Dear Ms***: I am in receipt of the above referenced patient inquiry dated April 7, regarding servicesrendered by CellNetix Pathology & Laboratories and submitted for payment to Premera BlueCross as part of the Blue Cross Blue Shield Association BlueCard programThiscorrespondence serves to address this patient's concerns and provide clarification regarding hisaccount As you may be aware, CellNetix was considered temporarily Out-of-Network with Premera BlueCross during the time period when this patient's services were providedThis Out-of-Networkstatus resulted in claims processing to Out-of-Network benefits, sometimes withoutreimbursementAdditionally, the non-contracted status also caused amounts beyond thePremera maximum allowable to be labeled as "not covered" and "your total responsibility" ontheir Explanation of Benefit (EOB) forms Although there was a delay in the CellNetix submission of claims to Premera for payment, thelack of payment for his claims was due to our temporary Out-of-Network status and not to aneligibility issue as alluded to in his desired settlementClaims submitted to payors forreimbursement process to benefits according to the date when services were providedIn thiscase, Mr [redacted] had coverage through the BlueCard program during his service date so hisclaims processed to benefits The following is a breakdown of Mr***'s billed services:Service Date January 21.2015Technical Component: For the total charges of $132.00, Premera processed the claim tobenefits and did not make a paymentPremera did apply the full charges of $to Out-ofNetworkdeductible Professional Component: For the total charges of $206.00, Premera processed the claim tobenefits, and again did not make a paymentPremera did apply the full charges of $toOut-of-Network deductible.Of note, is that Premera applied the full charges to the deductible rather than the Premeramaximum allowableAlthough CellNetix was not considered contracted during the time periodof this patient's services, we will not hold him accountable for amounts beyond the Premeramaximum allowable Further, as the patient paid his patient responsibility for the technical charges shortly afterreceiving his CellNetix billing statement, he should have been offered a 45% Prompt PayDiscountCellNetix has extended this Prompt Pay Discount to those patients negativelyimpacted by the temporary Out-of-Network status with PremeraThe Prompt Pay Discountapplied to the Premera maximum allowable for Mr***'s services would be:Technical Component Applied To Deductible:Less 45% Prompt Pay Discount:Revised Amount Due:$51.56-$23.20$28.36As the patient paid $132.00, he will receive a refund of $28.36.Professional Component Applied To Deductible:Less 45% Prompt Pay Discount:Revised Amount Due:$41.99- $18.90$23.09As the patient paid $206.00, he will receive a refund of $182.91.The total refund due to the patient will be $and he should receive it in three weeks.Referral to Collection Agency: The patient's account was forwarded to Audit & Adjustment Company Inc(AACI) for recovery ofthe professional charges of $after no payment had been received after daysAACIdoes confirm that they received the $payment from the patientAACI simply facilitatedthe payment and did not report any action to the credit bureaus regarding this patient's CeiiNetixaccounts Professional and Technical Components of Pathology Services:Mr***'s complaint also questions why there were charges for two services on the same day.It is an industry standard to separate the professional and technical components of manypathology services for reporting and reimbursement purposesThis billing methodologyprovides further transparency to the patient, as the two types of services are separated.Per the American Medical Association (AMA), certain Current Proced [redacted] Terminology (CPT)codes allow the separation of services by use of a modifier attached to the code whichdesignates which charges are professional, versus what charges are technicalAlthoughreported separately, the sum reimbursement for the professional and technical charges togetherwould remain the same, whether reported separately or as one comprehensive service.We appreciate Mr***'s feedback regarding his experiences with our Customer ServiceDepartment, and take his comments seriouslyCeiiNetix continually strives to provide the bestcustomer service experience to our patients and we appreciate the opportunity to review ourinternal processes.We apologize for any inconvenience that our temporary Out-of-Network status has caused.CellNetix is pleased to have reached a long term agreement with Premera, and look forward topartnering with them to provide high quality yet cost effective health care services.Sincerely,Kathleen F [redacted] Chief Executive OfficerCc: David K***, Chief Financial Officer
VIA FACSIMILE April 12, [redacted] ***, Revdex.com Resolutions Consultant Revdex.com P.OBox 1000DuPont, WA Re: [redacted] and [redacted] ID No.: [redacted] Dear Ms***: I are responding on behalf of CellNetix to the [redacted] s’ complaint.Due to some confusion at the third-party billing company CellNetix uses, the [redacted] s’ refund was delayedCellNetix has requested the billing company expedite the [redacted] s’ refund checkThe check will be overnighted to Seattle for signature and overnighted back to Texas once signedThe [redacted] s should have the refund by the end of this week or next Monday at the latest Best regards, Marlena G***Associate AttorneyCoopersmith Law + Strategy
March 8, Brittany Ural, Revdex.com Resolutions ConsultantRevdex.comP.OBox 1000DuPont, WA Re: [redacted] ***ID No.: [redacted] Dear Ms [redacted] I are responding on behalf of CellNetix to Ms [redacted] complaintMs [redacted] complains ofCellNetix billing practicesCellNetix respectfully disputes it has billed inappropriately I have made repeated attempts to contact Ms [redacted] to resolve this issueI left voicemailmessages asking Ms [redacted] for return calls on February 2, and February 23, Ms[redacted] did not respond to my February 2, call until February 18, when she left me avoicemailShe never responded to my February 23, message On March 1, 2016, I left a voicemail message and sent Ms [redacted] an emailShe responded to myemail saying she would contact meSee attachmentOn March 2, 2016, she left a voicemailagain promising to contact meIt is now March 8, 2016, and I have received no furthercommunication from her In light of Ms [redacted] lack of response to our multiple attempts to resolve her concerns, I askthis complaint be closedIf Ms [redacted] chooses at some future time to contact our office, I will ofcourse work with her to address whatever concerns she may have Best regards,Marlena G***Associate Attorney [redacted] ***Please see attached documents***
Dear Ms [redacted] , I am in receipt of the above referenced patient inquiry dated October 7, regarding services rendered by CellNetix Pathology & Laboratories and submitted for payment to Premera Blue CrossThis correspondence serves to address this patient's concerns and provide clarification regarding her account By way of background, it is an industry standard to separate the professional and technical components of many pathology services for reporting and reimbursement purposesThis billing methodology provides further transparency to the patient, as the two types of services are separatedThere was a billing correction submitted for Ms [redacted] 's technical charges, and it appears that there was a miscommunication regarding this correction conveyed to Ms [redacted] The following is a breakdown of Ms [redacted] 's billed services: Service Date February 17, Technical component: The original charges for the technical portion of the services were $These charges were then corrected to $These charges were not billed to Premera, and are not the patient's responsibility When Ms [redacted] contacted our external Customer Service Department, she was incorrectly informed that a refund was pending due to this billing correction Professional Component: For the total charges of $629.00, Premera reimbursed CellNetix directly in the amount of $on March 26, Premera did not apply any patient responsibility amounts such as coinsurance or deductible Due to an issue with our billing vendor, billing statements were sent to Ms [redacted] in April of for the amount of $She made payments in the amount of $on May 2nd and $on June 21st, for a total of $This error was caught, and a refund was initiated for the $on September 16thOur banking records indicate that the refund check was cashed by the patient on October 13, We appreciate Ms [redacted] 's feedback regarding her experiences with our Customer Service Department, and apologize for any inconvenience caused by this miscommunicationCellNetix continually strives to provide the best customer service experience to our patients and we appreciate the opportunity to review our internal processesTo that end, we have recently discontinued our contract with one of the billing vendors utilized during the time period of Ms [redacted] 's service date, in an effort to better serve our patients Thank you for the opportunity to respond to this patient's concerns Sincerely, Kathleen F [redacted] Chief Executive Officer
