Crown Vision Center

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID ***, and find that this resolution is satisfactory to me
Sincerely,
*** *** I am pleased that *** *** has finally straightened things out--after almost months I might add.I just don't appreciate it when *** *** billing argues with me over the phone, not believing me when I tell them what Medicaid tells me *** or *** could have easily picked up the phone and called Medicaid's help desk in July or August, once the Medicaid spenddown showed met by Medicaid, and resolved the matter.As mentioned in the complaint, it should be a businesses' obligation to submit a claim to both primary insurance and secondary before even attempting to collect payment from a client.To flat out refuse to submit a claim to a secondary insurance is absurd, but I'm glad they finally did.I'm satisfied with the businesses' response that they've acknowledged that the claim's been submitted and they're awaiting payment. Thank you. Rick ***

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID ***, and find that this resolution is satisfactory to me
Sincerely,
*** ***

Crown Vision Center has reviewed *** *** entire file. Patient *** *** came in for exam on 10/28/and was seen by Dr***. During Dr***'s exam it was discovered that patient has previously had a corneal abrasion in which doctor had discussed with Mr***. Dr***
states that it did not heal properly and he has developed RCE (Recurrent corneal erosion). Dr*** states that she went over with him treatment option (amniotic membrane vs more invasive corneal debridement) which he agreed to have the Amniotic membrane done. This procedure was done on this day and scheduled a follow up for 10/31/2017. Dr*** would not have done a procedure on the patient had they not given approval. I have also attached the Medical examination report giving us permission to bill to his Medical Insurance and it is clearly on this form that if insurance carrier denies payment or if your policy requires you to pay a co-payment or deductible not collected at that time of visit, you will be responsible for the charges. At this time, *** *** did sign giving us permission. *** *** has called our billing department on 12/30/and spoke with one of the billing representative and was explained this and was also sent a copy of everything from his exam date. Copy of his exam/ medical exam report for his records. The patient then called on 2/2/once he received another bill and states he is still disputing the charges. He was again explained everything and then ask for a Supervisor. At that time, I was out of the office. I returned a call to the patient on 2/8/and discussed this in further detail and explained to the patient exactly what Dr*** had done. He is disputing the charges. I then explained to him that his insurance company was billed correctly and that he had NOT met his deductible for the year. He also has a co-insurance that he is responsible for. His insurance company is stating that he is responsible for that went toward his deductible and which is his co-insurance for a total of Patient responsibility of $ 404.02. The patient did pay his co-pay amount of $ for the office visit. TOTAL due was - = balance. It then appears patient had a 2nd insurance that we also billed which they paid $ leaving a balance for the patient to pay of $ 232.49. I have explained this all to the patient and he feels he should not have to pay this. These amounts are the responsibility of the patient *** *** to pay. These are amounts his insurance company has clearly outlined in his particular plan with his deductible and his co-insurance amounts. This is NOT something that Crown Vision Center has any control over. We are responsible to collect from the patient what the insurance company has set up in their plan. We cannot waive any part of the patients deductible or co-insurance for the patient. This is something that has to be consistent with each and every patient. The patient clearly had a procedure that was done by Dr*** and clearly explained to the patient prior to her doing any type of procedureHowever, the Doctor does not know anything about the patient insurance information, which the office does not either in regards to any type of deductible or co-insurance that is strictly the patient responsibly to know and understand their insurance. I have apologized to the patient and also let him know we cannot waive anything for him. I attaching a copy of his Medical Examination Report and a copy of his insurance explanation of benefits to show the patients deductible and co-insurance responsibility. ThanksCrown Vision CenterCustomer Service Manager

