Denver Integrated Imaging, LLC

This overpayment was verified by the insurance company involved and refund was issued to the patient on 3/11/ The inconvenience is understandably frustrating, but could not be avoided

Initial Business Response / [redacted] (1000, 12, 2015/11/24) */ The insurance company instructed the clinic to collect a specific amount for payment at time of serviceThe clinic then requested the insurance to confirm the payment as processed to assure the correct benefits were applied to the claim when processedThe insurance company then confirmed the amount instructed at time of service was wrong and a patient overpayment existedThe refund was sent to the patientUnfortunately this process took some time but has been resolved

The issue originated with [redacted] instructing the staff that a deductible would apply to this patient's MRI -- not just a copay -- the staff is researching with [redacted] to assure they will not apply that quoted deductible as they reprocess the claim in the event of an audit Resolution is expected soon At that time a refund will be issued to either [redacted] or patient per [redacted] 's determination Insurance companies often audit and reprocess these types of claims and recover funds from the healthcare provider Therefore, the medical provider must have assurance from the insurance carrier to confirm the refund is due to patient or to the insurance before sending a refund

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 However, since September 2016, I've been given this exact response multiple times from them I've also been told multiple times that I would receive a refund and I have not I will wait two weeks for the refund, if I don't receive one I will file an additional complaint Sincerely, [redacted]

It takes time to research these types of issues The insurance company contact directed the staff to collect a specific amount at the time of service Since payment was processed differently the clinic now must research with the insurance company to assure the processing of the case was
correct and confirm the overpayment is due to the patient instead of the insurance company Without this confirmation from the insurance company, there is a possibility the insurance company will audit the case at a later date and recover funds they see as overpaid by the insurance claims division

Complaint: ***
I am rejecting this response because:
Sincerely,
*** ***

Initial Business Response /* (1000, 9, 2015/12/10) */
After the insurance company was able to confirm the correct payment and assure no reprocessing of the claim would be made, a refund was issued to the patient

Initial Business Response /* (1000, 9, 2015/10/19) */
The amount collected from the patient was based on the direction of his insurance companyUpon notice of the possibility the direction from insurance company was wrong the clinic staff started the process of researching the possible
overpaymentThe case was researched with the insurance company and refund was confirmed and issued on 10/2/

It is now 4/1/17, and have yet to receive the refund promised to me almost a month ago Please let me know what my next steps should be or if I need to file another complaint Thank you, *** ***

Initial Business Response /* *** ** *** */
This was resolved some time agoThe insurance verification was completed for the overpayment and insurance confirmed the claim was processed correctly the refund was issued to the patient on check # XXXXX in the amount of $
Initial
Consumer Rebuttal /* *** *** *** */
(The consumer indicated he/she ACCEPTED the response from the business.)
AFTER I submitted this case to the Revdex.com, I finally recieved my refundI am thankful for thisIn they're response the company is trying to save face by claiming this was "resolved some time ago." Perhaps the paperwork on their end was completed sometime ago but the issue is that I never knewEvery time I called the response was "someone will call you back" which did not happen once and in the end it still took over half a year and a Revdex.com case to get the refundSo again, I am thankful that I received my refund but I would not recommend this company to anyone

Complaint: ***
I am rejecting this response because: I talked with *** in the last week of March to confirm about the issueAnd they told me that they cleared any issues with the billing and that I needed to contact DII in order to get my refund which I didIt has been close to monthsIt cannot take DII to confirm with *** to find out where the refund should go.
Sincerely,
*** ***