Dear Ms***:I am in receipt of the above referenced patient inquiry dated March 22, regarding servicesrendered by CellNetix Pathology & Laboratories and submitted for payment to Premera BlueCrossThis correspondence serves to address this patient's concerns and provide clarificationregarding her account As you may be aware, CellNetix was considered temporarily Out-of-Network with Premera BlueCross during the time period when this patient's services were providedThis Out-of-Networkstatus resulted in Premera submitting reimbursement to the patient by check, rather thandirectly to CellNetixAdditionally, the non-contracted status also caused amounts beyond thePremera maximum allowable to be labeled as "not covered" and "your total responsibility" ontheir Explanation of Benefit (EOB) forms Although CellNetix was not contracted during this time period, we are accepting the Premeramaximum allowable as payment in full for these servicesThe following is a breakdown of Ms[redacted] 's billed services:Service Date February 20, 2015Technical Component: For the total charges of $191.50, Premera sent a check directly to thepatient for $which has been received by CellNetixPremera also applied $to thepatient's coinsuranceAs stated above, CellNetix will accept the sum amount of the Premerapayment of $and the patient's coinsurance of $as reimbursement in full for theservices Per our records, the patient made two payments totaling to $for these servicesAs herpatient liability amount was $9.67, this results in a refund/credit of $ Professional Component: For the total charges of $205.00, Premera sent a check directly to thepatient for $which has also been received by CellNetixPremera applied $tocoinsuranceAfter applying the above referenced credit, this account balance is now at zeroand the patient is due a refund in the amount of $ The refund has been requested today and Ms [redacted] should receive it in three weeks We appreciate Ms [redacted] 's feedback regarding her experiences with our Customer ServiceDepartmentCellNetix continually strives to provide the best customer service experience toour patients and we appreciate the opportunity to review our internal processes We apologize for any inconvenience that our temporary Out-of-Network status has caused, andthank Ms [redacted] for forwarding the Premera reimbursement checks to usCellNetix is pleasedto have reached a long term agreement with Premera, and look forward to partnering with themto provide high quality yet cost effective health care services Sincerely,Kathleen F [redacted] Chief Executive OfficerCc: David K***, Chief Financial Officer'
Revdex.com:I have reviewed the response made by the business in reference to complaint ID ***, and find that this resolution is satisfactory to meSincerely, *** & *** ***
We have received the complaint and are in the process of investigatingCellNetix values their consumers and hope to have a more thorough response within days
Hello: Please see attached for the CellNetix response to this patient inquiry I have also sent via fax to Please advise if you have any questions, or whether we can provide further clarification Thank you!
Shannon *H***, CPC
Billing Coordinator
CellNetix
Pathology & Laboratories
Columbia ST, Suite
Seattle, WA
Direct: 206-576-
Fax: 206-215-
www.cellnetix.com
“Our expertise…your peace of mind”
Hello ***:
Please see attached for our response concerning file # *** I will also be sending via fax and hard-copy to ensure delivery Please let me know if you have any questions Thank you!
~~~Shannon H***
Shannon MH***, CPC
Billing Coordinator
CellNetix Pathology
& Laboratories
Columbia ST, Suite
Seattle, WA
Direct: 206-576-
Fax: 206-576-
www.cellnetix.com
“Our expertise…your peace of mind”
Q Please consider the environment before printing this email
Revdex.com:I have reviewed the response made by the business in reference to complaint ID ***, and find that this resolution is satisfactory to meI would request that they double check their accounting though as I have made more payments than they list and have in fact paid the technical component of the bill in fullSincerely, *** ***
Hello ***:
Thank you again for working with me on this extension Please let me know if you need anything else
~~~Shannon H***
Shannon MH***, CPC
Billing Coordinator
CellNetix Pathology & Laboratories
*** *** *** *** ***
Seattle, WA
Direct: ***
Fax:
206-576-
www.cellnetix.com
“Our expertise…your peace of mind”
Q Please consider the environment before printing this email
Re: *** ** ***File Number: ***Dear Ms***:I am in receipt of the above referenced patient inquiry dated October 13, regardingservices rendered by CellNetix Pathology & Laboratories and submitted for payment to ZenithAdministratorsThis correspondence serves to address this patient's concerns and provideclarification regarding the account
The inquiry received from Mr*** concerned services rendered to his spouse *** ***on 12/16/Claims were submitted for insurance payment on behalf of the patient,but the insurance information originally received was incorrect and the claims denied.As a matter of routine, the charges were then referred to our collections department to eithercollect reimbursement for the charges as a self-pay (non-covered) account, or to obtain correctinsurance coverage information from the patientThis outreach is implemented throughtelephone calls and billing statements indicating the charges dueThe corrected insuranceinformation was received on May 10, 2016, and claims were then submitted to Zenith forpaymentPrior to the submission of the claims, the patient did pay $to CellNetix.On September 6, 2016, Zenith Administrators reimbursed the claims as follows:Technical Componenttotal charges $895.00: Zenith reimbursed CellNetix $and applied$to the patient's coinsuranceThe amount previously paid by the patient was applied,and this account is at a zero balance
Professional Componenttotal charges $697.50: Zenith reimbursed CellNetix $andapplied $to the patient's coinsuranceCellNetix applied the amount previously paid bythe patient to also bring this account to a zero balance
Refund:
After applying the patient's previous payment of $to coinsurance owed for the claims, arefund is due to the patient in the amount of This refund will be treated as priority, andthe patient should receive a check in approximately three weeks
We appreciate Mr***' feedback regarding his experiences with our Customer ServiceDepartment, and apologize for any inconvenience due to the delay in obtaining a refund.CellNetix continually strives to provide the best customer service experience to our patients andwe appreciate the opportunity to review our internal processesTo that end, we have recentlydiscontinued our contract with one of the billing vendors utilized during the time period of Ms.***-***' service date, in an effort to better serve our patients.Thank you for the opportunity to respond to this patient's concerns.Sincerely,Kathleen FChief Executive OfficerCc: David K***, Chief Financial Officer
***SUPPORTING DOCUMENTS REDACTED BY Revdex.com***
VIA FACSIMILE
April 12, 2016
[redacted], Revdex.com Resolutions Consultant
Revdex.com
P.O. Box 1000DuPont, WA 98327
Re: [redacted] and [redacted]
ID No.: [redacted]
Dear Ms. [redacted]:
I are responding on behalf of CellNetix to the [redacted]s’ complaint.Due to some confusion at the third-party...
