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Bronxville Eye Care Associates

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Bronxville Eye Care Associates Reviews (7)

[redacted] presented to the office with her insurance card on She stated that she had called and requested a referral authorization from her primary care physician [redacted] is participating with the insurance, but the patient is responsible to seek treatment within the guidelines of her policyThe patients primary care physician never sent the referral to the insurance company, resulting in non-payment to [redacted] ***This is in no way the fault of [redacted] ***The initial claim was submitted to Montefiore IPA who administers the patients insurance for $for a comprehensive exam as well as several diagnostic testsUpon receipt of an explanation of benefits from the patients insurance company CMO Claim # [redacted] , and [redacted] , [redacted] reduced her fee to the allowed contracted amounts payable per the insurance company which totals This is the contracted fee that would have been paid had the patients primary care physician issued the referral [redacted] provided care to the patient and is entitled to the approved fees for serviceThe patients insurance company did not resolve [redacted] 's issue because the procedure for benefits was not properly executed [redacted] is responsible for payment as a resultWe are willing to work out a payment plan that can assist the patient in paying the approved fee for the service provided, but are not willing to waive all the fees as no payment has been received

The business has responded Please see below: [redacted] filled out a New Patient Information form on Our office policy is clearly stated on that form" REFERRALS: If your insurance company requires that you obtain a referral for your visit, it is your responsibility to make appropriate arrangementsWe are not responsible to know the requirements of your insuranceIt is your responsibility to provide us with your current insurance information and referral if requiredIf your failure to obtain a referral or provide the correct insurance results in nonpayment from your insurance company you will be financially responsible for the visit." We have fully explained that we are operating within our understanding of our contract with the patients insurance companyUnless the patient can produce documentation from her insurance that we are contractually obligated NOT to balance bill her the bill stands as previously discussed

Revdex.com: I have reviewed the response made by the business in reference to complaint ID# [redacted] , and have determined that my complaint has NOT been resolved because:They still want me to pay the billSince I called my PCP to ask for the referral and followed all the insurance company policy It`s not my fault, the referral isn`t give to the patients it`s send through fax from one doctor (PCP) to another [Your Answer Here] In order for the Revdex.com to appropriately process your response, you MUST answer the question above Sincerely, [redacted]

[redacted] presented to the office with her insurance card on 08/**/14. She stated that she had called and requested a referral authorization from her primary care physician. [redacted] is participating with...

the insurance, but the patient is responsible to seek treatment within the guidelines of her policy. The patients primary care physician never sent the referral to the insurance company, resulting in non-payment to [redacted]. This is in no way the fault of [redacted]. The initial claim was submitted to Montefiore IPA who administers the patients insurance for $505.00 for a comprehensive exam as well as several diagnostic tests. Upon receipt of an explanation of benefits from the patients insurance company CMO Claim # [redacted], and [redacted], [redacted] reduced her fee to the allowed contracted amounts payable per the insurance company which totals 266.21. This is the contracted fee that would have been paid had the patients primary care physician issued the referral. [redacted] provided care to the patient and is entitled to the approved fees for service. The patients insurance company did not resolve [redacted]'s issue because the procedure for benefits was not properly executed. [redacted] is responsible for payment as a result. We are willing to work out a payment plan that can assist the patient in paying the approved fee for the service provided, but are not willing to waive all the fees as no payment has been received.

The business has responded.  Please see below:
[redacted] filled out a New Patient Information form on 08/**/14. Our office policy is clearly stated on that form. " REFERRALS: If your insurance company requires that you obtain a referral for your visit, it is your responsibility to make appropriate arrangements. We are not responsible to know the requirements of your insurance. It is your responsibility to provide us with your current insurance information and referral if required. If your failure to obtain a referral or provide the correct insurance results in nonpayment from your insurance company you will be financially responsible for the visit." We have fully explained that we are operating within our understanding of our contract with the patients insurance company. Unless the patient can produce documentation from her insurance that we are contractually obligated NOT to balance bill her the bill stands as previously discussed.

