Colon & Rectal Surgical Associates of San Antonio

Complaint: [redacted] I am rejecting this response because:I have read over your response to my claim Some of your information is correct but some is not I have gone over each part of your response and clarifying parts of it I am also adding more information that may help you understand why I am feel the way I do 5/16/ [redacted] denied claim 9/22/ The office decided to have me settle with insurance but I see in this portion of their statement, they did not contact me stating that they were going to have me settle on my own with my insurance Their reply simply states, and I quote “his account was reviewed and it was determined that since we had already billed both insurances, we would bill the patient and have him settle with his insurance.” Nowhere does it say they contacted me and told me they were going to do this 10/14/ Statement sent out I did not receive this statement 12/27/ Statement sent out I did not receive this statement 5RO/ I’m assuming she is referring to a statement dated 5/10/ I did receive this statement however her records are incorrect and missing information She did not have in her notes another statement dated 4/28/for $which is the statement which set this billing issue in motion The paragraph about the office visit on 7/18/– I can’t even decipher the beginning part of what she is trying to convey so I will skip over this commentary Onto what I can understand I reiterate, [redacted] has always been my primary insurance and I would not have said otherwise I was told several calls were made and statements were sent out concerning these two denied [redacted] claims I would like to bring up a few points as to why I have questions with what the office is saying about mailing statements and making calls First I started seeing [redacted] in November of for a fissure which led to a fissurectomy which led to the discovery of anal cancer When you have cancer, you have regular check ups every six months, so I saw [redacted] every six months from November until August of 2017, that is five years If [redacted] denied a claims in August and September of and all these calls were made and all these statements were sent out and I had an outstanding bill, why was this not brought to my attention during one of my regular six month follow up visits? After all, I’m in the office every six months I must have been in the office between 8/13/when [redacted] denied the claims to 4/28/2017, which is the first statement I received relating to the two denied [redacted] claims Please look in your records and tell me how many times I was in the office between 8/13/and 4/28/ Not once was this issue ever mentions to me while I was in the office during a follvisit Seems like the office would have had many opportunities to bring this to my attention Second If I was in extreme arrears with my account, in this case, two years, which is EXTREME why has my account not been sent to collections yet? My theory is that my [redacted] claims and the billing of these claims had been lost in the system somewhere and suddenly the bill popped up, the system discovered the bill, a statement was generated, a statement was sent out to the patient without a human even knowing this was happening Just my theory, but not far fetched I can’t say this is the situation here, but when software is changed or updated, data can be lost or misplaced or not converted properly, oh, there is also user error I could go on and on as my background is in IT and I know how software works but this is just a theory but something to consider Third I would never let something like this go on for two years Because it is two years later, [redacted] is out, now I'm responsible, I would NEVER had let this happen I take care of my bills swiftly because I have to I am on Social Security Disability with a monthly income of $ Not only am I a person who pays his bills fully and on time, I am a person who HAS to pay his bills on time to survive on such a low income The statement I received on 4/28/for $is 46% of my monthly income I challenge anyone reading this to calculate 46% of their monthly income and imagine getting a bill and being told you have to pay it or you will be sent to collections which is what I was told by one of your staff members I will say this again, because of my income, I would NEVER let something get this out of control so that I would end up with a bill that equals 46% of my monthly income.You say I'm angry, yes, I'm angry Please explain my first and second points above and I will become less angry I was so upset that I started bleeding through my nose, I nearly had a breakdown and it is associated with my disability.The last paragraph I do not understand The paragraph that starts with...We notice that you have, etc What does this mean? What is IIIPAA? Could you elaborate on this paragraph and explain? Maybe you can send me this information in the mail but it would be in basic language that a lay person could understand, not in legal jargon Regards, [redacted] ***