billing company CellNetix uses, the [redacted]s’ refund was delayed. CellNetix has requested the billing company expedite the [redacted]s’ refund check. The check will be overnighted to Seattle for signature and overnighted back to Texas once signed. The [redacted]s should have the refund by the end of this week or next Monday at the latest.
Best regards,
Marlena G[redacted]Associate AttorneyCoopersmith Law + Strategy
Dear Ms. [redacted],
I am in receipt of the above referenced patient inquiry dated October 7, 2016 regarding services rendered by CellNetix Pathology & Laboratories and submitted for payment to Premera Blue Cross. This correspondence serves to address this patient's concerns and provide...
clarification regarding her account.
By way of background, it is an industry standard to separate the professional and technical components of many pathology services for reporting and reimbursement purposes. This billing methodology provides further transparency to the patient, as the two types of services are separated. There was a billing correction submitted for Ms. [redacted]'s technical charges, and it appears that there was a miscommunication regarding this correction conveyed to Ms. [redacted].
The following is a breakdown of Ms. [redacted]'s billed services:
Service Date February 17,2016
Technical component: The original charges for the technical portion of the services were $827.00. These charges were then corrected to $175.13. These charges were not billed to Premera, and are not the patient's responsibility.
When Ms. [redacted] contacted our external Customer Service Department, she was incorrectly informed that a refund was pending due to this billing correction.
Professional Component: For the total charges of $629.00, Premera reimbursed CellNetix directly in the amount of $197.18 on March 26, 2016. Premera did not apply any patient responsibility amounts such as coinsurance or deductible.
Due to an issue with our billing vendor, billing statements were sent to Ms. [redacted] in April of 2016 for the amount of $431.82. She made payments in the amount of $71.97 on May 2nd and $76.97 on June 21st, for a total of $148.94. This error was caught, and a refund was initiated for the $148.94 on September 16th. Our banking records indicate that the refund check was cashed by the patient on October 13, 2016.
We appreciate Ms. [redacted]'s feedback regarding her experiences with our Customer Service Department, and apologize for any inconvenience caused by this miscommunication. CellNetix continually strives to provide the best customer service experience to our patients and we appreciate the opportunity to review our internal processes. To that end, we have recently discontinued our contract with one of the billing vendors utilized during the time period of Ms. [redacted]'s service date, in an effort to better serve our patients.
Thank you for the opportunity to respond to this patient's concerns.
Sincerely,
Kathleen F[redacted]
Chief Executive Officer
Revdex.com: The bottom line is this , it should have never had to get to the point that I have to file complaints with the Washington state attorney general and the Revdex.com. The stress and hurt Cellnetix caused us while my wife and I battle cancer, the $37.71 doesn't fix that but it does get them out of our lives . They should be ashamed that this is how they treat sick people. This seams to be a common practice for Cellnetix as seen on King 5 news story and my recent conversation with the Washington state attorney general. Goodbye I have reviewed the response made by the business in reference to complaint ID [redacted], and find that this resolution is satisfactory to me. Sincerely, [redacted]
Dear Ms. [redacted]:
I am in receipt of the above referenced patient inquiry dated April 7, 2016 regarding servicesrendered by CellNetix Pathology & Laboratories and submitted for payment to Premera BlueCross as part of the Blue Cross Blue Shield Association BlueCard program. Thiscorrespondence...
serves to address this patient's concerns and provide clarification regarding hisaccount.
As you may be aware, CellNetix was considered temporarily Out-of-Network with Premera BlueCross during the time period when this patient's services were provided. This Out-of-Networkstatus resulted in claims processing to Out-of-Network benefits, sometimes withoutreimbursement. Additionally, the non-contracted status also caused amounts beyond thePremera maximum allowable to be labeled as "not covered" and "your total responsibility" ontheir Explanation of Benefit (EOB) forms.
Although there was a delay in the CellNetix submission of claims to Premera for payment, thelack of payment for his claims was due to our temporary Out-of-Network status and not to aneligibility issue as alluded to in his desired settlement. Claims submitted to payors forreimbursement process to benefits according to the date when services were provided. In thiscase, Mr. [redacted] had coverage through the BlueCard program during his service date so hisclaims processed to benefits.
The following is a breakdown of Mr. [redacted]'s billed services:Service Date January 21.2015Technical Component: For the total charges of $132.00, Premera processed the claim tobenefits and did not make a payment. Premera did apply the full charges of $132.00 to Out-ofNetworkdeductible.
