Capital Pulmonary Internist Pc: Gross David C MD

[redacted] was seen in our office on October 28, When a patient presents to our office with complaints such as those of [redacted] ***, certain tests must be performed in order for the physician to make an accurate diagnosis and to treat the patient, Any time a patient makes an inquiry regarding pricing, we convey the most accurate information available and always let the patient know the amounts are an approximationOne component of pricing, that many patients have difficulty understanding and makes it difficult to give an exact amount, is the difference between what we charge and what any said insurance company deems their allowable reimbursement amount, (if we are contracted with that company), There is no way we could know this information on literally hundreds of insurance companies and on top of that the hundreds of different policies that fall under each companyIn the case of [redacted] ***, he had a rather high deductible, (I cannot quote a dollar amount or this because it would be a HIPPA violation, but I can say it was greater than $3000.00) [redacted] stated in his letter he was told, "just coming in for a visit would have a cost” but he does not remember the armountFor new patients we always quote a range anywhere from $to $ just for the visit and any necessary testing could range as high as $If you combine the amount quoted for the office visit with the amount he was quoted for the testing his total could have reached $900.00, again an approximation.As it turns out all his charges for that day were applied to his yearly deductible by this irisurance companyThe total charge was $991.00, of which $was written off as a contractual adjustment, leaving the remainder, $859.44,(which is well within the amount quoted), the patient's responsibilityAfter the $that he paid that day was applied, that leaves a balance of $ due from [redacted] ***I cannot find reason for a Billing Adjustment and the $is still due from [redacted] for services rendered.Sincerely,? Mark *B [redacted] Pratice Administrator

[redacted] was seen in our office on October 28, When a patient presents to our office with complaints such as those of [redacted] ***, certain tests must be performed in order for the physician to make an accurate diagnosis and to treat the patient, Any time a patient makes an inquiry regarding pricing, we convey the most accurate information available and always let the patient know the amounts are an approximationOne component of pricing, that many patients have difficulty understanding and makes it difficult to give an exact amount, is the difference between what we charge and what any said insurance company deems their allowable reimbursement amount, (if we are contracted with that company), There is no way we could know this information on literally hundreds of insurance companies and on top of that the hundreds of different policies that fall under each companyIn the case of [redacted] ***, he had a rather high deductible, (I cannot quote a dollar amount or this because it would be a HIPPA violation, but I can say it was greater than $3000.00) [redacted] stated in his letter he was told, "just coming in for a visit would have a cost” but he does not remember the armountFor new patients we always quote a range anywhere from $to $ just for the visit and any necessary testing could range as high as $If you combine the amount quoted for the office visit with the amount he was quoted for the testing his total could have reached $900.00, again an approximation.As it turns out all his charges for that day were applied to his yearly deductible by this irisurance companyThe total charge was $991.00, of which $was written off as a contractual adjustment, leaving the remainder, $859.44,(which is well within the amount quoted), the patient's responsibilityAfter the $that he paid that day was applied, that leaves a balance of $ due from [redacted] ***I cannot find reason for a Billing Adjustment and the $is still due from [redacted] for services rendered.Sincerely, Mark *B [redacted] Pratice Administrator

[To assist us in bringing this matter to a close, you must give us a reason why you are rejecting the responseIf no reason is received your complaint will be closed Administratively Resolved]
Complaint: ***
I am rejecting this response because: none of this information had been conveyed to me beforehand- all this justification of high deductibles (i know what my own deductible is), different components going into pricing, etcwas never mentioned when I asked about the pricing beforehand At any rate, I asked them what the cost for all this would be, not how much the insurance would cover or anything of that nature MrB*** is confused I never asked about their policies with regards to different insurance agencies, or about allowable reimbursements, or any of the things he mentions in his rebuttali simply asked them how much the total charge would be Surely they know how much they charge for their own services!I always try to evaluate the benefits VS the costs before agreeing to anything and gave myself a strict $budget that I would not go over, and if they had said anything about a $charge, I would have declined without as much as a second thought! I never agreed to such a price and am only responsible for what I actually agreed to Towards the end of my visit, when the doctor ordered additional testing, I declined, knowing that would trigger additional costs- I did not want to pay any additional expenses.Again, the price that was quoted to me, and the price I agreed to was $380-
Regards,
*** ***

