I am rejecting this response because:The excerpt provided in Burger's response states that it will attempt to verify insurance and relevant co-pay/deductible, and provide an estimate to the patientHowever, their staff members did not follow the procedure according to its agreementAs stated in the original complaint, we had never been provided with an estimate on co-pay/deductible during the multiple visits We were not informed with any out-of-pocket expense estimate prior to or during the treatmentWe were never been consulted by the therapist regarding costs or given the right to choose between treatment optionsThe response from Burger failed to address the second issue raised in the original complaint, which is related to their practice of not billing patients until they have completed the entire treatments with multiple visitsThis further hindered patients' ability to understand the cost implication, and therefore make corrective decisions as necessary, before finishing the entire treatmentIn my wife's case, her (nine) visits spanned over days and she had not received any bills before all visits were completed
I am rejecting this response because:First, the response provided by Burger was misleading It attempted to shift away from their failure of providing billing transparency to patients Instead, the letter accused the patient for not being financially responsible for the services received This is completely falseSecond, Burger attempted to blame the medical insurance system for their inability to disclose out-of-pocket expense for patients Although it may be true that the insurance system may cause some complexity to the calculation of patients' out-of-pocket expense They should provide training for their front office (as most dental offices do) so that they can consult with the insurance company and develop out-of-pocket expense estimate for each patient Third, Burger has the ability to provide individual service statements to patients However, they choose to only send monthly bills For whatever reason that I will not play judgement here, this basically prevents patients to take immediate actions after servicesIn summary, based on my communication with Burger, it is clear that for any patient that visits their offices, he or she should not expect to understand the out-of-pocket expense for the services until well after their service is completed, often times multiple sessions In my case, I now feel lucky that our total expense was around dollars But what if it was $6,or $60,000? The patients still would have no way to find out until receiving the monthly bill Just a final comment regarding Burger's practice Today I received a letter from Burger threatening to forward our bills to collection Keep in mind that this is in the midst of their ongoing communication with the patient through Revdex.com I will go ahead and make the payment instead of wasting more time on this matter But I hope at least this series of letters will become public as a reference for their future patients We will continue to seek legal services on this matter We will no longer work with Burger through Revdex.com
Burger Physical Therapy prides itself on excellent service and professionalismWe take any concern with our company very seriously and have completed a formal investigation regarding the aforementioned concerns As I Informed the complainant listed above, it is not our policy to quote insurance benefits to patientsDue to the complexity of coverage, frequently changing policies, and sheer number of insurance carriers that we are contracted with, we have informed our patients that it Is their responsibility to be informed regarding their insurance coverageWe encourage all of our patients to reach out to their insurance plan and/or employer If they have questions regarding coverage and/or benefitsAll patients receive and sign our form entitled “Know Your Benefits” and our “Consent Form.” See below for relevant excerpts from those forms which this complainant signed prior to his first treatment: You are responsible for charges incurred during the course of your treatmentAs a courtesy, we will attempt to verify your insurance benefits and relevant co-pay/deductible amountsThis is an estimate provided by your insurance carrier to usIt is only upon claim submittal and processing(which can take up to days or more) that we are informed by your Insurance company of the actual portion you owe of your treatment costIt is ultimately your responsibility to Inform yourself of your Insurance benefits and limitation We will bill your PRIMARY Insurance carrier; however, ALL bills are due and payable within daysPatients are financially responsible for all charges incurred during treatment, regardless pf expected reimbursement by insuranceBy signing this, I understand and agree that If my Insurance carrier or other parry makes payments to me or to my representative for my treatment, I agree to Immediately remit those funds to Burger Physical Therapy and Rehabilitation Agency, Inc In response to the desired settlement of this patient: We are comfortable with our billing practices and do not feel we need to make any changesUnfortunately, medical insurance/coverage can sometimes be difficult to understand which is why patients are encouraged to inform themselves regarding their coverage/benefits We are not exempting this patient or his wife from their financial responsibilityThey received the services provided and are financially responsible for their portion as dictated by their insurance company as outlined in the explanation of benefits received by the patient
To reiterate, it is not our policy to quote insurance benefits to patientsWe do not provide an estimate to the patients rather we inform our patients that is their responsibility to inform themselves regarding their insurance coverage and financial responsibilityWe encourage all of our patients to reach out to their insurance plan and/or employer if they have questions regarding coverage and/or benefitsAll patients receive and sign our form entitled "Know Your Benefits" and our "Consent Form" which was detailed in our previous response on 09/02/ We bill monthlyIt is not our practice to bill patients when they have completed their treatments, rather we bill patients as soon as we have accurate information from their insurance company regarding their financial responsibilitySee previous response dated 09/02/regarding our billing practices We are not exempting this patient or his wife from their financial responsibilityThey received the services provided and are financially responsible for their portion as dictated by their insurance company as outlined in the explanation of benefits received by the patient Respectfully,