Professional Component: For the total charges of $206.00, Premera processed the claim tobenefits, and again did not make a payment. Premera did apply the full charges of $206.00 toOut-of-Network deductible.Of note, is that Premera applied the full charges to the deductible rather than the Premeramaximum allowable. Although CellNetix was not considered contracted during the time periodof this patient's services, we will not hold him accountable for amounts beyond the Premeramaximum allowable.
Further, as the patient paid his patient responsibility for the technical charges shortly afterreceiving his CellNetix billing statement, he should have been offered a 45% Prompt PayDiscount. CellNetix has extended this Prompt Pay Discount to those patients negativelyimpacted by the temporary Out-of-Network status with Premera. The Prompt Pay Discountapplied to the Premera maximum allowable for Mr. [redacted]'s services would be:Technical Component Applied To Deductible:Less 45% Prompt Pay Discount:Revised Amount Due:$51.56-$23.20$28.36As the patient paid $132.00, he will receive a refund of $28.36.Professional Component Applied To Deductible:Less 45% Prompt Pay Discount:Revised Amount Due:$41.99- $18.90$23.09As the patient paid $206.00, he will receive a refund of $182.91.The total refund due to the patient will be $286.55 and he should receive it in three weeks.Referral to Collection Agency:
The patient's account was forwarded to Audit & Adjustment Company Inc. (AACI) for recovery ofthe professional charges of $206.00 after no payment had been received after 120 days. AACIdoes confirm that they received the $206.00 payment from the patient. AACI simply facilitatedthe payment and did not report any action to the credit bureaus regarding this patient's CeiiNetixaccounts.
Professional and Technical Components of Pathology Services:Mr. [redacted]'s complaint also questions why there were charges for two services on the same day.It is an industry standard to separate the professional and technical components of manypathology services for reporting and reimbursement purposes. This billing methodologyprovides further transparency to the patient, as the two types of services are separated.Per the American Medical Association (AMA), certain Current Proced[redacted] Terminology (CPT)codes allow the separation of services by use of a modifier attached to the code whichdesignates which charges are professional, versus what charges are technical. Althoughreported separately, the sum reimbursement for the professional and technical charges togetherwould remain the same, whether reported separately or as one comprehensive service.We appreciate Mr. [redacted]'s feedback regarding his experiences with our Customer ServiceDepartment, and take his comments seriously. CeiiNetix continually strives to provide the bestcustomer service experience to our patients and we appreciate the opportunity to review ourinternal processes.We apologize for any inconvenience that our temporary Out-of-Network status has caused.CellNetix is pleased to have reached a long term agreement with Premera, and look forward topartnering with them to provide high quality yet cost effective health care services.Sincerely,Kathleen F[redacted]Chief Executive OfficerCc: David K[redacted], Chief Financial Officer
Ural, Revdex.com Resolutions ConsultantRevdex.comP.O. Box 1000DuPont, WA 98327
Re:[redacted]ID No.:[redacted]
Dear Ms. [redacted]
I are responding on behalf of CellNetix to Ms. [redacted] complaint. Ms. [redacted] complains ofCellNetix billing practices. CellNetix respectfully disputes it has billed inappropriately.
I have made repeated attempts to contact Ms. [redacted] to resolve this issue. I left voicemailmessages asking Ms. [redacted] for return calls on February 2, 20 16 and February 23, 2016. Ms.[redacted] did not respond to my February 2, 2016 call until February 18, 2016 when she left me avoicemail. She never responded to my February 23, 2016 message.
On March 1, 2016, I left a voicemail message and sent Ms. [redacted] an email. She responded to myemail saying she would contact me. See attachment. On March 2, 2016, she left a voicemailagain promising to contact me. It is now March 8, 2016, and I have received no furthercommunication from her.
In light of Ms. [redacted] lack of response to our multiple attempts to resolve her concerns, I askthis complaint be closed. If Ms. [redacted] chooses at some future time to contact our office, I will ofcourse work with her to address whatever concerns she may have.
Best regards,Marlena G[redacted]Associate Attorney[redacted]
[redacted]Please see attached documents[redacted]
Dear Ms. [redacted]:I am in receipt of the above referenced patient inquiry dated March 22, 2016 regarding servicesrendered by CellNetix Pathology & Laboratories and submitted for payment to Premera BlueCross. This correspondence serves to address this patient's concerns and provide...
clarificationregarding her account.
As you may be aware, CellNetix was considered temporarily Out-of-Network with Premera BlueCross during the time period when this patient's services were provided. This Out-of-Networkstatus resulted in Premera submitting reimbursement to the patient by check, rather thandirectly to CellNetix. Additionally, the non-contracted status also caused amounts beyond thePremera maximum allowable to be labeled as "not covered" and "your total responsibility" ontheir Explanation of Benefit (EOB) forms.
Although CellNetix was not contracted during this time period, we are accepting the Premeramaximum allowable as payment in full for these services. The following is a breakdown of Ms.[redacted]'s billed services:Service Date February 20, 2015Technical Component: For the total charges of $191.50, Premera sent a check directly to thepatient for $38.66 which has been received by CellNetix. Premera also applied $9.67 to thepatient's coinsurance. As stated above, CellNetix will accept the sum amount of the Premerapayment of $38.66 and the patient's coinsurance of $9.67 as reimbursement in full for theservices.
Per our records, the patient made two payments totaling to $70.00 for these services. As herpatient liability amount was $9.67, this results in a refund/credit of $60.33
Professional Component: For the total charges of $205.00, Premera sent a check directly to thepatient for $35.09 which has also been received by CellNetix. Premera applied $8.77 tocoinsurance. After applying the above referenced credit, this account balance is now at zeroand the patient is due a refund in the amount of $51.56.
The refund has been requested today and Ms. [redacted] should receive it in three weeks.
We appreciate Ms. [redacted]'s feedback regarding her experiences with our Customer ServiceDepartment. CellNetix continually strives to provide the best customer service experience toour patients and we appreciate the opportunity to review our internal processes.
We apologize for any inconvenience that our temporary Out-of-Network status has caused, andthank Ms. [redacted] for forwarding the Premera reimbursement checks to us. CellNetix is pleasedto have reached a long term agreement with Premera, and look forward to partnering with themto provide high quality yet cost effective health care services.