The following is a description of the events that occurred with Complaint ID [redacted] .Date of service was 8/13/in which we billed [redacted] (primary), On 9/3/ [redacted] responded with a denial stating another insurance was primary.On March 9, one of our agents who was working the accounts receivable in our office called and spoke with the patient who stated that his partner is currently employed with [redacted] so [redacted] is primary, Agent informed thepatient that he needs to notify his insurances of who is primaryAt this time she sent the claim to [redacted] .On [redacted] denied our claim stating they were not primary payers9/his account was reviewed and it was determined that since we had already billed both insurances, we would bill the patient and have him settle with his insuranceAccount statements were sent to patient on 10/14/16,12/27/with delinquent megee8e and as a courtesy a third statement was sent on 5RO/Patient came into satellite office on 7/18/and had questions on his balance so he was connected with our billing departmentOur agent spoke with the patient and asked him about the insurance since [redacted] denied his claim due to them not being primary Patient claimed that he spoke to an employee here back in March about where to send his claim but he had no information on who he spoke with and after reviewing his chart, we had no documentation on that conversation ever taking placeAt this time he was reminded about our conversations with him on March of that we have documented and the issue of [redacted] denying the claim and about [redacted] being primary since his partner had ***Patient said [redacted] was his primary and he wouldn't have said thatAt this time he was informed that we were past the filing deadline with [redacted] but we would still try to file with themThe agent also informed him that if [redacted] denies the claim, he would be responsible for the balancePatient got angry and said that he would not pay for the claim because it was our fault that he was not informed Again he was told that a statement had been sent to him on three different dates and he then stated that he had moved a year ago and did not receive any snail from usWe also told him that his instance should have sent him a copy of the explanation cf benefitsHis response to this was "who looks at the EOB's"The agent informed him that we would Iet his account go thru the processing and he stated that he wanted a detailed print out of who he talked to and what he bad said to each agent plus the notes that were typed and his statements so he could bring them up to the physicianWe told him we would print all this info and have it ready for the physician when the patient was ready to come in and discuss.Patient called back and spoke with the Billing Coordinator who was already informed about the previous conversationShe asked him what she could do to assist him and he said he was going to pay this balancePatient was upset so she told him that we would work with him on the balanceHe proceeded to hand the phone call to his partner and continue the conversationThey were both informed that we would give him a courtesy discount since he was paying as a self-payHe was given a quote of [redacted] Allowable Rates and discounted the remainderHis partner was very nice and said that he appreciated us working with himThe conversation ended with us taking the payment and sending him a receipt.We notice that you have full discretion and authority to publish any claim and responsesIf you choose to do so, then you are responsible for any IIIPAA violations that may occur due to your act of publicizinginformation that could be deemed protected private health information and that we will not be held liable in any way for your decision to publish the information received from us or the patient.Thank you, [redacted] ***

As reading the response to our last letter I would like to say, in good faith we filed the claim to process through the insurance. We spoke with the patient to please contact his insurance to determine which health plan would be primary since neither insurance company was paying the claims. lithe patient would have contacted the insurance as we asked this would have quickly resolved the issue at no cost to the patient. We spent considerable time working with the insurance and holding the account in our office trying to resolve the issue. Since we received inaccurate information these are the results we now have to deal with. Patient has received excellent healthcare from our physician at partially no cost. In spite of the inaccurate information from the patient, and the subsequent lack of payment from the insurance company, our company still provided a significant discount to the patient. He was given a generous discount of $473.43 and patient paid $154.33 for services rendered to him 09/10/15 & 08/13/15. At this point, the patient is requesting a refund of $154.33 which was the only payment received for the doctor's time and effort. Unfortunately we are still dealing with the problem and have spent time responding to Revdex.com which has continued to cost us valuable time and money. We are willing to take a loss of $154.33 for services rendered to clear this matter once and for all. Unfortunately, the Revdex.com either doesn't read the correspondence between the parties or it doesn't want to assist with the reconciliation process. It simply provides a public forum for disputes. Sincerely,[redacted]

The following is a description of the events that occurred with Complaint ID. [redacted].Date of service was 8/13/15 in which we billed [redacted] (primary), On 9/3/15 [redacted] responded with a denial stating another insurance was primary.On March 9, 2016 one of our agents who was...

working the accounts receivable in our office called and spoke with the patient who stated that his partner is currently employed with [redacted] so [redacted] is primary, Agent informed thepatient that he needs to notify his insurances of who is primary. At this time she sent the claim to [redacted].On 516116 [redacted] denied our claim stating they were not primary payers. 9/22116 his account was reviewed and it was determined that since we had already billed both insurances, we would bill the patient and have him settle with his insurance. Account statements were sent to patient on 10/14/16,12/27/16 with delinquent megee8e and as a courtesy a third statement was sent on 5RO/17. Patient came into satellite office on 7/18/17 and had questions on his balance so he was connected with our billing department. Our agent spoke with the patient and asked him about the insurance since [redacted] denied his claim due to them not being primary Patient claimed that he spoke to an employee here back in March about where to send his claim but he had no information on who he spoke with and after reviewing his chart, we had no documentation on that conversation ever taking place. At this time he was reminded about our conversations with him on March 9 of 2016 that we have documented and the issue of [redacted] denying the claim and about [redacted] being primary since his partner had [redacted]. Patient said [redacted] was his primary and he wouldn't have said that. At this time he was informed that we were past the filing deadline with [redacted] but we would still try to file with them. The agent also informed him that if [redacted] denies the claim, he would be responsible for the balance. Patient got angry and said that he would not pay for the claim because it was our fault that he was not informed Again he was told that a statement had been sent to him on three different dates and he then stated that he had moved a year ago and did not receive any snail from us. We also told him that his instance should have sent him a copy of the explanation cf benefits. His response to this was "who looks at the EOB's". The agent informed him that we would Iet his account go thru the normal processing and he stated that he wanted a detailed print out of who he talked to and what he bad said to each agent plus the notes that were typed and his statements so he could bring them up to the physician. We told him we would print all this info and have it ready for the physician when the patient was ready to come in and discuss.Patient called back and spoke with the Billing Coordinator who was already informed about the previous conversation. She asked him what she could do to assist him and he said he was going to pay this balance. Patient was upset so she told him that we would work with him on the balance. He proceeded to hand the phone call to his partner and continue the conversation. They were both informed that we would give him a courtesy discount since he was paying as a self-pay. He was given a quote of [redacted] Allowable Rates and discounted the remainder. His partner was very nice and said that he appreciated us working with him. The conversation ended with us taking the payment and sending him a receipt.We notice that you have full discretion and authority to publish any claim and responses. If you choose to do so, then you are responsible for any IIIPAA violations that may occur due to your act of publicizinginformation that could be deemed protected private health information and that we will not be held liable in any way for your decision to publish the information received from us or the patient.Thank you,[redacted]

