Crownview Medical Group Inc

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID ***, and have determined that this proposed action would not resolve my complaint. For your reference, details of the offer I reviewed appear below
Regards,
*** ***

To Whom It May Concern: This letter is being written in response to complaint 10074963. Ms.[redacted]
[redacted] had been in treatment with our facility from January 14, 2013 until last
visit on March 7,...

2014. During her initial·session Ms. [redacted] brought in Blue Cross
insurance card and was in effect from January 1, 2013 and insurance plan was
terminated February 28, 2014. As a courtesy during her initial visit, we did verify
patient's benefits and Ms. [redacted] of a due $30 copay. Durlllg her services with us
all claims have been forwarded to insurance carrier under our group Name
(Crownview Medical Group) ~d Group Tax ID number ([redacted]). Unfortunately,.
claims began to be processed at a higher patient responsibility and as an out of network
benefit staned December 11, 2013. As you will note with the attached insurance
explanation of benefits, there was no change in billing practice as claims sent in
question, where always sent under our group information and never under the
individual provider. We received final notification of balance due to patient and claims
processing information on March 18, 2014 after the client had stopped coming for
services due to her insurance no longer being active. We did bill Ms. [redacted] on
March 18, 2014, March 25, 2014, April 16, 2014 and final statement sent on May 27,
2014.During her initial visit with us, Ms. [redacted] signed acknowledgement advising that
the insurance verification is a courtesy of CVMG and we shall be held harmless should
the account be rejected by insurance carriers) in whole, or in part. It also notes, that it
is the undersigned responsibility to understand and confirm insurance policy
limitations and/ or exclusions directly with the insurance carrier, this to include
contracted and non-contracted providers, share of cost, deductibles and/ or copays.
Ms. [redacted] contacted out billing depanm.ent on April 28th with questions in
regards to billing. Our billing department contacted Ms. [redacted] same date leaving a
message advising that balance was due for deductible as set forth by her insurance
company. She had also. been advised during that message that her insurance had
terminated on February 28. 2014 and patient would be fully responsible for visit, see
attached explanation of benefits, for ·date of service March 7, 2014. We once again had
contact with our Ms. [redacted] until June 2, 2014 as she contacted our office wanting
to discuss the balance on hand. On June 2, 2014 Ms. [redacted] and was involved in a
3-way call with her insurance company and our billing administrator directly. During
that call Blue Cross representative advised Ms. [redacted] that her benefit included a
deductible due and We, CVMG, had a right to bill patient for services and balances
due. After a review of all patients account actUal balance that should have been due,
should have been $876.55, which include~ patient deductible due and full cost of visit
for March 7, 2014 due to insurance coverage termination. Our billing depanment did
advise Ms. [redacted] on June 2, 2014 that we would give her a discount, see attached
statement, and the only balance due would be $287.07. (This is a discount of $589.48,
patient is not being billed for visit she had with no active coverage)
As you see even though Ms. [redacted] has signed and acknowledgement that she
would be fully and completely responsible for any balances due. we have worked with
her to decrease the full balance due and before her dispute.
We hope this clarifies the situation, please feel free to contact me should you have any
questions or need additional information.
Sincerely,
[redacted], Office Manager

May 23, 2014
Revdex.com
4747 Viewridge Ave #200
San Diego, CA 92123
Re: Complaint ID [redacted]
To Whom it May Concern: This letter is being written in...

