Crown Park Homes, LLC

Revdex.com: I have reviewed the response made by the business in reference to complaint ID [redacted] , and have determined that this does not resolve my complaint For your reference, details of the offer I reviewed appear below Regards, [redacted] If I would have gone to another doctors office it would have been coveredIt was the doctors idea for me to do Head tests and I specifically asked is this covered by my insurance and Tina said yes you unfortunately have a $copayBy taking my copay and me asking that I was assured they took my insuranceIf not I would have said no to these tests and gone to a facility that takes my insuranceThis would have been covered at percent if I would have gone to somewhere in network according to upmcWhen I asked Tina this she assured me they did and took my specialty copay of $Their own employee told me they take this and now I am suppose to pay for their misrepresentation? This is not fair and not how a business should be ran by misinforming peopleI pay privately for my health insurance at over $a monthI would not go to a facility that does not take my insurance so I have to pay more moneyI took Tina's word as they had me pay for the tests that day and I came back a week later when I picked up my glasses and then got the test done

To Whom It May Concern:This letter is being sent in response to the additional complaint submitted by [redacted] on 03/01/2017.The ID # is [redacted] Ms [redacted] was informed about the fact that the visit and any tests would be filed with to her UPMC plan We had her sign and date a document stating that she was aware of this fact that I am sending along with this correspondence We looked at her insurance card to see if there was any mention of a need for a referral or preauthorization for services There was nothing on her card stating that need It is the patient's responsibility to know their insurance benefits and any necessary procedures to use the benefits Also, there is no way for us to know what medical insurance company will cover because they all inform providers that they cannot guarantee payment of services unit they are filled with the insurance company As stated in our original response, we followed the protocol that her insurance company told us by billing Ms [redacted] In response to the issue of the $co pay thru her VSP insurance, Ms [redacted] did pay that amount The $co pay is a materiel c pay for her glasses that is dictated that she is responsible for per her VSP insurance We neither charged her a co pay for a vision exam nor did we bill VSP for the service of an exam lastly, I spoke to our billing department Kim had told me that they have been playing phone tag and she hasn't heard from s [redacted] since the last time she left a message Thank you , Rob S***

I would also like to add that the claim would have been covered if I went to an in-network providerI was told by Tina they took my insuranceSo it's not the matter of it being denied but it would at been covered at percent if they were in- network which when Tina said they took my insurance,
she had me believe I was in network

I received a bill from dormont vision center for $356.00. They took my $100.00 that I paid as an insurance copay for a specialists through medical insurance upmc. I had a scheduled eye exam on January 4th 2017. I had my eye exam done and after the eye exam they told me my optic nerve was thick behind my eye and do I get headaches often. I replied no and they said they wanted to do further testing. I asked Tina how much is this going to cost? Tina said who do you have for medical insurance? I replied upmc. She asked to see my medical card. Tina took the medical card to the front desk as I was sitting at the table picking out of 3 frames I liked. Tina came back and said the further tests we want to run are covered but unfortunately you have a $100.00 copay. I said to Tina are you sure as I do not want a $500.00 bill. I did not go in here this day knowing they wanted to run additional tests so when Tina assured me they took my insurance I took her word for it. I paid $133.00 that day for my insurance copay, my vsp Co pay and my vsp frame coverage difference. I had to leave as they said the test would take another hour and I had to be at work at noon as I was not expecting to have to do any of these additional tests. I called my vision insurance vsp on 2/23/17 and the customer service representative told me vsp was not billed for an exam at all. Vsp called dormont vision center as I read them the charges on my bill from dormont vision center and the representative told me the comprehensive exam and the refraction on my bill would be covered through vsp vision insurance as 100%. Vsp called dormont vision center on 2/23 and spoke to [redacted] and she said it was billed as medical. The other 3 things on the bill were medical but not the exam and refraction as that's what I had scheduled for that day. They refused to rebill it to vsp vision. I then called upmc and I explained to the representative again what was going on as I was appealing the denial through them as they said I was out of network, which would have been covered at 100% if they were in network which Tina who works at dormont vision center had told me, etc when I asked her since they wanted to run further testing that day. When upmc called dormont vision center they spoke to [redacted] again and [redacted] said the office manager Rob who is the owners son is not in today and she will see if he can rebill it when he comes to work the following day. On the bill I received from dormont vision center the dates are incorrect for the billing and the amounts showing what I paid. When I spoke to [redacted] she said well I can give you the $10 copay back. I said no it was $25 and they are committing fraud by falsely billing the wrong insurance for the two items on the bill. I have called their billing department over 5 times and left numerous messages and Kim K[redacted] never answers the phone and never returns any calls. I was not expecting to get these tests done I just went in for a scheduled eye exam and they wanted to do the additional tests. I would have gone somewhere else if Tina had never told me they took my insurance. Again the appeal was denied through medical insurance as I was out of network. Tina is giving wrong information. When I told vsp about what was going on they suggested I contact the board of optometry in Pennsylvania. It's now march 1st and no one not the office manager of dormont vision center or Kim's k[redacted] in the billing department have returned any of my call and voicemails. Sent from my iPhone