Sincerely,Kathleen F[redacted]Chief Executive OfficerCc: David K[redacted], Chief Financial Officer'
Dear Ms***: I am in receipt of the above referenced patient inquiry dated April 7, regarding servicesrendered by CellNetix Pathology & Laboratories and submitted for payment to Premera BlueCross as part of the Blue Cross Blue Shield Association BlueCard programThiscorrespondence serves to address this patient's concerns and provide clarification regarding hisaccount As you may be aware, CellNetix was considered temporarily Out-of-Network with Premera BlueCross during the time period when this patient's services were providedThis Out-of-Networkstatus resulted in claims processing to Out-of-Network benefits, sometimes withoutreimbursementAdditionally, the non-contracted status also caused amounts beyond thePremera maximum allowable to be labeled as "not covered" and "your total responsibility" ontheir Explanation of Benefit (EOB) forms Although there was a delay in the CellNetix submission of claims to Premera for payment, thelack of payment for his claims was due to our temporary Out-of-Network status and not to aneligibility issue as alluded to in his desired settlementClaims submitted to payors forreimbursement process to benefits according to the date when services were providedIn thiscase, Mr [redacted] had coverage through the BlueCard program during his service date so hisclaims processed to benefits The following is a breakdown of Mr***'s billed services:Service Date January 21.2015Technical Component: For the total charges of $132.00, Premera processed the claim tobenefits and did not make a paymentPremera did apply the full charges of $to Out-ofNetworkdeductible Professional Component: For the total charges of $206.00, Premera processed the claim tobenefits, and again did not make a paymentPremera did apply the full charges of $toOut-of-Network deductible.Of note, is that Premera applied the full charges to the deductible rather than the Premeramaximum allowableAlthough CellNetix was not considered contracted during the time periodof this patient's services, we will not hold him accountable for amounts beyond the Premeramaximum allowable Further, as the patient paid his patient responsibility for the technical charges shortly afterreceiving his CellNetix billing statement, he should have been offered a 45% Prompt PayDiscountCellNetix has extended this Prompt Pay Discount to those patients negativelyimpacted by the temporary Out-of-Network status with PremeraThe Prompt Pay Discountapplied to the Premera maximum allowable for Mr***'s services would be:Technical Component Applied To Deductible:Less 45% Prompt Pay Discount:Revised Amount Due:$51.56-$23.20$28.36As the patient paid $132.00, he will receive a refund of $28.36.Professional Component Applied To Deductible:Less 45% Prompt Pay Discount:Revised Amount Due:$41.99- $18.90$23.09As the patient paid $206.00, he will receive a refund of $182.91.The total refund due to the patient will be $and he should receive it in three weeks.Referral to Collection Agency: The patient's account was forwarded to Audit & Adjustment Company Inc(AACI) for recovery ofthe professional charges of $after no payment had been received after daysAACIdoes confirm that they received the $payment from the patientAACI simply facilitatedthe payment and did not report any action to the credit bureaus regarding this patient's CeiiNetixaccounts Professional and Technical Components of Pathology Services:Mr***'s complaint also questions why there were charges for two services on the same day.It is an industry standard to separate the professional and technical components of manypathology services for reporting and reimbursement purposesThis billing methodologyprovides further transparency to the patient, as the two types of services are separated.Per the American Medical Association (AMA), certain Current Proced [redacted] Terminology (CPT)codes allow the separation of services by use of a modifier attached to the code whichdesignates which charges are professional, versus what charges are technicalAlthoughreported separately, the sum reimbursement for the professional and technical charges togetherwould remain the same, whether reported separately or as one comprehensive service.We appreciate Mr***'s feedback regarding his experiences with our Customer ServiceDepartment, and take his comments seriouslyCeiiNetix continually strives to provide the bestcustomer service experience to our patients and we appreciate the opportunity to review ourinternal processes.We apologize for any inconvenience that our temporary Out-of-Network status has caused.CellNetix is pleased to have reached a long term agreement with Premera, and look forward topartnering with them to provide high quality yet cost effective health care services.Sincerely,Kathleen F [redacted] Chief Executive OfficerCc: David K***, Chief Financial Officer
VIA FACSIMILE April 12, [redacted] ***, Revdex.com Resolutions Consultant Revdex.com P.OBox 1000DuPont, WA Re: [redacted] and [redacted] ID No.: [redacted] Dear Ms***: I are responding on behalf of CellNetix to the [redacted] s’ complaint.Due to some confusion at the third-party billing company CellNetix uses, the [redacted] s’ refund was delayedCellNetix has requested the billing company expedite the [redacted] s’ refund checkThe check will be overnighted to Seattle for signature and overnighted back to Texas once signedThe [redacted] s should have the refund by the end of this week or next Monday at the latest Best regards, Marlena G***Associate AttorneyCoopersmith Law + Strategy
March 8, Brittany Ural, Revdex.com Resolutions ConsultantRevdex.comP.OBox 1000DuPont, WA Re: [redacted] ***ID No.: [redacted] Dear Ms [redacted] I are responding on behalf of CellNetix to Ms [redacted] complaintMs [redacted] complains ofCellNetix billing practicesCellNetix respectfully disputes it has billed inappropriately I have made repeated attempts to contact Ms [redacted] to resolve this issueI left voicemailmessages asking Ms [redacted] for return calls on February 2, and February 23, Ms[redacted] did not respond to my February 2, call until February 18, when she left me avoicemailShe never responded to my February 23, message On March 1, 2016, I left a voicemail message and sent Ms [redacted] an emailShe responded to myemail saying she would contact meSee attachmentOn March 2, 2016, she left a voicemailagain promising to contact meIt is now March 8, 2016, and I have received no furthercommunication from her In light of Ms [redacted] lack of response to our multiple attempts to resolve her concerns, I askthis complaint be closedIf Ms [redacted] chooses at some future time to contact our office, I will ofcourse work with her to address whatever concerns she may have Best regards,Marlena G***Associate Attorney [redacted] ***Please see attached documents***
Dear Ms [redacted] , I am in receipt of the above referenced patient inquiry dated October 7, regarding services rendered by CellNetix Pathology & Laboratories and submitted for payment to Premera Blue CrossThis correspondence serves to address this patient's concerns and provide clarification regarding her account By way of background, it is an industry standard to separate the professional and technical components of many pathology services for reporting and reimbursement purposesThis billing methodology provides further transparency to the patient, as the two types of services are separatedThere was a billing correction submitted for Ms [redacted] 's technical charges, and it appears that there was a miscommunication regarding this correction conveyed to Ms [redacted] The following is a breakdown of Ms [redacted] 's billed services: Service Date February 17, Technical component: The original charges for the technical portion of the services were $These charges were then corrected to $These charges were not billed to Premera, and are not the patient's responsibility When Ms [redacted] contacted our external Customer Service Department, she was incorrectly informed that a refund was pending due to this billing correction Professional Component: For the total charges of $629.00, Premera reimbursed CellNetix directly in the amount of $on March 26, Premera did not apply any patient responsibility amounts such as coinsurance or deductible Due to an issue with our billing vendor, billing statements were sent to Ms [redacted] in April of for the amount of $She made payments in the amount of $on May 2nd and $on June 21st, for a total of $This error was caught, and a refund was initiated for the $on September 16thOur banking records indicate that the refund check was cashed by the patient on October 13, We appreciate Ms [redacted] 's feedback regarding her experiences with our Customer Service Department, and apologize for any inconvenience caused by this miscommunicationCellNetix continually strives to provide the best customer service experience to our patients and we appreciate the opportunity to review our internal processesTo that end, we have recently discontinued our contract with one of the billing vendors utilized during the time period of Ms [redacted] 's service date, in an effort to better serve our patients Thank you for the opportunity to respond to this patient's concerns Sincerely, Kathleen F [redacted] Chief Executive Officer