response to complaint [redacted]. Mrs. [redacted] had brought her daughter [redacted] for initial consultation on December 10, 2013 at 2:45 pm at which time they had arrived to the scheduled appointment at 2:15 pm, see attached sign in sheet . Since Ms. [redacted] appointment was the last appointment on the schedule, the provider did run 10 minuets behind and patient had been brought in 10 minuets after the scheduled appointment time of 2:45 pm. Ms. [redacted] had been rescheduled to follow up in 4 weeks, appointment scheduled January 14, 2014 as this is standard of practice to see patient closely and follow up on any newly prescribed medications. The second appointment was cancelled by Mrs. [redacted] on January 14, 2014, the same day as the patient was to see a doctor. Mrs. [redacted] was once again re scheduled to come in on January 28, 2014 at 2:30 pm. patient arrived to the visit at 2:14 pm, see attached sign in sheet, and there is no notation of provider running late for that appointment or during that time. The appointment would not have been moved as it was originally scheduled for the 2:30 pm time slot by Mr. [redacted] during the late cancellation of January 14, 2014.
We had billed Mrs. [redacted] 3 times for patient responsibility balance due as set forth by her insurance, see attached explanation of benefits, on January 9, 2014, February 17, 2014 and March 31, 2014 with no response. We did have a signed financial agreement on file with, credit card information and authorization by Mrs. [redacted], to run for any unpaid balances. We do service numerous military dependents families and do give them the option to pay in payments, or make necessary arrangements in order to not run any credit cards and put a financial burden on them. To date had not heard of any concerns in regards to the balance or statements being received. We did contact the insurance on May 20, 2014 to advice of the issue on hand and the complaint in regards to the clients concern of amounts being billed per her insurance request. Per insurance company, the error did occur on their end and will be corrected. The claim will be reprocessed and paid fully to us and no balance would be due to the patient. They will be mailed Mrs. [redacted] explanation of issue and reprocessing.
During the initial visit on December 10, 2013 prescription of Pristiq was given to the patient to assist with her current symptoms. Mrs. [redacted] had been advised of the standard of practice and the importance in following up and making sure that the medications are taken at all times. As noted in the records for the visit for January 28, 2014, patient had advised the doctor that she had run out of her medication and was given a prescription for 3 months (90 days) worth of medication advising that client would need to be seen no later than 3 months or before patient was completely out of medication. The prescription was given to make sure the patient would not run out and allow more time for client to return. Office received a call from Mrs. [redacted] on May 7, 2014 asking for a refill on the medication as patient had been out a couple of days. Mrs. [redacted] was advised that an appointment would be need to be scheduled and medication would be called in until patient was seen, this would have been for May 20, 2014. She explained her concerns in regards to not been advised she needed to come back, did not understand why she would need to be seen since the medication is nothing " heavy" and felt we were not assisting with her concerns. Again, we reiterated to her the importance of continuous follow up as this is standard practice and is necessary for any client to follow up anywhere between 2 weeks to 90 days depending on the treatment. 
We hope this clarifies the situation, please feel free to contact me should you have any questions or need additional information. 
Sincerely,
[redacted], Office Manager

Review: Issue 1. 1st appt my daughter was not seen until 45 minutes past her appt time. 2nd appt we were called and asked if we could make an earlier appt (only 30mins earlier than the already scheduled appt) - we arrived on time for the new designated appt time, but my daughter was still not seen until 15mins past the original scheduled time

Issue 2. Billing issue - There was a problem w/ the way the medical group filed the claim w/ our insurance. They acknowledged the issue was on their end, but we continued to receive phone calls and letters in the mail. We were sent a paper bill w/ FINAL NOTICE (ON A BIG ORANGE STICKER) on the envelope.

Issue 3. We were instructed by Dr. [redacted] to contact him with questions or concerns about the medication he prescribed or my daughter's treatment. I called 2 times to speak with Dr. [redacted], understanding I would most likely leave a message for him to call me back. Both times when I called the office number and request to leave a message for Dr. [redacted], I felt interrogated. They would ask why I needed to speak with him and expected specific reasons. I even advised I had questions about her medication and the office staff directed me to seek consultation from pharmacist and refused to let me leave a message.