*** *** was seen in our office on October 28, When a patient presents to our office with complaints such as those of *** ***, certain tests must be performed in order for the physician to make an accurate diagnosis and to treat the patient, Any time a patient makes an inquiry regarding
pricing, we convey the most accurate information available and always let the patient know the amounts are an approximationOne component of pricing, that many patients have difficulty understanding and makes it difficult to give an exact amount, is the difference between what we charge and what any said insurance company deems their allowable reimbursement amount, (if we are contracted with that company), There is no way we could know this information on literally hundreds of insurance companies and on top of that the hundreds of different policies that fall under each companyIn the case of *** ***, he had a rather high deductible, (I cannot quote a dollar amount or this because it would be a HIPPA violation, but I can say it was greater than $3000.00)*** *** stated in his letter he was told, "just coming in for a visit would have a cost” but he does not remember the armountFor new patients we always quote a range anywhere from $to $ just for the visit and any necessary testing could range as high as $If you combine the amount quoted for the office visit with the amount he was quoted for the testing his total could have reached $900.00, again an approximation.As it turns out all his charges for that day were applied to his yearly deductible by this irisurance companyThe total charge was $991.00, of which $was written off as a contractual adjustment, leaving the remainder, $859.44,(which is well within the amount quoted), the patient's responsibilityAfter the $that he paid that day was applied, that leaves a balance of $ due from *** ***I cannot find reason for a Billing Adjustment and the $is still due from *** *** for services rendered.Sincerely, Mark *B***Pratice Administrator

[To assist us in bringing this matter to a close, you must give us a reason why you are rejecting the response. If no reason is received your complaint will be closed Administratively Resolved]
 Complaint: [redacted]
I am rejecting this response because: none of this information had been conveyed to me beforehand- all this justification of high deductibles (i know what my own deductible is), different components going into pricing, etc... was never mentioned when I asked about the pricing beforehand.  At any rate, I asked them what the cost for all this would be, not how much the insurance would cover or anything of that nature....  Mr. B[redacted] is confused.  I never asked about their policies with regards to different insurance agencies, or about allowable reimbursements, or any of the things he mentions in his rebuttal... I simply asked them how much the total charge would be.  Surely they know how much they charge for their own services!I always try to  evaluate the benefits VS the costs before agreeing to anything and gave myself a strict $500 budget that I would not go over, and if they had said anything about a $991 charge, I would have declined without as much as a second thought!  I never agreed to such a price and am only responsible for what I actually agreed to.  Towards the end of my visit, when the doctor ordered additional testing, I declined, knowing that would trigger additional costs- I did not want to pay any additional expenses.Again, the price that was quoted to me, and the price I agreed to was $380-400.
Regards,
[redacted]

[redacted] was seen in our office on October 28, 2015. When a patient presents to our office with complaints such as those of [redacted], certain tests must be performed in order for the physician to make an accurate diagnosis and to treat the patient, Any time a patient makes an inquiry regarding...

pricing, we convey the most accurate information available and always let the patient know the amounts are an approximation. One component of pricing, that many patients have difficulty understanding and makes it difficult to give an exact amount, is the difference between what we charge and what any said insurance company deems their allowable reimbursement amount, (if we are contracted with that company), There is no way we could know this information on literally hundreds of insurance companies and on top of that the hundreds of different policies that fall under each company. In the case of [redacted], he had a rather high deductible, (I cannot quote a dollar amount or this because it would be a HIPPA violation, but I can say it was greater than $3000.00). [redacted] stated in his letter he was told, "just coming in for a visit would have a cost” but he does not remember the armount. For new patients we always quote a range anywhere from $250.00 to $ 500.00 just for the visit and any necessary testing could range as high as $500.00. If you combine the amount quoted for the office visit with the amount he was quoted for the testing his total could have reached $900.00, again an approximation.As it turns out all his charges for that day were applied to his yearly deductible by this irisurance company. The total charge was $991.00, of which $121.56 was written off as a contractual adjustment, leaving the remainder, $859.44,(which is well within the amount quoted), the patient's responsibility. After the $460.00 that he paid that day was applied, that leaves a balance of $ 409.44 due from [redacted]. I cannot find reason for a Billing Adjustment and the $403.44 is still due from [redacted] for services rendered.Sincerely, Mark *. B[redacted]Pratice Administrator