Dear Ms***:I am in receipt of the above referenced patient inquiry dated March 22, regarding servicesrendered by CellNetix Pathology & Laboratories and submitted for payment to Premera BlueCrossThis correspondence serves to address this patient's concerns and provide clarificationregarding her account As you may be aware, CellNetix was considered temporarily Out-of-Network with Premera BlueCross during the time period when this patient's services were providedThis Out-of-Networkstatus resulted in Premera submitting reimbursement to the patient by check, rather thandirectly to CellNetixAdditionally, the non-contracted status also caused amounts beyond thePremera maximum allowable to be labeled as "not covered" and "your total responsibility" ontheir Explanation of Benefit (EOB) forms Although CellNetix was not contracted during this time period, we are accepting the Premeramaximum allowable as payment in full for these servicesThe following is a breakdown of Ms[redacted] 's billed services:Service Date February 20, 2015Technical Component: For the total charges of $191.50, Premera sent a check directly to thepatient for $which has been received by CellNetixPremera also applied $to thepatient's coinsuranceAs stated above, CellNetix will accept the sum amount of the Premerapayment of $and the patient's coinsurance of $as reimbursement in full for theservices Per our records, the patient made two payments totaling to $for these servicesAs herpatient liability amount was $9.67, this results in a refund/credit of $ Professional Component: For the total charges of $205.00, Premera sent a check directly to thepatient for $which has also been received by CellNetixPremera applied $tocoinsuranceAfter applying the above referenced credit, this account balance is now at zeroand the patient is due a refund in the amount of $ The refund has been requested today and Ms [redacted] should receive it in three weeks We appreciate Ms [redacted] 's feedback regarding her experiences with our Customer ServiceDepartmentCellNetix continually strives to provide the best customer service experience toour patients and we appreciate the opportunity to review our internal processes We apologize for any inconvenience that our temporary Out-of-Network status has caused, andthank Ms [redacted] for forwarding the Premera reimbursement checks to usCellNetix is pleasedto have reached a long term agreement with Premera, and look forward to partnering with themto provide high quality yet cost effective health care services Sincerely,Kathleen F [redacted] Chief Executive OfficerCc: David K***, Chief Financial Officer'
Revdex.com:I have reviewed the response made by the business in reference to complaint ID ***, and find that this resolution is satisfactory to meSincerely, *** & *** ***
We have received the complaint and are in the process of investigatingCellNetix values their consumers and hope to have a more thorough response within days
Hello: Please see attached for the CellNetix response to this patient inquiry I have also sent via fax to Please advise if you have any questions, or whether we can provide further clarification Thank you!
Shannon *H***, CPC
Billing Coordinator
CellNetix
Pathology & Laboratories
Columbia ST, Suite
Seattle, WA
Direct: 206-576-
Fax: 206-215-
www.cellnetix.com
“Our expertise…your peace of mind”
Hello ***:
Please see attached for our response concerning file # *** I will also be sending via fax and hard-copy to ensure delivery Please let me know if you have any questions Thank you!
~~~Shannon H***
Shannon MH***, CPC
Billing Coordinator
CellNetix Pathology
& Laboratories
Columbia ST, Suite
Seattle, WA
Direct: 206-576-
Fax: 206-576-
www.cellnetix.com
“Our expertise…your peace of mind”
Q Please consider the environment before printing this email
Revdex.com:I have reviewed the response made by the business in reference to complaint ID ***, and find that this resolution is satisfactory to meI would request that they double check their accounting though as I have made more payments than they list and have in fact paid the technical component of the bill in fullSincerely, *** ***
Hello ***:
Chief Executive OfficerCc: David K***, Chief Financial Officer
Thank you again for working with me on this extension Please let me know if you need anything else
~~~Shannon H***
Shannon MH***, CPC
Billing Coordinator
CellNetix Pathology & Laboratories
*** *** *** *** ***
Seattle, WA
Direct: ***
Fax:
206-576-
www.cellnetix.com
“Our expertise…your peace of mind”
Q Please consider the environment before printing this email
Re: *** ** ***File Number: ***Dear Ms***:I am in receipt of the above referenced patient inquiry dated October 13, regardingservices rendered by CellNetix Pathology & Laboratories and submitted for payment to ZenithAdministratorsThis correspondence serves to address this patient's concerns and provideclarification regarding the account
The inquiry received from Mr*** concerned services rendered to his spouse *** ***on 12/16/Claims were submitted for insurance payment on behalf of the patient,but the insurance information originally received was incorrect and the claims denied.As a matter of routine, the charges were then referred to our collections department to eithercollect reimbursement for the charges as a self-pay (non-covered) account, or to obtain correctinsurance coverage information from the patientThis outreach is implemented throughtelephone calls and billing statements indicating the charges dueThe corrected insuranceinformation was received on May 10, 2016, and claims were then submitted to Zenith forpaymentPrior to the submission of the claims, the patient did pay $to CellNetix.On September 6, 2016, Zenith Administrators reimbursed the claims as follows:Technical Componenttotal charges $895.00: Zenith reimbursed CellNetix $and applied$to the patient's coinsuranceThe amount previously paid by the patient was applied,and this account is at a zero balance
Professional Componenttotal charges $697.50: Zenith reimbursed CellNetix $andapplied $to the patient's coinsuranceCellNetix applied the amount previously paid bythe patient to also bring this account to a zero balance
Refund:
After applying the patient's previous payment of $to coinsurance owed for the claims, arefund is due to the patient in the amount of This refund will be treated as priority, andthe patient should receive a check in approximately three weeks
We appreciate Mr***' feedback regarding his experiences with our Customer ServiceDepartment, and apologize for any inconvenience due to the delay in obtaining a refund.CellNetix continually strives to provide the best customer service experience to our patients andwe appreciate the opportunity to review our internal processesTo that end, we have recentlydiscontinued our contract with one of the billing vendors utilized during the time period of Ms.***-***' service date, in an effort to better serve our patients.Thank you for the opportunity to respond to this patient's concerns.Sincerely,Kathleen F
***SUPPORTING DOCUMENTS REDACTED BY Revdex.com***
Complaint: ***I am rejecting this response because: This is not a resolution. Sincerely,*** ***
VIA FACSIMILE
April 12, 2016
[redacted], Revdex.com Resolutions Consultant
Revdex.com
P.O. Box 1000DuPont, WA 98327
Re: [redacted] and [redacted]
ID No.: [redacted]
Dear Ms. [redacted]:
I are responding on behalf of CellNetix to the [redacted]s’ complaint.Due to some confusion at the third-party...
