To Whom It May Concern: This letter is being written in response to complaint Ms[redacted] had been in treatment with our facility from January 14, until last visit on March 7, During her initial·session Ms [redacted] brought in Blue Cross insurance card and was in effect from January 1, and insurance plan was terminated February 28, As a courtesy during her initial visit, we did verify patient's benefits and Ms [redacted] of a due $copayDurlllg 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, 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 providerWe received final notification of balance due to patient and claims processing information on March 18, after the client had stopped coming for services due to her insurance no longer being activeWe did bill Ms [redacted] on March 18, 2014, March 25, 2014, April 16, 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 partIt 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 billingOur billing department contacted Ms [redacted] same date leaving a message advising that balance was due for deductible as set forth by her insurance companyShe had alsobeen advised during that message that her insurance had terminated on February and patient would be fully responsible for visit, see attached explanation of benefits, for ·date of service March 7, We once again had contact with our Ms [redacted] until June 2, as she contacted our office wanting to discuss the balance on handOn June 2, Ms [redacted] and was involved in a 3-way call with her insurance company and our billing administrator directlyDuring 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 dueAfter 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, due to insurance coverage terminationOur billing depanment did advise Ms [redacted] on June 2, that we would give her a discount, see attached statement, and the only balance due would be $(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 duewe 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, Revdex.com Viewridge Ave # San Diego, CA 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, at 2:pm at which time they had arrived to the scheduled appointment at 2:pm, see attached sign in sheet Since Ms [redacted] appointment was the last appointment on the schedule, the provider did run minuets behind and patient had been brought in minuets after the scheduled appointment time of 2:pmMs [redacted] had been rescheduled to follow up in weeks, appointment scheduled January 14, as this is standard of practice to see patient closely and follow up on any newly prescribed medicationsThe second appointment was cancelled by Mrs [redacted] on January 14, 2014, the same day as the patient was to see a doctorMrs [redacted] was once again re scheduled to come in on January 28, at 2:pmpatient arrived to the visit at 2:pm, see attached sign in sheet, and there is no notation of provider running late for that appointment or during that timeThe appointment would not have been moved as it was originally scheduled for the 2:pm time slot by Mr [redacted] during the late cancellation of January 14, We had billed Mrs [redacted] times for patient responsibility balance due as set forth by her insurance, see attached explanation of benefits, on January 9, 2014, February 17, and March 31, with no responseWe did have a signed financial agreement on file with, credit card information and authorization by Mrs [redacted] , to run for any unpaid balancesWe 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 themTo date had not heard of any concerns in regards to the balance or statements being receivedWe did contact the insurance on May 20, to advice of the issue on hand and the complaint in regards to the clients concern of amounts being billed per her insurance requestPer insurance company, the error did occur on their end and will be correctedThe claim will be reprocessed and paid fully to us and no balance would be due to the patientThey will be mailed Mrs [redacted] explanation of issue and reprocessing During the initial visit on December 10, prescription of Pristiq was given to the patient to assist with her current symptomsMrs [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 timesAs 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 months (days) worth of medication advising that client would need to be seen no later than months or before patient was completely out of medicationThe prescription was given to make sure the patient would not run out and allow more time for client to returnOffice received a call from Mrs [redacted] on May 7, asking for a refill on the medication as patient had been out a couple of daysMrs [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, 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 concernsAgain, 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 weeks to 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
To Whom It May Concern: This letter is being written in response to complaint Ms[redacted] had been in treatment with our facility from January 14, until last visit on March 7, During her initial·session Ms [redacted] brought in Blue Cross insurance card and was in effect from January 1, and insurance plan was terminated February 28, As a courtesy during her initial visit, we did verify patient's benefits and Ms [redacted] of a due $copayDurlllg 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, 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 providerWe received final notification of balance due to patient and claims processing information on March 18, after the client had stopped coming for services due to her insurance no longer being activeWe did bill Ms [redacted] on March 18, 2014, March 25, 2014, April 16, 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 partIt 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 billingOur billing department contacted Ms [redacted] same date leaving a message advising that balance was due for deductible as set forth by her insurance companyShe had alsobeen advised during that message that her insurance had terminated on February and patient would be fully responsible for visit, see attached explanation of benefits, for ·date of service March 7, We once again had contact with our Ms [redacted] until June 2, as she contacted our office wanting to discuss the balance on handOn June 2, Ms [redacted] and was involved in a 3-way call with her insurance company and our billing administrator directlyDuring 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 dueAfter 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, due to insurance coverage terminationOur billing depanment did advise Ms [redacted] on June 2, that we would give her a discount, see attached statement, and the only balance due would be $(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 duewe 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, Revdex.com Viewridge Ave # San Diego, CA 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, at 2:pm at which time they had arrived to the scheduled appointment at 2:pm, see attached sign in sheet Since Ms [redacted] appointment was the last appointment on the schedule, the provider did run minuets behind and patient had been brought in minuets after the scheduled appointment time of 2:pmMs [redacted] had been rescheduled to follow up in weeks, appointment scheduled January 14, as this is standard of practice to see patient closely and follow up on any newly prescribed medicationsThe second appointment was cancelled by Mrs [redacted] on January 14, 2014, the same day as the patient was to see a doctorMrs [redacted] was once again re scheduled to come in on January 28, at 2:pmpatient arrived to the visit at 2:pm, see attached sign in sheet, and there is no notation of provider running late for that appointment or during that timeThe appointment would not have been moved as it was originally scheduled for the 2:pm time slot by Mr [redacted] during the late cancellation of January 14, We had billed Mrs [redacted] times for patient responsibility balance due as set forth by her insurance, see attached explanation of benefits, on January 9, 2014, February 17, and March 31, with no responseWe did have a signed financial agreement on file with, credit card information and authorization by Mrs [redacted] , to run for any unpaid balancesWe 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 themTo date had not heard of any concerns in regards to the balance or statements being receivedWe did contact the insurance on May 20, to advice of the issue on hand and the complaint in regards to the clients concern of amounts being billed per her insurance requestPer insurance company, the error did occur on their end and will be correctedThe claim will be reprocessed and paid fully to us and no balance would be due to the patientThey will be mailed Mrs [redacted] explanation of issue and reprocessing During the initial visit on December 10, prescription of Pristiq was given to the patient to assist with her current symptomsMrs [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 timesAs 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 months (days) worth of medication advising that client would need to be seen no later than months or before patient was completely out of medicationThe prescription was given to make sure the patient would not run out and allow more time for client to returnOffice received a call from Mrs [redacted] on May 7, asking for a refill on the medication as patient had been out a couple of daysMrs [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, 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 concernsAgain, 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 weeks to 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