Complaint: [redacted]
I am rejecting this response because:I have read over your response to my claim.  Some of your information is correct but some is not.  I have gone over each part of your response and clarifying parts of it.  I am also adding more information that may help you understand why I am feel the way I do. 
5/16/2016            [redacted]
denied claim.
9/22/2016            The
office decided to have me settle with insurance but I see in this portion of
their statement, they did not contact me stating that they were going to have
me settle on my own with my insurance. 
Their reply simply states, and I quote “his account was reviewed and it
was determined that since we had already billed both insurances, we would bill
the patient and have him settle with his insurance.”  Nowhere does it say they contacted me and
told me they were going to do this.
10/14/2016          Statement
sent out.  I did not receive this
statement.
12/27/2016          Statement
sent out.  I did not receive this
statement.
5RO/17                  I’m
assuming she is referring to a statement dated 5/10/2017.  I did receive this statement however her
records are incorrect and missing information. 
She did not have in her notes another statement dated 4/28/2017 for
$627.76 which is the statement which set this billing issue in motion.
                                The
paragraph about the office visit on 7/18/2017 – I can’t even decipher the
beginning part of what she is trying to convey so I will skip over this
commentary.  Onto what I can
understand.  I reiterate, [redacted] has
always been my primary insurance and I would not have said otherwise.  I was told several calls were made and statements
were sent out concerning these two denied [redacted] claims.  I would like to bring up a few points as to
why I have questions with what the office is saying about mailing statements
and making calls.
                                First.  I started seeing [redacted] in November of
2012 for a fissure which led to a fissurectomy which led to the discovery of
anal cancer.  When you have cancer, you
have regular check ups every six months, so I saw [redacted] every six months
from November 2012 until August of 2017, that is five years.  If [redacted] denied a claims in August and
September of 2015 and all these calls were made and all these statements were
sent out and I had an outstanding bill, why was this not brought to my
attention during one of my regular six month follow up visits?  After all, I’m in the office every six
months.  I must have been in the office
between 8/13/2015 when [redacted] denied the claims to 4/28/2017, which is the
first statement I received relating to the two denied [redacted] claims.  Please look in your records and tell me how many times I was in the office between 8/13/2015 and 4/28/2017.  Not once was this issue ever mentions to me
while I was in the office during a follow-up visit.  Seems like the office would have had many
opportunities to bring this to my attention.
                                Second.  If I was in extreme arrears with my account,
in this case, two years, which is EXTREME…why has my account not been sent to
collections yet?  My theory is that my
[redacted] claims and the billing of these claims had been lost in the system
somewhere and suddenly the bill popped up, the system discovered the bill, a
statement was generated, a statement was sent out to the patient without a
human even knowing this was happening.  Just my theory, but
not far fetched.  I can’t say this is the
situation here, but when software is changed or updated, data can be lost or
misplaced or not converted properly, oh, there is also user error…I could go on and on as my background is in
IT and I know how software works but this is just a theory but something to consider.
                                Third.  I would never let something like this go on
for two years.  Because it is two years later, [redacted] is out,  now I'm responsible, I would NEVER had let this happen.  I take care of my bills swiftly because I have to.  I am on Social
Security Disability with a monthly income of $1365.00.  Not only am I a person who pays his bills
fully and on time, I am a person who HAS to pay his bills on time to survive on
such a low income.  The statement I
received on 4/28/2017 for $627.76 is 46% of my monthly income.  I challenge anyone reading this to calculate
46% of their monthly income and imagine getting a bill and being told you have
to pay it or you will be sent to collections which is what I was told by one of
your staff members.  I will say this
again, because of my income, I would NEVER let something get this out of
control so that I would end up with a bill that equals 46% of my monthly
income.You say I'm angry, yes, I'm angry.  Please explain my first and second points above and I will become less angry.  I was so upset that I started bleeding through my nose, I nearly had a breakdown and it is associated with my disability.The last paragraph I do not understand.  The paragraph that starts with...We notice that you have, etc.   What does this mean?  What is IIIPAA?  Could you elaborate on this paragraph and explain?  Maybe you can send me this information in the mail but it would be in basic language that a lay person could understand, not in legal jargon.
Regards,
[redacted]