We are responding to a letter received from your office yesterday regarding complaint ID [redacted] (pleased see attachment). Since this issue involves medical information, due to HIPPA, some relevant information cannot be disclosed without explicit patient’s written request for disclosure of this...
information. However, the follow information can be based on what the patient has already disclosed.On the day of her visit Ms. [redacted] received a patient information packet to complete which clearly in bold letters indicated that we only participate with medical plans and that the cost of a routine eye exams are not covered by most medical insurance plans. Her medical insurance plan, Anthem, does not cover routine eye exams. Blue view covers routine eye exams which we do not participate with since it is a vision plan. Patient has blue view for her routine eye exam. Eye exams are typically considered “routine” if the patient has no eye symptoms and no medical problems are found. Attached please find the copy of routine eye exam policy that the patient signed before her visit on 9/29/15.Nonetheless, the patient’s complaints put the exam in the category of a medical exam. The documentation in the chart for the reason for visit obtained first by the technician and further investigated by the doctor, based on ICD 9 and ICD 10 codes and usual definition of routine eye exam, put the exam under medical. Therefore, as is in our contract with Anthem, the claim was submitted to Anthem. If the patient provides a written consent to disclose her exam notes to you we would be more than happy to release the exam notes to confirm this. During patient’s phone call to dispute this charge, this was explained to the patient and since she did not know that she had signed paperwork about the routine eye exam policy before her visit, her exam notes and the copy of the signed policy were mailed to her. Of note, the patient would have owed more if the exam was truly routine. This is since her Anthem medical plan does not cover routine eye exams and since we do not participate with Blue View, the full cost of the exam (not the lower contracted rate) would have had to be paid by the patient. I suspect that part of the problem is that Blue View vision plan does not provide a separate insurance card for the patient even though it is a separate company from Anthem. Instead the insurance card in large letters indicate Anthem in the top and in a small footnote Blue View. Therefore, this could create confusion for patient who would state Anthem as their insurance carrier, not Blue View. Some medical insurances do have a routine policy as part of medical. But her plan does not. Ms. [redacted] can further contact Blue View and Anthem customer representatives which could help her regarding the claim and explanation of the ICD 9 codes which put the exam in medical category. The numbers for those representatives appear in the back of her insurance card. I wish Ms. [redacted] the best and we hope that this letter helps. Cordially Yours, Parisa Farhi, MD
We are responding to a letter received from your office yesterday regarding complaint ID [redacted] (pleased see attachment). Since this issue involves medical information, due to HIPPA, some relevant information cannot be disclosed without explicit patient’s written request for disclosure of this...
information. However, the follow information can be based on what the patient has already disclosed.On the day of her visit Ms. [redacted] received a patient information packet to complete which clearly in bold letters indicated that we only participate with medical plans and that the cost of a routine eye exams are not covered by most medical insurance plans. Her medical insurance plan, Anthem, does not cover routine eye exams. Blue view covers routine eye exams which we do not participate with since it is a vision plan. Patient has blue view for her routine eye exam. Eye exams are typically considered “routine” if the patient has no eye symptoms and no medical problems are found. Attached please find the copy of routine eye exam policy that the patient signed before her visit on 9/29/15.Nonetheless, the patient’s complaints put the exam in the category of a medical exam. The documentation in the chart for the reason for visit obtained first by the technician and further investigated by the doctor, based on ICD 9 and ICD 10 codes and usual definition of routine eye exam, put the exam under medical. Therefore, as is in our contract with Anthem, the claim was submitted to Anthem. If the patient provides a written consent to disclose her exam notes to you we would be more than happy to release the exam notes to confirm this. During patient’s phone call to dispute this charge, this was explained to the patient and since she did not know that she had signed paperwork about the routine eye exam policy before her visit, her exam notes and the copy of the signed policy were mailed to her. Of note, the patient would have owed more if the exam was truly routine. This is since her Anthem medical plan does not cover routine eye exams and since we do not participate with Blue View, the full cost of the exam (not the lower contracted rate) would have had to be paid by the patient. I suspect that part of the problem is that Blue View vision plan does not provide a separate insurance card for the patient even though it is a separate company from Anthem. Instead the insurance card in large letters indicate Anthem in the top and in a small footnote Blue View. Therefore, this could create confusion for patient who would state Anthem as their insurance carrier, not Blue View. Some medical insurances do have a routine policy as part of medical. But her plan does not. Ms. [redacted] can further contact Blue View and Anthem customer representatives which could help her regarding the claim and explanation of the ICD 9 codes which put the exam in medical category. The numbers for those representatives appear in the back of her insurance card. I wish Ms. [redacted] the best and we hope that this letter helps. Cordially Yours, Parisa Farhi, MD