Initial Business Response /* (1000, 6, 2015/07/08) */
Crown Vision Center has had a chance to review this customer situation and talk with the office involvedThe patient's refund was actually wrote today 7/8/and mailed this afternoonOur Home office only writes checks on Wednesday'sMr
***'s refund was processed on Thursday June 25, and it normally does take weeks before the patient will receive his refundDue to the Holiday it can possibly take more timeThe check was made out today check # XXXXXX for the amount of $(- = 313.37)
At this time, I am also having the office send me a hard case for the patients glassesI will then mail this directly to his house to avoid him having to make another trip to the officeHe will probably be receiving the check on Saturday depending on how long the mail takes to deliverAs soon as I have the case here at our HQ, I will ship it out Federal ExpressHe should have received a hard case when he picked up his glasses
I will also be contacting the patient directly to discuss and apologize for the entire experience
Crown Vision Center Customer Service Manager

Crown Vision Center has issued a refund check for [redacted] in the amount of $305.29 to the patient.  The check # [redacted] was mailed on 5/14/2008.  [redacted] should be receiving this any day now if she has not already received it.  Our checks come from our Corporate Office in [redacted]...

[redacted].   Our offices are instructed to let the patient know that it will take about 3 weeks for them to receive their refund check from our Corporate office.  Crown Vision Center, Customer Service Manager.

Patient came in to the office presenting that he needed to have his eyes checked and wanting a full diabetic exam.  At this time, with his insurance he has a $40 co-pay for a specialist which is what an ophthalmologist is considered.  His primary Doctor telling him there would be no charge...

for the exam was not correct.  It may be that his PCP he would not have a copay, but that is just not the case with an OD.  Once the Medical exam is completed the Doctor also does a Refraction which was the $25 charge, to determine if there was any vision prescription change.  At his original office visit the patient did not pay anything out of pocket.   The patient did sign the Medical Exam Report giving us permission to bill to his medical insurance company.  Crown Vision Center has reviewed this patient's file and we have decided to waive the $65.00 charge to this patient as a one time courtesy.  The patient will not receive any further billing from us at this time.

Complaint: [redacted]
I am rejecting this response because:
The staff at Crown Vision led me to believe that the entire test would cost $45 and that any extra expense would be for lenses and frames.  There was no explanation of the difference between optical and medical examinations or that there might be additional charges levied against my insurance policy.We had offered to pay the $45 for the test but the staff declined to accept it, saying that it may well be covered by insurance.I was surprised by [redacted] note that I had any sort of cataract condition, as I had only a week earlier been tested overseas and was not diagnosed with any cataract condition.  Note that the page headed "Medical Examination Report" is anonymous, with no details of the business making the report.  My research results since then included information that "nuclear sclerotic cataract" is a common condition after middle age and does not impair vision for many years after initial diagnosis.
Furthermore, [redacted] wanted to dilate my eyes during the test and I replied that I had to drive elsewhere soon afterwards, so could not continue with any more testing.  I was then presented with the small pad of multiple copies of the "Medical Examination Report" and asked to sign it before I left.My understanding of the paragraph that I signed was that I would be responsible for the $45 if my insurer declined to pay it.  I was happy to do so and had already offered to pay that amount and am still willing to do so.I would be interested to know if the later bill for $200 assumed that dilation was included.Note that the bill was submitted to Medicare first, who declined to pay anything, but passed it on to [redacted], where we have a high deductible coverage.The response from Crown Vision states, "When the patient was given the price of $45 for an exam, that was under the impression that this would be a wellness routine eye exam.  However, we always state that the exam starts at $45.00 and go go up depending on what the doctor finds."My wife and I are prepared to testify that we were NOT informed that "the exam starts at $45".  We were told that the cost would be $45, and that was what we offered to pay immediately, with cash.
Sincerely,
[redacted]

Complaint: [redacted]
I am rejecting this response because: I understand that cooperation is not something that your company has a strong suite as seen in your response and from the rotation of doctors and staff at the [redacted] location.  One, I did not "deny" dilatation, I was told that the back of my eyes were clear and it would not be necessary, thank you for your concern. Two, I was not there for "medical" reasons and it would be understood if I was there for that, and nothing that was done during the annual visit was because of being diabetic.  According to the board of optometry you should not be running this a "medical" unless this appointment was made specific to the medical condition and it was not, remember I stated it was an "annual" and nothing in regards to any "diabetes".  I was there for an "annual" eye exam, nothing more.  You seem not to have mentioned in your response anything about my having specific insurance in regards to eye exams which is interesting.  This insurance will cover refraction and I verified this with the company.  All you are required to do is run it through my insurance.  I promise I will never return to your business but I must stand up to you and for others that you are charging erroneous fees.  The insurance companies have not figured out what you are doing, but I have.  Please explain to Revdex.com why you refuse to run the refraction through my eye insurance of which will be glad to reimburse you for this service.  
Sincerely,
[redacted]