billing company CellNetix uses, the [redacted]s’ refund was delayed. CellNetix has requested the billing company expedite the [redacted]s’ refund check. The check will be overnighted to Seattle for signature and overnighted back to Texas once signed. The [redacted]s should have the refund by the end of this week or next Monday at the latest.
Best regards,
Marlena G[redacted]Associate AttorneyCoopersmith Law + Strategy
Dear Ms. [redacted],
I am in receipt of the above referenced patient inquiry dated October 7, 2016 regarding services rendered by CellNetix Pathology & Laboratories and submitted for payment to Premera Blue Cross. This correspondence serves to address this patient's concerns and provide...
clarification regarding her account.
By way of background, it is an industry standard to separate the professional and technical components of many pathology services for reporting and reimbursement purposes. This billing methodology provides further transparency to the patient, as the two types of services are separated. There was a billing correction submitted for Ms. [redacted]'s technical charges, and it appears that there was a miscommunication regarding this correction conveyed to Ms. [redacted].
The following is a breakdown of Ms. [redacted]'s billed services:
Service Date February 17,2016
Technical component: The original charges for the technical portion of the services were $827.00. These charges were then corrected to $175.13. These charges were not billed to Premera, and are not the patient's responsibility.
When Ms. [redacted] contacted our external Customer Service Department, she was incorrectly informed that a refund was pending due to this billing correction.
Professional Component: For the total charges of $629.00, Premera reimbursed CellNetix directly in the amount of $197.18 on March 26, 2016. Premera did not apply any patient responsibility amounts such as coinsurance or deductible.
Due to an issue with our billing vendor, billing statements were sent to Ms. [redacted] in April of 2016 for the amount of $431.82. She made payments in the amount of $71.97 on May 2nd and $76.97 on June 21st, for a total of $148.94. This error was caught, and a refund was initiated for the $148.94 on September 16th. Our banking records indicate that the refund check was cashed by the patient on October 13, 2016.
We appreciate Ms. [redacted]'s feedback regarding her experiences with our Customer Service Department, and apologize for any inconvenience caused by this miscommunication. CellNetix continually strives to provide the best customer service experience to our patients and we appreciate the opportunity to review our internal processes. To that end, we have recently discontinued our contract with one of the billing vendors utilized during the time period of Ms. [redacted]'s service date, in an effort to better serve our patients.
Thank you for the opportunity to respond to this patient's concerns.
Sincerely,
Kathleen F[redacted]
Chief Executive Officer
Revdex.com: The bottom line is this , it should have never had to get to the point that I have to file complaints with the Washington state attorney general and the Revdex.com. The stress and hurt Cellnetix caused us while my wife and I battle cancer, the $37.71 doesn't fix that but it does get them out of our lives . They should be ashamed that this is how they treat sick people. This seams to be a common practice for Cellnetix as seen on King 5 news story and my recent conversation with the Washington state attorney general. Goodbye I have reviewed the response made by the business in reference to complaint ID [redacted], and find that this resolution is satisfactory to me. Sincerely, [redacted]
Dear Ms. [redacted]:
I am in receipt of the above referenced patient inquiry dated April 7, 2016 regarding servicesrendered by CellNetix Pathology & Laboratories and submitted for payment to Premera BlueCross as part of the Blue Cross Blue Shield Association BlueCard program. Thiscorrespondence...
serves to address this patient's concerns and provide clarification regarding hisaccount.
As you may be aware, CellNetix was considered temporarily Out-of-Network with Premera BlueCross during the time period when this patient's services were provided. This Out-of-Networkstatus resulted in claims processing to Out-of-Network benefits, sometimes withoutreimbursement. Additionally, the non-contracted status also caused amounts beyond thePremera maximum allowable to be labeled as "not covered" and "your total responsibility" ontheir Explanation of Benefit (EOB) forms.
Although there was a delay in the CellNetix submission of claims to Premera for payment, thelack of payment for his claims was due to our temporary Out-of-Network status and not to aneligibility issue as alluded to in his desired settlement. Claims submitted to payors forreimbursement process to benefits according to the date when services were provided. In thiscase, Mr. [redacted] had coverage through the BlueCard program during his service date so hisclaims processed to benefits.
The following is a breakdown of Mr. [redacted]'s billed services:Service Date January 21.2015Technical Component: For the total charges of $132.00, Premera processed the claim tobenefits and did not make a payment. Premera did apply the full charges of $132.00 to Out-ofNetworkdeductible.