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID# [redacted], and have determined that my complaint has NOT been resolved because:They still want me to pay the bill. Since I called my PCP to ask for the referral and followed all the insurance company policy It`s not my fault, the referral isn`t give to the patients it`s send through fax from one doctor (PCP) to another. 

[Your Answer Here]
 
 
 
 
In order for the Revdex.com to appropriately process your response, you MUST answer the question above.
Sincerely,[redacted]

Review: The issue is about Bronxville Eye Associates trying to collect a bill for 266.21 for an office visit which they claim they received no payment from my insurance company.

Initially I contacted my Primary care Physician, PCP ([redacted]'s office) for a referral since the Eye Associates office doctor Audell Ray is in my plan.

([redacted]'s office phone is ###-###-####, [redacted])

The insurance company, EmblemHealth (My ID: [redacted]), has a case number for this issue: Claim # [redacted], Service Date: 08/**/2014, provider Audell Ray.

The insurance company says the office of [redacted]'s never sent the referral so it doesn't have it on file as of yet, and therefore it never paid the Eye Associates's office.

I contacted both offices and the insurance company to explain that I requested the referral but nothing could be done since [redacted]’s office never sent the referral.

This is not the first time the office of [redacted]’s forgot to send a referral in my behalf since I had him as my PCP.

I don’t think I am responsible to pay the bill since [redacted] is in my plan, I requested the referral as my plan requires and followed the procedures as I normally do. I even called the office of [redacted]'s to confirm the referral had been sent since I had problems with the office before. The bill from Eye Associates is already over 30 days old and I can’t get it resolved by regular means.Desired Settlement: As soon as possible since the bill is over 30 days old.

Business

Response:

[redacted] presented to the office with her insurance card on 08/**/14. She stated that she had called and requested a referral authorization from her primary care physician. [redacted] is participating with the insurance, but the patient is responsible to seek treatment within the guidelines of her policy. The patients primary care physician never sent the referral to the insurance company, resulting in non-payment to [redacted]. This is in no way the fault of [redacted]. The initial claim was submitted to Montefiore IPA who administers the patients insurance for $505.00 for a comprehensive exam as well as several diagnostic tests. Upon receipt of an explanation of benefits from the patients insurance company CMO Claim # [redacted], and [redacted], [redacted] reduced her fee to the allowed contracted amounts payable per the insurance company which totals 266.21. This is the contracted fee that would have been paid had the patients primary care physician issued the referral. [redacted] provided care to the patient and is entitled to the approved fees for service. The patients insurance company did not resolve [redacted]'s issue because the procedure for benefits was not properly executed. [redacted] is responsible for payment as a result. We are willing to work out a payment plan that can assist the patient in paying the approved fee for the service provided, but are not willing to waive all the fees as no payment has been received.

Consumer

Response:

I have reviewed the response made by the business in reference to complaint ID# [redacted], and have determined that my complaint has NOT been resolved because:They still want me to pay the bill. Since I called my PCP to ask for the referral and followed all the insurance company policy It`s not my fault, the referral isn`t give to the patients it`s send through fax from one doctor (PCP) to another.

[Your Answer Here]

In order for the Revdex.com to appropriately process your response, you MUST answer the question above.

Sincerely,

Business

Response:

The business has responded. Please see below:[redacted] filled out a New Patient Information form on 08/**/14. Our office policy is clearly stated on that form. " REFERRALS: If your insurance company requires that you obtain a referral for your visit, it is your responsibility to make appropriate arrangements. We are not responsible to know the requirements of your insurance. It is your responsibility to provide us with your current insurance information and referral if required. If your failure to obtain a referral or provide the correct insurance results in nonpayment from your insurance company you will be financially responsible for the visit." We have fully explained that we are operating within our understanding of our contract with the patients insurance company. Unless the patient can produce documentation from her insurance that we are contractually obligated NOT to balance bill her the bill stands as previously discussed.

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Description: OPTICIANS

Address: 77 Pondfield Road, Bronxville, New York, United States, 10708


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