Crown Vision Center has reviewed [redacted] exam records and documentation.  [redacted] came in on Friday March 9, 2018 for an exam.   When the patient was given the price of $45 for an exam, that was under the impression that this would be a wellness routine eye exam. ...

However, we always state that the exam starts at $45.00 and go go up depending on what the doctor finds.  In [redacted] case, he was diagnosed with Cataracts.  When a patient has a medical condition of their eyes (which is what a cataract is) then we can no longer bill the patients routine vision coverage because they will automatically deny coverage because it is outside the guidelines of a routine exam.  This condition makes the exam Medical which in return we bill to his Medical Insurance.  All of this is explained to the patient at the date of service and we also require the patient to sign a Medical Examination Report (which I have attached) which is giving us permission to bill his medical insurance.   We did bill [redacted] medical insurance and it was not that the insurance company did not pay anything.  [redacted] has NOT met his deductible for the year, so this amount was applied to his deductible(I have attached) and he is responsible for this out of pocket.  [redacted] does not know if the patient has a deductible or if the patient has met this amount, that is the patient's responsibility to know and understand their insurance deductibles.

Crown Vision Center has reviewed reviewed the file of [redacted].  [redacted] has been a patient of crown for several years.  The past 3 years the patient has been seen at our [redacted] and at each one of these visits [redacted] has had a Medical Exam associated with her...

diabetes.  In 2015 she was seen by [redacted] and it was coded Medical in which she had a dilated exam, and [redacted] did sign our Medical Examination report explaining that this was going to be billed to her Medical insurance.  At this time, she was responsible for her $25 copay and the $25 refraction (which is the actual prescription part of the exam that her Medical insurance does not pay) for a total out of pocket of $50 which she did pay.  When the patient has a medical condition that can effect the eye/ vision then their Routine insurance will NOT pay for the exam.  Had we billed this to her routine vision insurance they would have denied the claim.   In 2016 patient returned to the [redacted] office and was seen by [redacted].  At this date of service she was also coded a Medical exam due to diabetes which she also had a dilated exam.  In 2016 she was responsible for her $30 copay and the $25 refraction, which the patient also paid.  In 2017 the patient returned to the [redacted] office and was seen by [redacted], and this was the same situation.  [redacted] was seen her for Diabetic Medical exam,, only the difference this time, [redacted] wanted to do a dilated exam and the Patient DENIED... so that is the reason there was not a dilation done at this date of service.  The Patient [redacted] again signed the Medical Examination report acknowledging this was a Medical exam and it would be billed to her Medical insurance.  She is responsible for a $30 copay and the $25 refraction.  I have included all 3 Explanation of Benefits for each year with her insurance explaining what the patient responsibility is for each exam.  I have also included the 2017 Medical examination report acknowledging she gave us permission and she understood we were billing her Medical insurance.  I have also included a copy of her receipt showing that she did not pay her Medical insurance copay at the office at the date of service.    [redacted] has had the same type of Medical Examination for the past 3 years with Crown Vision Center.  She has been charged her normal Medical insurance Copay and charged for a refraction each year.  In 2015 and 2016 she paid the patient responsibility.  For her 2017 she had the same type of exam with the exception of her denying the dilation so the patient is responsible for the charges $55.00.

