Complete Chiropractic Health

I have reviewed the response made by the business in reference to complaint ID [redacted] , and although I do not agree with some of the statements that were made in their response (in regards to timing as I do have proof to substantiate when I notified them by phone while I was on vacation and the refund was received weeks after I first brought it to their attention ), I acknowledge that I have finally received the refund that was due meI do not believe that their billing practices are fair to the consumer (not providing timely (waited weeks) reimbursement of refunds owed the customer, waiting for my entire treatment to be completed before reimbursing me even though my refund only pertained to my initial treatments, having to wait for their 3rd party company to reimburse them before they reimburse the customer, telling a customer that they only reimburse once a month, etc.) so therefore I choose to no longer patronize their business in the future

Response to complain ID [redacted]
The customer came to our office on July 2l~ and proceeded to have six visits between July 2l’~ and July
315t At that point, the customer was away, I believe, on vacation until returning August 12th, On the
section from the Revdex.com called...

complaint background the customer states the problem occurred on 8/6/14
however our records show the customer was not in the office between the dates of 7/31/14 and
8/12/14. We were notified by the customer later that week (middle of August) that they had received
an Explanation of Benefits from their insurance company stating that their Out of Pocket expense had
been met for the year which meant that they no longer owed their $40. We contacted the customer’s
insurance company to verify this since our office had not received the same Explanation of Benefits yet.
We told the customer that OUR Explanation of Benefits come much later than the patients. So we did
not have a matching copy.
After several attempt to reach them, we were told by the customer’s insurance company that a THIRD
party handles their insurance claims, payments and Explanation of Benefits. Our employee in charge of
insurance claims now had to call and track down the third party to confirm the Out of Pocket being met,
In conversations with the customer, it is my understanding that this may have been mistaken for our
office “not believing them” that their Out of Pocket had been met. This certainly is not the case. Our
office was simply following insurance guidelines, safety, security and general best practices to confirm
information from the insurance company which we were unable to do initially. I understand that
sometimes customers might not understand the complexities with Insurance companies. lt should be
noted at this time our office ceased to collect the $40 copay from the customer in acknowledgement of
the Explanation of Benefits the customer showed us and the customer continued to receive treatment
at our office. There are several steps when dealing with insurance companies that must be followed
which is different than say returning a piece of clothing to Target, for example, where a customer can
take in the article of clothing and receive an instant refund.
We did tell the customer that all of our refunds, and bills for that matter, are on a monthly billing cycle
and that the refund would be coming. Our office has always, 100% of the time, issued refunds to
patients when necessary. The refunds, and bills, on the monthly cycle are the same as any other
company that has a billing cycle. I personally have received refunds from my cell phone company, credit
card company and cable company, but I have always received them on my next statement or bill.
We explained this in detail to the costumer, which the customer and spouse both acknowledged they
understood. The customer stated that “weeks went by” and they kept calling about their refund but
again they both acknowledged that we told them of the billing cycle and time period to expect their
refund. The customer also said, “it is now 6 weeks later” after informing our office of the Out of Pocket
being met Yes that Is true. But it has been exactly 4 weeks this week since we confirmed the Out of
Pocket with the insurance company and then the third party payor, went through our billing cycle and
the refund check has now been sent exactly when we said it was coming. So in the end, the refund
check has been sent. Our office followed procedures from the insurance company and our office exactly
and now the customer has their refund.

I have reviewed the response made by the business in reference to complaint ID [redacted], and although I do not agree with some of the statements that were made in their response (in regards to timing as I do have proof to substantiate when I notified them by phone while I was on vacation and the refund was received 7 weeks after I first brought it to their attention ), I acknowledge that I have finally received the refund that was due me. I do not believe that their billing practices are fair to the consumer (not providing timely (waited 7 weeks) reimbursement of refunds owed the customer, waiting for my entire treatment to be completed before reimbursing me even though my refund only pertained to my initial 6 treatments, having to wait for their 3rd party company to reimburse them before they reimburse the customer, telling a customer that they only reimburse once a month, etc.) so therefore I choose to no longer patronize their business in the future.