I would like to add a few comments regarding the complaint filed regarding our billing practices at Burger Rehabilitation After researching the information from the patient and from our billing department, I am trying to correlate the expectations from the patient related to services rendered and the cost of those services along with our policies and procedures I am always looking for ways to improve process and we will certainly look at any opportunities to make this easier for patients to understand in the future However, we struggle with current insurance processes outside of our control and consequently are not able to give anyone a hard and fast number when it comes to cost when they are using an insurance policy It is our policy to direct any patient that requests further assistance to our billing department and ultimately to their own insurance carrier for specific information It is also the patient’s responsibility to know what their benefits are and what insurance they have purchased We call to verify eligibility but cannot depend upon the insurance company to give us full information until after the plan is billed Each insurance plan has multiple variables that change with every single policy While I understand that this patient is frustrated with the complexities of the billing system and likely does not understand how it works, I would like to point out that in his case, the insurance approved a total of $for the service rendered The insurance only paid $apparently because the patient still had a share of copay and an unmet deductible His request to have us discount his entire bill down to the $paid by the insurance company seems disingenuous at best It appears that he is saying that he wants to pay nothing for his multiple days of service Surely, he understood that he would have responsibility for his deductible and copays He did sign intake paperwork acknowledging this fact If he had a concern about the total bill, he certainly had the right to decline service prior to receiving it With regard to his wife’s services, the insurance company authorized $as total payment and reimbursed us for $ This again left copays and deductibles for her visits of $ We are required by law to collect these amounts as the insurance company does not allow us to waive copays except for extreme circumstance, specifically documented financial hardship It is unclear to me just what his expectations were and in future, we would consider providing a charge list to a patient who might want that information However, the charge sheet is generally irrelevant to what the insurance company actually pays and once again, we don’t know what that will be until we receive payment We would like very much to be able to provide the information being requested but we cannot vouch for its accuracy due to the variables created and implemented by each insurance company We of course want to have clear communication with our clients to the extent it is possible Along that line, we will be reviewing and continuing our ongoing training with the front desk staff of each clinic to ensure that they know who to call and who to refer to if a patient wishes to have additional information related to their bill Please contact [redacted] at [redacted] if you have further questions or would like additional clarification
I am rejecting this response because:The excerpt provided in Burger's response states that it will attempt to verify insurance and relevant co-pay/deductible, and provide an estimate to the patientHowever, their staff members did not follow the procedure according to its agreementAs stated in the original complaint, we had never been provided with an estimate on co-pay/deductible during the multiple visits We were not informed with any out-of-pocket expense estimate prior to or during the treatmentWe were never been consulted by the therapist regarding costs or given the right to choose between treatment optionsThe response from Burger failed to address the second issue raised in the original complaint, which is related to their practice of not billing patients until they have completed the entire treatments with multiple visitsThis further hindered patients' ability to understand the cost implication, and therefore make corrective decisions as necessary, before finishing the entire treatmentIn my wife's case, her (nine) visits spanned over days and she had not received any bills before all visits were completed
I am rejecting this response because:First, the response provided by Burger was misleading It attempted to shift away from their failure of providing billing transparency to patients Instead, the letter accused the patient for not being financially responsible for the services received This is completely falseSecond, Burger attempted to blame the medical insurance system for their inability to disclose out-of-pocket expense for patients Although it may be true that the insurance system may cause some complexity to the calculation of patients' out-of-pocket expense They should provide training for their front office (as most dental offices do) so that they can consult with the insurance company and develop out-of-pocket expense estimate for each patient Third, Burger has the ability to provide individual service statements to patients However, they choose to only send monthly bills For whatever reason that I will not play judgement here, this basically prevents patients to take immediate actions after servicesIn summary, based on my communication with Burger, it is clear that for any patient that visits their offices, he or she should not expect to understand the out-of-pocket expense for the services until well after their service is completed, often times multiple sessions In my case, I now feel lucky that our total expense was around dollars But what if it was $6,or $60,000? The patients still would have no way to find out until receiving the monthly bill Just a final comment regarding Burger's practice Today I received a letter from Burger threatening to forward our bills to collection Keep in mind that this is in the midst of their ongoing communication with the patient through Revdex.com I will go ahead and make the payment instead of wasting more time on this matter But I hope at least this series of letters will become public as a reference for their future patients We will continue to seek legal services on this matter We will no longer work with Burger through Revdex.com
