[redacted].June 7, 2017 [redacted] 2800 Euclid Ave., 4th Fl Cleveland, OH 44115-2408 RE: Complaint ID [redacted] Dear [redacted] I am in receipt of the complaint filed with your organization with the above reference number. After reviewing the accounts in question, here are...
our findings: Account #1: [redacted] was seen numerous times by the Nurse Practitioner in our office during 2015 and 2016. Her insurance company denied the claims stating that they needed to be billed under the supervising physician. All claims were rebilled multiple times, one check never showed up and a tracer was ordered, and then a take back and reprocess. The final EOB was dated 01/25/2017 with insurance company processed the claims for date of service 12/02/2015. Please see the attached Explanation of Benefits dated 1/25/2017 showing the member is responsible for 150.00 I cannot get an explanation from the medical biller in the office about not returning Mr. [redacted]'s calls because she is out on maternity leave. I called the insurance company to verify and they stated from date of service.12/2/2015, patient total responsibility is $76.66 and was applied to deductible. From date of service 7/16/2015, patient's responsibility is $40.00. The reference # for this call is [redacted] and the phone number for customer service is [redacted]. This, of course, does not match the EOB that was sent. I adjusted the account to match what I was told on the phone. Account #2: [redacted] pre-paid for 3 cosmetic treatments on 3/27/15 in the amount of 1300.00 1St treatment was received 3/27/15 2nd treatment was received 8/26/15. We no longer have the equipment to honor the 3rd treatment and I have a note and a credit on the account for 433.40 which can be used towards a different treatment or refunded to the patient. It is our office policy that we do not move money on patients accounts back and forth unless the patient requests so. Please let me know how Mr. [redacted] wishes to proceed with this credit. I can have a check mailed today. Sincerely, Brenda H[redacted] Practice Manager [redacted]
[redacted].June 7, 2017 [redacted] 2800 Euclid Ave., 4th Fl Cleveland, OH 44115-2408 RE: Complaint ID [redacted] Dear [redacted] I am in receipt of the complaint filed with your organization with the above reference number. After reviewing the accounts in question, here are...
our findings: Account #1: [redacted] was seen numerous times by the Nurse Practitioner in our office during 2015 and 2016. Her insurance company denied the claims stating that they needed to be billed under the supervising physician. All claims were rebilled multiple times, one check never showed up and a tracer was ordered, and then a take back and reprocess. The final EOB was dated 01/25/2017 with insurance company processed the claims for date of service 12/02/2015. Please see the attached Explanation of Benefits dated 1/25/2017 showing the member is responsible for 150.00 I cannot get an explanation from the medical biller in the office about not returning Mr. [redacted]'s calls because she is out on maternity leave. I called the insurance company to verify and they stated from date of service.12/2/2015, patient total responsibility is $76.66 and was applied to deductible. From date of service 7/16/2015, patient's responsibility is $40.00. The reference # for this call is [redacted] and the phone number for customer service is [redacted]. This, of course, does not match the EOB that was sent. I adjusted the account to match what I was told on the phone. Account #2: [redacted] pre-paid for 3 cosmetic treatments on 3/27/15 in the amount of 1300.00 1St treatment was received 3/27/15 2nd treatment was received 8/26/15. We no longer have the equipment to honor the 3rd treatment and I have a note and a credit on the account for 433.40 which can be used towards a different treatment or refunded to the patient. It is our office policy that we do not move money on patients accounts back and forth unless the patient requests so. Please let me know how Mr. [redacted] wishes to proceed with this credit. I can have a check mailed today. Sincerely, Brenda H[redacted] Practice Manager [redacted]