no response, my collection agent contacted them several times for payment.  On August 21, 2014 they paid the bill, which was 6 months after the services were rendered.

            When the client started service, the claimant’s wife signed Brain N Sync’s Informed Consent. She signed the informed consent and initialed besides the insurance statement: “It is my responsibility to know if the services rendered are covered by insurance, if there is a deductible and/or co-pay, and agree to pay remaining charges”. 

At no time did I lie or deceive the claimant. I was up front with the insurance issue from March 26th on.  The claimant’s wife was aware of what I was doing with the insurance. I kept her updated every week. The claimant could have stopped treatment at any time.    

Most insurance companies will reimburse their beneficiaries for services rendered by a non provider, usually at a discounted rate. The claimant can contact [redacted] to find out how to submit a claim for reimbursement themselves. If they need a superbill to submit to the insurance company, I would be happy to provide one for them.   [redacted]’s form is [redacted] DoD/[redacted] MEDICAL CLAIM PATIENT'S REQUEST FOR MEDICAL PAYMENT, ** Form[redacted]. It is on [redacted]’s website under medical forms.

Since it took them over 6 months to pay for the services that were rendered from February to April, discounted the rate to my cash rate for them,   and waived the collection fee, Brain N Sync, LLC will not be refunding any money to the claimant.

Sincerely,

Owner

Brain N Sync, LLC