Issue 4. During the appt in March 2014, Dr [redacted] advised he was giving a new prescription w/ 2 refills and when more was needed to simply call the office and ask them to send refills to the pharmacy. On 4/25/14 I called the office to request refills and they request I call the pharmacy for a faxed request. I called Rite Aid pharmacy and they faxed a refill request to the provider's office. On 5/7/14 I called the provider office again and advised still no refills on my daughter's prescription. They asked that I have RiteAid send another fax. I did so. I called again today 5/8/14 and was advised they would not call in or fax in refills, because my daughter needed to be seen again. They advised this was a recently changed policy of theirs. They did not have any available appts until 5/20/14 @ 2pm. I let them know my daughter has been without medication for a few days. I asked why I was not contacted to make an appt (because I didn't know one was needed.) They told me it was my responsibility to make a new appt for my daughter if it was needed. They offered to call in a 14 days supply of her medication and when I said that was not cost effective (14 days supply = $44 copay as well as 30 days supply = $44 copy) they told me they could not help. At this point I cancelled her 5/20/14 appt and will seek a new provider. My daughter is not in any kind of danger from the sudden absence of her medication, but a pharmacsist has advised that titration from her medication is suggested.Desired Settlement: I would like a phone call from Dr. [redacted]. I would like to know why he seems so helpful, but his staff does not. I would also like an apology letter from the medical group. I am also going to write reviews on such webistes as Yelp. I plan to post my experiences on social media and will also post on Bookoo. Thank you.

Business

Response:

May 23, 2014

Revdex.com

4747 Viewridge Ave #200

San Diego, CA 92123

Re: Complaint ID [redacted]

To Whom it May Concern:

This letter is being written in response to complaint [redacted]. Mrs. [redacted] had brought her daughter [redacted] for initial consultation on December 10, 2013 at 2:45 pm at which time they had arrived to the scheduled appointment at 2:15 pm, see attached sign in sheet . Since Ms. [redacted] appointment was the last appointment on the schedule, the provider did run 10 minuets behind and patient had been brought in 10 minuets after the scheduled appointment time of 2:45 pm. Ms. [redacted] had been rescheduled to follow up in 4 weeks, appointment scheduled January 14, 2014 as this is standard of practice to see patient closely and follow up on any newly prescribed medications. The second appointment was cancelled by Mrs. [redacted] on January 14, 2014, the same day as the patient was to see a doctor. Mrs. [redacted] was once again re scheduled to come in on January 28, 2014 at 2:30 pm. patient arrived to the visit at 2:14 pm, see attached sign in sheet, and there is no notation of provider running late for that appointment or during that time. The appointment would not have been moved as it was originally scheduled for the 2:30 pm time slot by Mr. [redacted] during the late cancellation of January 14, 2014.

We had billed Mrs. [redacted] 3 times for patient responsibility balance due as set forth by her insurance, see attached explanation of benefits, on January 9, 2014, February 17, 2014 and March 31, 2014 with no response. We did have a signed financial agreement on file with, credit card information and authorization by Mrs. [redacted], to run for any unpaid balances. We do service numerous military dependents families and do give them the option to pay in payments, or make necessary arrangements in order to not run any credit cards and put a financial burden on them. To date had not heard of any concerns in regards to the balance or statements being received. We did contact the insurance on May 20, 2014 to advice of the issue on hand and the complaint in regards to the clients concern of amounts being billed per her insurance request. Per insurance company, the error did occur on their end and will be corrected. The claim will be reprocessed and paid fully to us and no balance would be due to the patient. They will be mailed Mrs. [redacted] explanation of issue and reprocessing.

During the initial visit on December 10, 2013 prescription of Pristiq was given to the patient to assist with her current symptoms. Mrs. [redacted] had been advised of the standard of practice and the importance in following up and making sure that the medications are taken at all times. As noted in the records for the visit for January 28, 2014, patient had advised the doctor that she had run out of her medication and was given a prescription for 3 months (90 days) worth of medication advising that client would need to be seen no later than 3 months or before patient was completely out of medication. The prescription was given to make sure the patient would not run out and allow more time for client to return. Office received a call from Mrs. [redacted] on May 7, 2014 asking for a refill on the medication as patient had been out a couple of days. Mrs. [redacted] was advised that an appointment would be need to be scheduled and medication would be called in until patient was seen, this would have been for May 20, 2014. She explained her concerns in regards to not been advised she needed to come back, did not understand why she would need to be seen since the medication is nothing " heavy" and felt we were not assisting with her concerns. Again, we reiterated to her the importance of continuous follow up as this is standard practice and is necessary for any client to follow up anywhere between 2 weeks to 90 days depending on the treatment.