Prior to providing the *** exam for this patient on 11/19/16, our office contacted *** to obtain the insurance information they would use to process his claim for the *** ordered by his doctor *** told our staff the *** would be covered at 100% We passed this
information on to the patient and the exam was provided Upon completion the claim was submitted per the requirements with *** under the patient's insurance policy The insurance company applied a copayment to the exam which was not expected based on the information they had provided to our office staff during the previous communications Unfortunately we are at their mercy in this matter The patient is able to contact the insurance company and argue or appeal with *** for payment at the rate they quoted during initial telephone calls, but the provider's hands are tied by the insurance policy as written between the patient and his insurance company The medical provider is only able to provide information as provided by the insurance company during these telphone quotes The insurance company holds the right to process the claim using benefits as described and covered in the patient policy and a quote is not a guarantee of payment This is the insurance company's policy We have offered a payment plan to the patient in an effort to work within his budget Monthly payments will be accomodated if he will contact our office at *** and speak to billing department

At time of service *** *** instructed DII staff to collect the full $deductible plus 10% When *** *** processed the claim at different benefit level, the clinic had to contact *** for confirmation When that confirmation is received the clinic will know if a
refund is due to *** or to the patient and make the refund accordingly We expect an answer within the next days

Often insurance companies will return to a case, audit and require money paid previously to be returned to the insurance For that reason, the clinic must take time to fully research any overpayment and assure the insurance will not reprocess the claim at a lesser rate during a future audit
This process takes time That research has been completed and the refund due to this patient is being processed in the Accounts Payable Deptnow The refund to the patient will be sent within a few daysWe understand and share the frustration the process of confirming with insurance company requires

Customer Information: [redacted] 
[redacted] 
[redacted]
[redacted] Ms. Sudduth,  The above issue was resolved with the patient on 2/12/16.  Ms. [redacted] was able to confirm with the insurance company the overpayment was due to the...

patient.  Unfortunately, in cases like this we must obtain that confirmation from the insurance carrier and it does take time.  As you may not know, insurance carriers will often contact a medical provider months (and even up to 36 months) after payment was issued to reconcile an overpayment they see as refundable to the insurance directly.  Therefore, the practitioner must obtain confirmation as clearly as possible from the insurance to assure the insurance carrier will not demand a refund at a later date. Sincerely,  [redacted] Denver Integrated Imaging

We were able to confirm with insurance company the overpayment is due as refund to the patient.  The account has been forwarded to our AP Dept and a refund will be created an sent to the payor within a business week.

Complaint: [redacted]
I am rejecting this response because:Thank you for your reply. My complaint was due to the amount of time it is taking to complete this step: the clinic now must research with the insurance company to assure the processing of the case was correct and confirm the overpayment is due to the patient instead of the insurance company.The service was provided more than 9 weeks ago, and the payment from the insurance company was received/cleared more than 6 weeks ago. I would like to know at least a ballpark timeframe that you will initiate the process.
Sincerely,
[redacted]

The issue originated with [redacted] instructing the staff that a deductible would apply to this patient's MRI -- not just a copay -- the staff is researching with [redacted] to assure they will not apply that quoted deductible as they reprocess the claim in the event of an audit.  Resolution is...

expected soon.  At that time a  refund will be issued to either [redacted] or patient per [redacted]'s determination.  Insurance companies often audit and reprocess these types of claims and recover funds from the healthcare provider.  Therefore, the medical provider must have assurance from the insurance carrier to confirm the refund is due to patient or to the insurance before sending a refund.

Prior to the appointment, our staff contacted the patient's insurance company and was told the insurance would cover the exam in full.  The insurance company processed the claim differently after it was submitted to them.  Based on the patient's policy, the insurance only paid 80% of the allowed amount for his [redacted].  We acted exactly as the insurance has instructed.  The patient's policy is the determining factor here.  The patient has a policy which only covers part of his health service expense.  We have offered a payment plan to make the cost a bit more manageable, but the patient owes this money based on how his insurance decided to process the claim.  The fact that the insurance provided bad information at the time of service is not the clinic's fault.  The patient should contact his insurance company if he has a policy which should pay 100% and have this cover the $158.12 which is now his balance due.

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.
However, since September 2016, I've been given this exact response multiple times from them.  I've also been told multiple times that I would receive a refund and I have not.  I will wait two weeks for the refund, if I don't receive one I will file an additional complaint.
Sincerely,
[redacted]