Cascade Eye & Skin Centers

From: Lynn H [redacted] Sent: Thursday, March 09, 5:PMSubject: [redacted] Good afternoon! After reviewing patients complaint I noted there is not a authorization to release medical information to the Revdex.comMy response would include diagnosis and chart informationCan you check with the patient to ensure we have his authorization to do this? I look forward to your response.Sincerely, Lynn H [redacted] Manager [redacted]

Dear Revdex.com, This is the letter I mailed to your office today: Mr*** was scheduled for an eye exam in our office on June 23, 2016, patient’s chief complaint was itching and tearing, allergic conjunctivitis was the doctor’s diagnosisThis diagnosis turned the eye exam into a medical exam and it was billed accordingly Our Quality Assurance board reviewed the patient’s dispute, after a thorough review of the medical chart and discussion with clinical personnel it was determined the diagnosis was appropriate. This was explained to the patient by the Bookkeeping Supervisor We cannot change the diagnosis; it would be considered fraud by the insurance company Patient sent a letter of dispute to Cascade Eye & Skin Centers, P.C., after reviewing patient’s letter and financial situation a 40% discount was given to the patient We feel we have worked with the patient to come up with a happy solution, giving him a discount and the offer to make payments. Best regards, Lynn H***Office Manager Please let me know if I can be of further assistance. Best regards, Lynn H***Office Manager

Ms. [redacted] called our Contact Lens department on or about May 12, 2015 to order contacts, at that time our CL Tech verified insurance coverage (insurance information on file from last visit). The insurance rep stated there was "no activity on file". Patient was informed of this and wanted to...

continue with the order. On May 14, 2015 Ms. [redacted] called our bookkeeping department to let us know she had vision coverage, we were unable to verify benefits due to lack of information (we did not have her card). When Ms. [redacted] came into the Sunrise office on May 21, 2015 to pick up her contacts she presented her new insurance card to the front desk.  At that time she paid for her contacts.It is our policy to have contact lenses paid for by the patient or insurance coverage verified before they are dispensed. Ms. [redacted] was reassured once her insurance company paid for the contacts we would issue her a refund check. Insurance was billed, after we received payment for patients contact lenses. On June 16, 2015  the bookkeeping department sent a message to our Controller to issue a check to Ms. [redacted]. We issue refund checks once a month; her refund was mailed early yesterday morning. I'm sorry Ms. [redacted] feels we were withholding her refund; our bookkeeping department is very diligent with communicating with our Controller to ensure refunds are sent to patients. I would have personally looked into the refund check status for Ms. [redacted] if she would have called our office. We do not withhold patient's refunds nor do we "scam" patients Again, I am sorry Ms. [redacted] feels this way.Please contact me if you have any further questions and/or concerns.Sincerely,Lynn H[redacted]Office Manager

From: Lynn H[redacted] Sent: Thursday, March 09, 2017 5:02 PMSubject: [redacted]Good afternoon!  After reviewing patients complaint I noted there is not a authorization to release medical information to the Revdex.com. My response would include diagnosis and chart information. Can you check with the patient...

to ensure we have his authorization to do this?  I look forward to your response.Sincerely, Lynn H[redacted] Manager[redacted]

Dear Revdex.com,The patient did schedule for a routine eye exam, however once the patient told the tech he had itchy, tearing AND was “poked” in the eye the day before  the doctor immediately  checked to see what was going on with his eyes. It was documented in the patients chart he had allergic conjunctivitis. This changed his visit from a routine eye exam to a medical eye exam. We are a preferred provider with numerous insurance companies, which requires us to follow their protocol. Anytime there is a medical diagnosis we are required to bill accordingly. Changing a diagnosis to suit the patient’s requirements of having their insurance pay for the exam is not appropriate and considered fraud.Stating that we bill the insurance company based on the patient’s symptoms clearly shows he understands the medical diagnosis; he is in disagreement with us following the rules implemented by the insurance company. The patient indicated he has spoken to numerous billing personnel; they may or may not be familiar with Ophthalmology billing. Either way, we have reached out to the patient and he accepted our offer of reducing his balance by 40%.  The Bookkeeping Supervisor sent the patient a letter confirming we would make the reduction. Patient returned his December statement to us in January, written on the statement was: “Please update amount due based on enclosed letter.” He is referring to the letter sent to him by the Bookkeeping Supervisor.  He did accept our offer to reduce his balance; unfortunately he did not make any payments which forced us to turn his account over to collections. Cascade Eye & Skin Centers did bill the exam appropriately and worked with the patient to resolve his complaint. Please let me know if I can be of further assistance.Best regards,Lynn H[redacted]Office Manager

Complaint: [redacted]
I am rejecting this response because: I am still unable to understand how this practice is legal. This still feels like unethical behavior. Under the company’s logic, if you were to have a routine annual physical exam at a Doctor’s office (covered 100% by your insurance), and the doctor realizes that you have the flu at your appointment; this requires the medical provider to do more work. Thus, they are able to bill you for additional services and you are now required to pay $150+ out of pocket. How is this not taking advantage of the patient and the situation? And how is this in the best interest of the patient? This situation sounds like fraud – yet Cascade Eye & Skin is claiming this is standard protocol. I am clearly not alone in thinking this behavior is unethical and illegal. In December 2016 I called my insurance company (Premera) and explained the situation. They agreed that this behavior did not seem appropriate, but have no ability to intervene. Looking at [redacted] reviews from University Place and other locations shows that I am not alone. Other patients have been taken advantage of, going in for an annual eye exam, and ended up getting billed for amounts they did not expect. This is reflected in the company’s 2 star rating out of 50+ reviews. My parents are both medical professionals in the community and have consulted experts at their place of employment, and have questioned the legality of this behavior. I disagree with the assessment that the exam was billed appropriately. There are clear red flags from an ethical and legal perspective.
Sincerely,
[redacted]