Crown Vision Center has reviewed [redacted] complete file.  The patient came in for exam with [redacted].  When she was ask why she was here her chief complaint was that she had Redness around her eyes, her eyes feel dry, her eyes itch, and she is having blurry vision.  This is what...

the Doctor has entered on the patients examination report.  The patient presented with a medical condition of her eyes.  The patient was diagnosed with Dry Eye Syndrome and was advised to use drops daily.  She can try over the counter drops first to see if this helps and if not was advised to return and the Doctor can prescribe some drops.  The patient did not pay anything for her exam at the date of service, she did however choose to have an optional test Visual Field Screening in which she paid $ 20.00.  The patient also purchased a pair of glasses and paid $ 152.71 for them.  At the date of service the patient paid $ 172.71 out of pocket for her glasses and the optional test.  She did ZERO for her exam.  The patient did sign our Medical Examination Report explaining the Doctors diagnosis and treatment plan.  This document explains that we are submitting the Medical examination to her Medical Insurance Carrier.  The patient did have a complete Well Vision Exam.  However, when there is a medical condition of the eyes we cannot bill this exam to their Routine Vision Insurance because they will not pay for this exam because it is considered a Medical Condition of the patients eyes.  I have provided all of the documents the patient received and signed.  I have also included copies of her Explanation of Benefits provided to us by her insurance company.  This patient has not yet met their deductible for the year, so these charges were applied toward that amount.  Thus, the patient is responsible for the exam charges of $129.56.

Crown Vision Center has reviewed this account again and while everything has been billed correctly and according to the Doctor's diagnosis.  It wasn't that the patient's insurance did not pay,,  The patient did get the benefit of this amount because it was applied to his deductible and going forward he just has less of a deductible to meet.  However,  Crown Vision Center feels this is causing much frustration for the patient and has agreed to waive $144.87 so the patient now has a balance of $45.00.   Crown Vision Center Customer Service Manager

[redacted] Center has reviewed Mr. [redacted]'s entire account.  We have now billed out to his secondary insurance company.  His primary insurance company was billed out first and came back that he owed a co-pay amount.  If the patient has a secondary insurance we will certainly bill...

this each and every time if the patient is eligible.  At the date of service, his secondary insurance was Missouri Medicaid and the plan code they were showing was a plan code that does not cover an exam.  However, which we did not know at the time, Mr. [redacted] had met the requirements that the state of Missouri requires and they will then cover this remaining balance.  The Missouri Medicaid website was NOT updated at his date of service so we were only going by what we had and the documentation at his date of service.  Mr. [redacted] has since talked with his insurance company and they have now, today, updated his profile to reflect that we can now bill to them.We have submitted his claim to Missouri Medicaid for them to review today 9/19/2017 and pay his remaining balance on his account.  At this time,  Mr. [redacted] will not receive any further statements unless is secondary insurance does not pay.  [redacted] Center Customer Service Manager.

Crown Vision Center has reviewed this patient billing.  The patient was in our Mackenzie Point office on 2/6/2016.  She did present her insurance information with a copy of her insurance card scanned into her file.  [redacted] has a $ 40.00 copay for any Specialist Doctor visit which...

is what an our offices are considered.  If you review a copy of her receipt you will see that we only collected a $35.00 copay at this time. (The optician clearly looked at the wrong copay pricing on the insurance card).  Once we then bill the insurance company and we received payment it was discovered that we failed to collect the correct amount from the patient for her copay.  The patient and her insurance company set the amounts of her copay to be paid at each and every office visit she has.  This is not something Crown does.  Absolutely, Crown Vision Center collected the wrong amount from the patient. However, it is the patient responsibility to pay the entire amount of their copay at each and every type of office visit.  Thus, our billing department has bill the patient the balance of $5.00.  I have attached a copy of the patient receipt showing that we only collected $35.00 and a copy of the patients Explanation of Benefits from her insurance company clearly stating that she has a copay in the amount of $40.00 that is her responsibility.  Crown Vision Center has made the decision to waive the patient's balance of $5.00 as a good faith resolution as to not cause any further frustration to the patient. thanks[redacted]Crown Vision CenterCustomer Service Manager

Initial Business Response /* (1000, 5, 2016/02/23) */
2/23/2016 Crown Vision Center has waived this balance of $ 17.89 for the patient's satisfaction. They will not be receiving any further billing statements at this time for this date of service. Crown Vision Center, Customer Service...