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID [redacted], and have determined that this does not resolve my complaint.  For your reference, details of the offer I reviewed appear below.
Regards,
[redacted].   If I would have gone to another doctors office it would have been covered. It was the doctors idea for me to do  Head tests and I specifically asked is this covered by my insurance and Tina said yes you unfortunately have a $100.00 copay. By taking my copay and me asking that I was assured they took my insurance. If not I would have said no to these tests and gone to a facility that takes my insurance. This would have been covered at 100 percent if I would have gone to somewhere in network according to upmc. When I asked Tina this she assured me they did and took my specialty copay of $100.00. Their own employee told me they take this and now I am suppose to pay for their misrepresentation? This is not fair and not how a business should be ran by misinforming people. I pay privately for my health insurance at over $200 a month. I would not go to a facility that does not take my insurance so I have to pay more money. I took Tina's word as they had me pay for the tests that day and I came back a week later when I picked up my glasses and then got the test done.

To Whom It May Concern:This letter is being sent in response to the additional complaint submitted by [redacted] on 03/01/2017.The ID # is [redacted]. Ms. [redacted] was informed about the fact that the visit and any tests would be filed with to her UPMC plan.  We had her sign and date a document stating that she was aware of this fact that I am sending along with this correspondence.  We looked at her insurance card to see if there was any mention of  a need for a referral or preauthorization for services.  There was nothing on her card stating that need.  It is the patient's responsibility to know their insurance benefits and any necessary procedures to use the benefits.  Also, there is no way for us to know what medical insurance company will cover because they all inform providers that they cannot guarantee payment of services unit they are filled with the insurance company.  As stated in our original response, we followed the protocol that her insurance company told us by billing Ms. [redacted].  In response to the issue of the $25 co pay thru her VSP insurance, Ms. [redacted] did pay that amount.  The $25 co pay is a materiel c pay for her glasses that is dictated that she is responsible for per her VSP insurance.  We neither charged her a co pay for a vision exam nor did we bill VSP for the service of an exam.  lastly, I spoke to our billing department.  Kim  had told me that they have been playing phone tag and she hasn't heard from s [redacted] since the last time she left a message.  Thank you , Rob S[redacted]

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID [redacted], and have determined that this does not resolve my complaint.  For your reference, details of the offer I reviewed appear below.
[To assist us in bringing this matter to a close, we would like to know your view on the matter.]
Regards,
[redacted].   I just called Kim k[redacted] again and yet again left another message. We have not been playing phone tag as I never receive any calls back it's just myself making them. Dormont vision center did not bill the VSP insurance as I talked to them myself and they said the exam and refraction would be covered by dr s[redacted] is billig my upmc health insurance. As I already stated it was only medical half way through my appointment. And again I will say this again. Your employee Tina told me you take my insurance. I never walked in there expecting to get these extra tests done. The doctor wanted them done that day. How would I have time to look and see if you are in network for health insurance I was going for a routine eye exam. Then I had to pay for the test that day per Tina and did not get the test done until a week later when I picked up my glasses. I specifically asked Tina do you take my insurance. And she said yes.

Dormont Vision CenterDr. Paul S[redacted]To Whop It May ConcernThis letter is being sent in response to the complaint filed by [redacted] on 2/8/2017. The ID# is [redacted].Ms. [redacted] was seen by Dr. S[redacted] on 1/4/2017 for medical reasons. She was informed about the fact that the visit and any tests would be filed to her UPMC insurance plan. We had her sign and date a  document stating that she was aware of this fact that I am sending along with this correspondence. We looked at her insurance card to see if there was any mention of a need for a referral or preauthorization for services.  There was nothing on her insurance card that stated that need. It is the patient's responsibility to know their insurance benefits and any necessary procedures to use the benefits. Also, There is no way for us to know what any medical insurance company will cover because they all inform providers that they cannot guarantee payment of services until they are filed with the insurance company.  Ms. [redacted] notified our office to inform us that the services were denied by her insurance. I spoke to our billing department. They spoke to Ms [redacted]'s insurance company. Our billing department told us that the patient didn't request pre-authorization for services and UPMC directed us to bill the patient  directly for services. I tried to explain to Ms [redacted] what her insurance company directed us to do.  Ms [redacted] stated that she will contact The Revdex.com.Thank you,Rob S[redacted]