Professional Component: For the total charges of $206.00, Premera processed the claim tobenefits, and again did not make a payment. Premera did apply the full charges of $206.00 toOut-of-Network deductible.Of note, is that Premera applied the full charges to the deductible rather than the Premeramaximum allowable. Although CellNetix was not considered contracted during the time periodof this patient's services, we will not hold him accountable for amounts beyond the Premeramaximum allowable.
Further, as the patient paid his patient responsibility for the technical charges shortly afterreceiving his CellNetix billing statement, he should have been offered a 45% Prompt PayDiscount. CellNetix has extended this Prompt Pay Discount to those patients negativelyimpacted by the temporary Out-of-Network status with Premera. The Prompt Pay Discountapplied to the Premera maximum allowable for Mr. [redacted]'s services would be:Technical Component Applied To Deductible:Less 45% Prompt Pay Discount:Revised Amount Due:$51.56-$23.20$28.36As the patient paid $132.00, he will receive a refund of $28.36.Professional Component Applied To Deductible:Less 45% Prompt Pay Discount:Revised Amount Due:$41.99- $18.90$23.09As the patient paid $206.00, he will receive a refund of $182.91.The total refund due to the patient will be $286.55 and he should receive it in three weeks.Referral to Collection Agency:
The patient's account was forwarded to Audit & Adjustment Company Inc. (AACI) for recovery ofthe professional charges of $206.00 after no payment had been received after 120 days. AACIdoes confirm that they received the $206.00 payment from the patient. AACI simply facilitatedthe payment and did not report any action to the credit bureaus regarding this patient's CeiiNetixaccounts.
Professional and Technical Components of Pathology Services:Mr. [redacted]'s complaint also questions why there were charges for two services on the same day.It is an industry standard to separate the professional and technical components of manypathology services for reporting and reimbursement purposes. This billing methodologyprovides further transparency to the patient, as the two types of services are separated.Per the American Medical Association (AMA), certain Current Proced[redacted] Terminology (CPT)codes allow the separation of services by use of a modifier attached to the code whichdesignates which charges are professional, versus what charges are technical. Althoughreported separately, the sum reimbursement for the professional and technical charges togetherwould remain the same, whether reported separately or as one comprehensive service.We appreciate Mr. [redacted]'s feedback regarding his experiences with our Customer ServiceDepartment, and take his comments seriously. CeiiNetix continually strives to provide the bestcustomer service experience to our patients and we appreciate the opportunity to review ourinternal processes.We apologize for any inconvenience that our temporary Out-of-Network status has caused.CellNetix is pleased to have reached a long term agreement with Premera, and look forward topartnering with them to provide high quality yet cost effective health care services.Sincerely,Kathleen F[redacted]Chief Executive OfficerCc: David K[redacted], Chief Financial Officer
March 8, 201 6
Brittany...
Ural, Revdex.com Resolutions ConsultantRevdex.comP.O. Box 1000DuPont, WA 98327
Re:[redacted]ID No.:[redacted]
Dear Ms. [redacted]
I are responding on behalf of CellNetix to Ms. [redacted] complaint. Ms. [redacted] complains ofCellNetix billing practices. CellNetix respectfully disputes it has billed inappropriately.
I have made repeated attempts to contact Ms. [redacted] to resolve this issue. I left voicemailmessages asking Ms. [redacted] for return calls on February 2, 20 16 and February 23, 2016. Ms.[redacted] did not respond to my February 2, 2016 call until February 18, 2016 when she left me avoicemail. She never responded to my February 23, 2016 message.
On March 1, 2016, I left a voicemail message and sent Ms. [redacted] an email. She responded to myemail saying she would contact me. See attachment. On March 2, 2016, she left a voicemailagain promising to contact me. It is now March 8, 2016, and I have received no furthercommunication from her.
In light of Ms. [redacted] lack of response to our multiple attempts to resolve her concerns, I askthis complaint be closed. If Ms. [redacted] chooses at some future time to contact our office, I will ofcourse work with her to address whatever concerns she may have.
Best regards,Marlena G[redacted]Associate Attorney[redacted]
[redacted]Please see attached documents[redacted]
Dear Ms. [redacted]:I am in receipt of the above referenced patient inquiry dated March 22, 2016 regarding servicesrendered by CellNetix Pathology & Laboratories and submitted for payment to Premera BlueCross. This correspondence serves to address this patient's concerns and provide...
clarificationregarding her account.
As you may be aware, CellNetix was considered temporarily Out-of-Network with Premera BlueCross during the time period when this patient's services were provided. This Out-of-Networkstatus resulted in Premera submitting reimbursement to the patient by check, rather thandirectly to CellNetix. Additionally, the non-contracted status also caused amounts beyond thePremera maximum allowable to be labeled as "not covered" and "your total responsibility" ontheir Explanation of Benefit (EOB) forms.
Although CellNetix was not contracted during this time period, we are accepting the Premeramaximum allowable as payment in full for these services. The following is a breakdown of Ms.[redacted]'s billed services:Service Date February 20, 2015Technical Component: For the total charges of $191.50, Premera sent a check directly to thepatient for $38.66 which has been received by CellNetix. Premera also applied $9.67 to thepatient's coinsurance. As stated above, CellNetix will accept the sum amount of the Premerapayment of $38.66 and the patient's coinsurance of $9.67 as reimbursement in full for theservices.
Per our records, the patient made two payments totaling to $70.00 for these services. As herpatient liability amount was $9.67, this results in a refund/credit of $60.33
Professional Component: For the total charges of $205.00, Premera sent a check directly to thepatient for $35.09 which has also been received by CellNetix. Premera applied $8.77 tocoinsurance. After applying the above referenced credit, this account balance is now at zeroand the patient is due a refund in the amount of $51.56.
The refund has been requested today and Ms. [redacted] should receive it in three weeks.
We appreciate Ms. [redacted]'s feedback regarding her experiences with our Customer ServiceDepartment. CellNetix continually strives to provide the best customer service experience toour patients and we appreciate the opportunity to review our internal processes.
We apologize for any inconvenience that our temporary Out-of-Network status has caused, andthank Ms. [redacted] for forwarding the Premera reimbursement checks to us. CellNetix is pleasedto have reached a long term agreement with Premera, and look forward to partnering with themto provide high quality yet cost effective health care services.
Sincerely,Kathleen F[redacted]Chief Executive OfficerCc: David K[redacted], Chief Financial Officer'