Cambridge Health Alliance

The $balance is the patient's copayment per EOB (explanation of benefits) They have paid $and it leave a balance of $as patient responsibilityTheir insurance company should be able to explain to them why to was an increase in this copaymentExplanation of bills from Cambridge Health Alliance:Your bills from Cambridge Health Alliance may have two types of charges: doctor’s fees and facility feesWe are required to bill this way because our hospitals and health centers are licensed as hospital clinicsWhen clinics are doctor-owned and operated, they are able to charge a single fee that includes all the costs of care, including the costs of running the officeWhen clinics are hospital-owned (like CHA hospitals and health centers), there must be two separate bills, one from the medical group for the doctor’s professional fees, and one from the hospital for other costsThis second bill is known as the "facility fee." The facility fee covers things like registration, nursing care, use of the room, supplies used in your care, etc Because hospital-owned clinics are required to meet strict safety standards and have more legal requirements than physician-owned practices, facility fees also help offset the cost of meeting these standardsMost insurance plans pay for these servicesHowever, as they are defined as hospital outpatient services, some insurance plans apply these costs to co-payments, deductibles and coinsurance amountsThis may lead to out-of-pocket costs for some patients This is due to the way insurance plans are structuredThere is nothing that Cambridge Health Alliance can do differently in our billing to change this In order to avoid any unexpected costs, please check with your insurance plan to see how they handle payment of the “facility fee” for your type of coverage If you need more help, please call our Customer Service Department at ______________

We followed up with this patient to obtain additional information (patient's name) and shared her concerns with our Billing and Registration leadership The information we have on file is correct and we apologized for any frustration she experienced

Account #*** for date of service 02/03/2016: The remaining balance of $has been adjusted. Our biller reached out to *** to confirm the remit of copayment change because it did not occur in our system automatically. The account has been removed from collections and it will not affect your creditWe apologized for any inconvenient this may have caused you. We appreciate you as a patient of Cambridge Health Alliance

Revdex.com:
I have reviewed the response submitted by the business and have determined that the response does not satisfy or resolve my issues and/or concerns in reference to complaint # ***
I reached out to *** (my insurance company) to ask for clarification on my two claims and EOBs for the 2-3-date of serviceI have attached ***'s response to my inquiry since getting a response from the business via the Revdex.com*** says the EOB was revised from $to $in OctoberI am also attaching screenshots of both claims and EOBs for the 2-3-date of serviceOn those documents you will see my copay is $and that I do not have a balance over $ For some reason my CHA hospital is not recognizing that the EOB was revised/corrected and that I should not owe the $because that was originally filed incorrectly by CHAThere is a limit on how many attachments I can add, but I have attached the claim and EOB for the hospital for the 2-3-date of service and the claim for Dr*** for date of service 2-3-I am not able to add the last screenshot of my EOB for Dr*** for 2-3-though. I simply request that CHA recognize the EOB was revised from $copay to the $25.
Regards,
*** ***

Thank you for the opportunity to review Mr***'s concern. Mr*** also contacted our Billing Department and the attached email was sent in response. Efforts by the Billing Department to return Mr***'s calls were unsuccessful

Good afternoon, [redacted], the Lead Customer Service/Billing Support representative at Cambridge Health Alliance has responded to this complaint. On January 31, 2018, she received the complaint and after investigation noted the following action:"The patient will be receiving the...

refund for the amount requested, as he is correct that it is due to him."  [redacted] can be reached at [redacted] Option#1 for further inquiry.  Thank you.

I recently received the refund check. It's disappointing that I had to resort to contacting the Revdex.com, my credit card company, and Cambridge Health Alliance Media Relations in order to finally have the refund issued. I hope that Cambridge Health Alliance will examine their refund process and educate their billing representatives to more proactively follow through with legitimate requests from patients, instead of just repeating "it's being worked on" month after month.

The $40.00 balance is the patient's copayment per EOB (explanation of benefits).  They have paid $25.00 and it leave a balance of $15.00 as patient responsibility. Their insurance company should be able to explain to them why to was an increase in this copayment. Explanation of bills from...

Cambridge Health Alliance:Your bills from Cambridge Health Alliance may have two types of charges: doctor’s fees and facility fees. We are required to bill this way because our hospitals and health centers are licensed as hospital clinics. When clinics are doctor-owned and operated, they are able to charge a single fee that includes all the costs of care, including the costs of running the office. When clinics are hospital-owned (like CHA hospitals and health centers), there must be two separate bills, one from the medical group for the doctor’s professional fees, and one from the hospital for other costs. This second bill is known as the "facility fee." The facility fee covers things like registration, nursing care, use of the room, supplies used in your care, etc.  Because hospital-owned clinics are required to meet strict safety standards and have more legal requirements than physician-owned practices, facility fees also help offset the cost of meeting these standards. Most insurance plans pay for these services. However, as they are defined as hospital outpatient services, some insurance plans apply these costs to co-payments, deductibles and coinsurance amounts. This may lead to out-of-pocket costs for some patients.         This is due to the way insurance plans are structured. There is nothing that Cambridge Health Alliance can do differently in our billing to change this.   In order to avoid any unexpected costs, please check with your insurance plan to see how they handle payment of the “facility fee” for your type of coverage.   If you need more help, please call our Customer Service Department at ______________.

Better...

Business Bureau:
I have reviewed the response submitted by the business and have determined that the response does satisfy my issues and/or concerns in reference to complaint #[redacted]. I understand that by choosing to accept the business response that my complaint will be closed as resolved. 
Regards,
[redacted]