We hope this clarifies the situation, please feel free to contact me should you have any questions or need additional information.

Sincerely,

[redacted], Office Manager

Consumer

Response:

I have reviewed the response made by the business in reference to complaint ID [redacted], and have determined that this proposed action would not resolve my complaint. For your reference, details of the offer I reviewed appear below.

Regards,

Review: I received a bill from the company after terminating services with them. They claim they have changed their billing practices and my services were now out of network. I had been receiving the same services for the last year for a $30 co pay. Even though they stated they changed the billing practice Jan 1 2014 they have made claims with the insurance company in December. I spoke with the insurance company. I was never notified of the billing changes and never told I had a balance until after I terminated services. If they did change there billing practices aren't they required to notify the patients. I have tried multiple times to fix this with them but they are rude and don't listen to my concerns. I have even involved the insurance company and they still refuse to fix the situation.Desired Settlement: I would like the bill to be zero. I have paid all my co pays and the balance I owed for services rendered when I changed insurances.

Business

Response:

To Whom It May Concern:

This letter is being written in response to complaint 10074963. Ms.[redacted] had been in treatment with our facility from January 14, 2013 until last

visit on March 7, 2014. During her initial·session Ms. [redacted] brought in Blue Cross

insurance card and was in effect from January 1, 2013 and insurance plan was

terminated February 28, 2014. As a courtesy during her initial visit, we did verify

patient's benefits and Ms. [redacted] of a due $30 copay. Durlllg her services with us

all claims have been forwarded to insurance carrier under our group Name

(Crownview Medical Group) ~d Group Tax ID number ([redacted]). Unfortunately,.

claims began to be processed at a higher patient responsibility and as an out of network

benefit staned December 11, 2013. As you will note with the attached insurance

explanation of benefits, there was no change in billing practice as claims sent in

question, where always sent under our group information and never under the

individual provider. We received final notification of balance due to patient and claims

processing information on March 18, 2014 after the client had stopped coming for

services due to her insurance no longer being active. We did bill Ms. [redacted] on

March 18, 2014, March 25, 2014, April 16, 2014 and final statement sent on May 27,

2014.

During her initial visit with us, Ms. [redacted] signed acknowledgement advising that

the insurance verification is a courtesy of CVMG and we shall be held harmless should

the account be rejected by insurance carriers) in whole, or in part. It also notes, that it

is the undersigned responsibility to understand and confirm insurance policy

limitations and/ or exclusions directly with the insurance carrier, this to include

contracted and non-contracted providers, share of cost, deductibles and/ or copays.

Ms. [redacted] contacted out billing depanm.ent on April 28th with questions in

regards to billing. Our billing department contacted Ms. [redacted] same date leaving a

message advising that balance was due for deductible as set forth by her insurance

company. She had also. been advised during that message that her insurance had

terminated on February 28. 2014 and patient would be fully responsible for visit, see

attached explanation of benefits, for ·date of service March 7, 2014. We once again had

contact with our Ms. [redacted] until June 2, 2014 as she contacted our office wanting

to discuss the balance on hand. On June 2, 2014 Ms. [redacted] and was involved in a

3-way call with her insurance company and our billing administrator directly. During

that call Blue Cross representative advised Ms. [redacted] that her benefit included a

deductible due and We, CVMG, had a right to bill patient for services and balances

due. After a review of all patients account actUal balance that should have been due,

should have been $876.55, which include~ patient deductible due and full cost of visit

for March 7, 2014 due to insurance coverage termination. Our billing depanment did

advise Ms. [redacted] on June 2, 2014 that we would give her a discount, see attached

statement, and the only balance due would be $287.07. (This is a discount of $589.48,

patient is not being billed for visit she had with no active coverage)

As you see even though Ms. [redacted] has signed and acknowledgement that she

would be fully and completely responsible for any balances due. we have worked with

her to decrease the full balance due and before her dispute.