Review: I sought chiropractic care at Complete Chiropractic Health (CCH) beginning in late July. I was cleared by my insurance to receive 10 treatments. CCH verified my health insurance and co-ay ($40/co-pay per session). In the beginning of August, I became aware (through received Explanation of Benfefits statement) that I had met my maximum out-of-pocket limit with my healthcare provider and and did not have to pay any co-pays/co-insurance for the remainder of the year. I immediately notified CCH so that they could make preparations to refund the amount I already paid ($240 = $40 x 6 sessions) as well be notified to no longer collect co-pays on the remainder of my treatments. It took a couple voicemails back and forth before CCH would understand since they still tried to maintain that I had to keep paying $40/co-pay per visit. CCH eventually called my insurance company and verified that I had met my out-of-pocket maxiumum and did not charge me a co-pay on subsequent visits. When I asked about the refund, they informed me that it could take up to a month before they would receive the Explanation of Benefits from my insurance carrier. Weeks went by and I continued to ask about the refund and even provided copies of my Explanation of Benefits statements. It is now 6 weeks later after I first informed them and I still have yet to receive any refund. Last week my husband called them and they still maintain that they haven't been paid for all my visits (not just the first 6 that I paid a co-pay) even though their 3rd party billing company has been paid from my insurance carrier for all visits (as of 9/12). CCH admitted that they got paid for the 1st visit already (from their 3rd party billed) which means that they recceived over 100% of the expense (because my insurance paid 100% of the expense billed AND they received my co-pay from me. So they know that I met my out-of-pocket max from my insurance and have received more than 100% of their billing and yet they still refuse to refund my overpayment.Desired Settlement: Would like immediate refund of overpayment in the amount of $240.

Business

Response:

Response to complain ID [redacted]

The customer came to our office on July 2l~ and proceeded to have six visits between July 2l’~ and July

315t At that point, the customer was away, I believe, on vacation until returning August 12th, On the

section from the Revdex.com called complaint background the customer states the problem occurred on 8/6/14

however our records show the customer was not in the office between the dates of 7/31/14 and

8/12/14. We were notified by the customer later that week (middle of August) that they had received

an Explanation of Benefits from their insurance company stating that their Out of Pocket expense had

been met for the year which meant that they no longer owed their $40. We contacted the customer’s

insurance company to verify this since our office had not received the same Explanation of Benefits yet.

We told the customer that OUR Explanation of Benefits come much later than the patients. So we did

not have a matching copy.

After several attempt to reach them, we were told by the customer’s insurance company that a THIRD

party handles their insurance claims, payments and Explanation of Benefits. Our employee in charge of

insurance claims now had to call and track down the third party to confirm the Out of Pocket being met,

In conversations with the customer, it is my understanding that this may have been mistaken for our

office “not believing them” that their Out of Pocket had been met. This certainly is not the case. Our

office was simply following insurance guidelines, safety, security and general best practices to confirm

information from the insurance company which we were unable to do initially. I understand that

sometimes customers might not understand the complexities with Insurance companies. lt should be

noted at this time our office ceased to collect the $40 copay from the customer in acknowledgement of

the Explanation of Benefits the customer showed us and the customer continued to receive treatment

at our office. There are several steps when dealing with insurance companies that must be followed

which is different than say returning a piece of clothing to Target, for example, where a customer can

take in the article of clothing and receive an instant refund.

We did tell the customer that all of our refunds, and bills for that matter, are on a monthly billing cycle

and that the refund would be coming. Our office has always, 100% of the time, issued refunds to

patients when necessary. The refunds, and bills, on the monthly cycle are the same as any other

company that has a billing cycle. I personally have received refunds from my cell phone company, credit

card company and cable company, but I have always received them on my next statement or bill.

We explained this in detail to the costumer, which the customer and spouse both acknowledged they

understood. The customer stated that “weeks went by” and they kept calling about their refund but

again they both acknowledged that we told them of the billing cycle and time period to expect their

refund. The customer also said, “it is now 6 weeks later” after informing our office of the Out of Pocket

being met Yes that Is true. But it has been exactly 4 weeks this week since we confirmed the Out of

Pocket with the insurance company and then the third party payor, went through our billing cycle and

the refund check has now been sent exactly when we said it was coming. So in the end, the refund

check has been sent. Our office followed procedures from the insurance company and our office exactly

and now the customer has their refund.

Consumer

Response:

I have reviewed the response made by the business in reference to complaint ID [redacted], and although I do not agree with some of the statements that were made in their response (in regards to timing as I do have proof to substantiate when I notified them by phone while I was on vacation and the refund was received 7 weeks after I first brought it to their attention ), I acknowledge that I have finally received the refund that was due me. I do not believe that their billing practices are fair to the consumer (not providing timely (waited 7 weeks) reimbursement of refunds owed the customer, waiting for my entire treatment to be completed before reimbursing me even though my refund only pertained to my initial 6 treatments, having to wait for their 3rd party company to reimburse them before they reimburse the customer, telling a customer that they only reimburse once a month, etc.) so therefore I choose to no longer patronize their business in the future.