Manager

Revdex.com:
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]

Initial Business Response /* (1000, 7, 2015/07/07) */
Crown Vision Center has talked with [redacted] today 7/7/2015 and discussed the entire situation.
Ms [redacted] does have her new glasses she picked them up on 6/20/2015 with the correct prescription and a new frame (she was restyled to a...

different frame that fit her better). She is currently having some discomfort with this frame being a little too tight. I have let her know she may need some time to adjust to this frame or she can bring the glasses in to any of our Crown Offices and an optician can certainly check the fit and adjust them if necessary. She does not have to return to the Southfield office.
Ms [redacted] and I have discussed several things that have gone wrong with her experience at Crown Vision Center and things I will be discussing with the office manager and her District Manager to provide them with feedback to improve patient satisfaction. I am sending [redacted] a $100 Gift Card and apology letter. She is welcome to use this Gift Card at ANY of our Crown Vision Center offices in the future. I am giving this to her to give us a 2nd chance to provide her with stellar Customer Service next year when she is ready for her annual eye exam. Patient seemed satisfied that someone called her and expressed concern for the situation and was thankful for the gift card. Will think about giving us another opportunity in the future.
Crown Vision Center Customer Service Manager

Initial Business Response /* (1000, 7, 2015/11/06) */
Crown Vision Center has reviewed the patients records. On 8/19/2015 patient came in to the office and purchases a complete pair of glasses and had an eye exam. The patient DID NOT have a routine eye exam (which his vision insurance would have...

covered) he had a Medical eye exam. The doctor diagnosed him with early stages of Cataracts which is a medical condition and cannot be billed to routine vision insurance because they will not pay. When a patient has a Medical exam we bill this to their Medical insurance and it is covered. However, Mr. [redacted] HAD NOT met his deductible thus his insurance applied this amount to his deductible which is why he is receiving a bill. Original invoice the patient only paid for his frame and lenses and NOTHING for his exam as we billed this to insurance. Original purchase prices was $ 491.56 which $63.25 billed to his vision insurance (he has a frame benefit) which they paid leaving the patient balance our of pocket for his glasses $ 428.31. Patient put $214.00 down at time of order and when he picked up his glasses he paid the remaining balance for his glasses 214.31 so his glasses were paid in full. He was not billed anything for his glasses. However, once his medical insurance provided us with an explanation of benefits letting us know they covered the exam but the patient has not met their deductible and they have applied this amount to his deductible this would be the patients responsibility to pay. We have then billed the patient $ 132.35 for their Medical exam. The patient did sign the paperwork at the original date of service allowing us to bill his insurance. At the original date of service the Doctor has also put notes that he wanted to do a further exam and wanted the patient to return to have a dilation done. The patient then did return on 9/3/2015 and was NOT charged for this office visit. The patient picked out the frame and lenses of their choice and knew the price of them before he ordered. We do not owe any type of refund to the patient for his glasses.
The patient does owe for the Medical exam the doctor provided as this was applied to his insurance deductible (which is patient responsibility) We did not bill the patient anything other the $132.35 for his exam. If waiving the $ 132.25 balance the patient currently owes would satisfy and resolve the situation Crown Vision Center will do this as a one time courtesy to the patient. Have not been able to reach the patient to see if this is acceptable. Patient can respond to Revdex.com and will check once received Revdex.com feedback. Crown Vision Center Customer Service Manager
Final Business Response /* (1000, 11, 2016/02/19) */
In the interest of time and the patient is soon to be getting another statement. Crown Vision Center has waived the charge of $132.35 so the patient does not owe anything further. Have not heard anything from the patient and see that Revdex.com has not heard anything either as nothing is noted. Crown Vision Center is hoping this has resolved the situation for the patient as he will owe nothing for his exam balance. Customer Service Manager