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Denials Management

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Denials Management Reviews (1)

We apologize that there was a miscommunication on this case. Our Operations Team and Management Team reviewed the case correspondence extensively over the last two days and we have located the issue. Per the review of the case, while we rarely give a solid quote for how long it will take for us to... send a file to an attorney, we did overshoot the general quoted time by over 30 minutes. We hadn’t worked on this client’s file for over seven months, and the file had been sent to Archives. When we were recently contacted by the client to send the file to the attorney, we had to pull it from Archive, scan it in, assemble and send to the attorney’s office. Due to the amount of time that had lapsed, it took us longer than the original quote from six months earlier. The client was originally quoted “an hour or so” (which equates to $90.00), and the work done to send the file actually took 99 minutes. Another one of the breakdowns in communication was between the Advocate working the file and our Accounting Department. Our Accounting Department was under the assumption that additional work would be done on this file, which is why there was a charge for future work to be done. This was not accurately noted in our system, and our Accounting Department should have reviewed more closely. They would have seen that this was being sent to an attorney and our part of the process was 100% over. We were not acting fraudulently, but we can see where this would be confusing and irritating for the client. The portion of the complaint stating that the credit card was charged without the client’s permission is not exactly accurate. When we originally went to charge the credit card for the work on the file after we were contacted to send the file to the attorney, the client’s credit card had declined. The client was aware that this would take some time, and we had to contact her for a new credit card number. She provided the new number to our Accounting Dept. and was aware that her card was going to be charged. The confusion mainly appears to be over how much was to be charged, which we have explained above. At this time, we are processing a refund to the client of $270.00. While we did in fact do 99 minutes of work on this case, we feel it is best refund the charge and provide this service to this client for free. These sort of breakdowns in communication between our departments, and between our staff and our clients, are not acceptable. After reviewing the full account, we have identified several coaching opportunities for our staff that we will make sure to address. We know the process with insurance is confusing and frustrating, and communication issues from our office are never intentional. It is our mission to partner with families to make this process easier... not harder. We apologize that we did not live up to that in this instance. Again, we apologize for any frustration we may have caused. Our management team appreciates constructive reviews and we want to provide the highest quality service to our families.

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