Burger Physical Therapy prides itself on excellent service and professionalismWe take any concern with our company very seriously and have completed a formal investigation regarding the aforementioned concerns As I Informed the complainant listed above, it is not our policy to quote insurance benefits to patientsDue to the complexity of coverage, frequently changing policies, and sheer number of insurance carriers that we are contracted with, we have informed our patients that it Is their responsibility to be informed regarding their insurance coverageWe encourage all of our patients to reach out to their insurance plan and/or employer If they have questions regarding coverage and/or benefitsAll patients receive and sign our form entitled “Know Your Benefits” and our “Consent Form.” See below for relevant excerpts from those forms which this complainant signed prior to his first treatment: You are responsible for charges incurred during the course of your treatmentAs a courtesy, we will attempt to verify your insurance benefits and relevant co-pay/deductible amountsThis is an estimate provided by your insurance carrier to usIt is only upon claim submittal and processing(which can take up to days or more) that we are informed by your Insurance company of the actual portion you owe of your treatment costIt is ultimately your responsibility to Inform yourself of your Insurance benefits and limitation We will bill your PRIMARY Insurance carrier; however, ALL bills are due and payable within daysPatients are financially responsible for all charges incurred during treatment, regardless pf expected reimbursement by insuranceBy signing this, I understand and agree that If my Insurance carrier or other parry makes payments to me or to my representative for my treatment, I agree to Immediately remit those funds to Burger Physical Therapy and Rehabilitation Agency, Inc In response to the desired settlement of this patient: We are comfortable with our billing practices and do not feel we need to make any changesUnfortunately, medical insurance/coverage can sometimes be difficult to understand which is why patients are encouraged to inform themselves regarding their coverage/benefits We are not exempting this patient or his wife from their financial responsibilityThey received the services provided and are financially responsible for their portion as dictated by their insurance company as outlined in the explanation of benefits received by the patient
To reiterate, it is not our policy to quote insurance benefits to patientsWe do not provide an estimate to the patients rather we inform our patients that is their responsibility to inform themselves regarding their insurance coverage and financial responsibilityWe encourage all of our patients to reach out to their insurance plan and/or employer if they have questions regarding coverage and/or benefitsAll patients receive and sign our form entitled "Know Your Benefits" and our "Consent Form" which was detailed in our previous response on 09/02/ We bill monthlyIt is not our practice to bill patients when they have completed their treatments, rather we bill patients as soon as we have accurate information from their insurance company regarding their financial responsibilitySee previous response dated 09/02/regarding our billing practices We are not exempting this patient or his wife from their financial responsibilityThey received the services provided and are financially responsible for their portion as dictated by their insurance company as outlined in the explanation of benefits received by the patient Respectfully,
I would like to add a few comments regarding the complaint filed regarding our billing practices at Burger Rehabilitation After researching the information from the patient and from our billing department, I am trying to correlate the expectations from the patient related to services rendered and the cost of those services along with our policies and procedures I am always looking for ways to improve process and we will certainly look at any opportunities to make this easier for patients to understand in the future However, we struggle with current insurance processes outside of our control and consequently are not able to give anyone a hard and fast number when it comes to cost when they are using an insurance policy It is our policy to direct any patient that requests further assistance to our billing department and ultimately to their own insurance carrier for specific information It is also the patient’s responsibility to know what their benefits are and what insurance they have purchased We call to verify eligibility but cannot depend upon the insurance company to give us full information until after the plan is billed Each insurance plan has multiple variables that change with every single policy While I understand that this patient is frustrated with the complexities of the billing system and likely does not understand how it works, I would like to point out that in his case, the insurance approved a total of $for the service rendered The insurance only paid $apparently because the patient still had a share of copay and an unmet deductible His request to have us discount his entire bill down to the $paid by the insurance company seems disingenuous at best It appears that he is saying that he wants to pay nothing for his multiple days of service Surely, he understood that he would have responsibility for his deductible and copays He did sign intake paperwork acknowledging this fact If he had a concern about the total bill, he certainly had the right to decline service prior to receiving it With regard to his wife’s services, the insurance company authorized $as total payment and reimbursed us for $ This again left copays and deductibles for her visits of $ We are required by law to collect these amounts as the insurance company does not allow us to waive copays except for extreme circumstance, specifically documented financial hardship It is unclear to me just what his expectations were and in future, we would consider providing a charge list to a patient who might want that information However, the charge sheet is generally irrelevant to what the insurance company actually pays and once again, we don’t know what that will be until we receive payment We would like very much to be able to provide the information being requested but we cannot vouch for its accuracy due to the variables created and implemented by each insurance company We of course want to have clear communication with our clients to the extent it is possible Along that line, we will be reviewing and continuing our ongoing training with the front desk staff of each clinic to ensure that they know who to call and who to refer to if a patient wishes to have additional information related to their bill Please contact [redacted] at [redacted] if you have further questions or would like additional clarification