We hope this clarifies the situation, please feel free to contact me should you have any

questions or need additional information.

Sincerely,

[redacted], Office Manager

Review: Crownview Medical Group has made two (2) unapproved appointments for my military dependent (spouse) without notifying the patient. There is a $75 late/cancellation/no show charge for each appointment missed. In this case, they've charged $150 and sent my spouse's information to collections. During my spouse's next appointment (involving a refill for medication), they refused her service until she disclosed her credit card information. She had to comply, because she needed her refills. She notified the secretary of the mistake, and they refused to dismiss the $150 charge and was told to "take it up with collections." This is an instance of fraudulent charges.Desired Settlement: I would like the appointment fees dismissed and for Crownview Medical Group to notify and verify patient appointments in the future, as well as cease making fraudulent appointments.

Business

Response:

RE: Response to ID [redacted]

Dear Revdex.com,

We have read the letter given to you by our mutual consumer from June 25th 2013. We believe

there has been some confusion of the circumstances and have tried several times

to contact the consumer to clarify. Unfortunately, we have not heard back from

him so we are responding to his letter.

The consumer’s wife is a client of ours and has had in the past several months regular scheduled weekly

appointments with our offices. On April 26, 2013 she was in the office and

scheduled weekly visits through the month of May 2013, as well as another

separate appointment for May 14th.

As a courtesy, we called the Friday before each of the scheduled Monday appointments, and left a message

for her to remind her of her appointment the following business day. She never

called or left a message to cancel over the 72 hour period.

Our client missed her appointments on May 6th. We called her within 30 minutes and she

said she did not have transportation. She agreed to pay the missed appointment

fee at that time. She then missed her appointment on May13th even though we did call to try to confirm

with her. She came in for her other appointment on May 14th. The receptionist asked her about the

previous 2 missed appointments, and then confirmed with her to keep the

appointment on May 20th and beyond which she wanted to keep. We did

not have her pay her outstanding balance at that time and she was seen in our

office. She then missed her May 20th appointment even after our reminder call.

We mailed out a bill for the missed appointments, per our office policy, on May 20th. Neither husband nor

wife called or responded to the invoice. We cancelled all further appointments until we could get in

touch with the client. A second invoice was sent on June 19th to follow up with them.

On June 25th the client came into the office. The receptionist and the office manager spoke

with her about the missed appointments. She agreed she had missed the May 6th

and paid for the appointment. However, she did miss the other appointments that

she made while in our office and is the ordinary arrangement for her visits.

We offered to remove one of the fees to rectify the situation and come to a compromise. Unfortunately it

was the situation that we were not able to fill that appointment spot since she

did not cancel that appointment, and no other client was able to be seen during

that time. We do charge when our clients do not cancel their appointments in a

timely manner because we could have called people on the wait list and filled in those hours.

On the second part of the concern, during the month of June our offices have been updating every client’s

file with a revised payment agreement form. The request to have our client fill

this form out was not exclusive to her. We never refused her service. In fact,

although she had outstanding invoices, we saw her and allowed her to fill out

the form and turn it in after her appointment with the doctor. Her filling out

the form was not a factor in her being seen on that day.

We have not released any information nor have we sent the client to collections to date. Although, after

three unaddressed billings and final notices, this may be the next step we could take.

We have not spoken with her husband who wrote in the complaint, although we did call him several times

and left a voice mail for him. We have only spoken to his wife, our client,

about the situation. We are hoping that there was a miscommunication between the three parties.

It is our sincere desire to clarify and resolve this situation. We have no desire to create more stress

in other’s lives. Hopefully the consumers will contact us to discuss since our

attempts to contact them via phone and mail have gone unanswered.

Thank you very much,

Crownview Medical Group