No refund is due On January 29, [redacted] representative [redacted] ref# [redacted] stated the claim was processed in error and will be reprocessed to reflect the correct benefit level for X-Rays This service is covered @ 100% after a $copayThe rep confirmed that this claim was in fact processed incorrectly and it is being sent back to reprocess with a copayOur staff called patient to inform her no refund will be issued and that [redacted] is reprocessing her claim at this timeShe did not answerA voice mail was left for her to call for details Unfortunately this happens with insurance companies They process a claim in error and it takes months for them to audit the case and reprocess with the correct patient responsibility We apologize for the delay, but sometimes we have no control over the time the process takes
Revdex.com: 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 I am quite disappointed that you are closing this claim as resolved, I read the last response form the company and at this point I did not feel like I needed to respond since as you can see from below we are waiting on a response from *** Regards,
Part of the problem here is that [redacted] uses an outside vendor to process all imaging claims. So our team is working with both [redacted] and [redacted] (the outside vendor [redacted] employs for claims management). We spoke to [redacted] and [redacted] again today. They have requested another week to reprocess the claim under the $45 copay. This is not our decision. As for the patient being told the exam is not subject to a $45 copay we can only abide with the benefit information given to us at the time of service and the insurance direction we are being given now. I am not sure if the patient spoke to exactly the same representative we have been talking to, but I do know the representatives both at [redacted] and [redacted] have instructed us to wait for the decision. If the claim is not subject to the copay and [redacted] along with [redacted] sends the documentation to confirm this we will happily refund any overpayment.
Prior to providing medical services our clinic contacts the
appropriate insurance company to obtain eligibility and benefit information for
the patient At that time the insurance company will tell us
the
estimated copay/co-insurance/ deductible amount to be paid by the patient
In this patient case the insurance company paid the claim using very
different benefits than used at the time of service when they instructed the
clinic to collect the amount paid at time of service from the patient Unfortunately insurance
companies make incorrect payments If the payment made by the insurance
company does not match the information given to the clinic at time of service,
it must be fully researched In numerous cases the insurance carrier
will return to the medical provider and recover payments made on a case months
or even years old with instructions for the medical provider to collect
additional payment from the patient The medical provider must
obtain confirmation from the insurance provider regarding which amount the
patient was actually responsible to pay This does take some time, but is
a necessary step
Prior to providing medical services our clinic contacts the appropriate insurance company to obtain eligibility and benefit information for the patient At that time the insurance company will tell us the estimated copay/co-insurance/ deductible amount to be paid by the patient In this
patient case the insurance company paid the claim using very different benefits than used at the time of service when they instructed the clinic to collect the $from the patient Unfortunately insurance companies make incorrect payments If the payment made by the insurance company does not match the information given to the clinic at time of service, it must be fully researched In numerous cases the insurance carrier will return to the medical provider and recover payments made on a case months or even years old with instructions for the medical provider to collect additional payment from the patient The medical provider must obtain confirmation from the insurance provider regarding which amount the patient was actually responsible to pay This does take some time, but is a necessary step *** *** was refunded via credit card the original payment of $on 2/**/
Our collections manager spoke to the patient on 7/**/14. We understand the patient is very upset that a refund hasn't been issuedShe explained to him in detail that *** sent his claim back for reprocessing because they are showing the deductible has not been metHe said that is
correct, the deductible hasn't been met but he believes for radiology it should pay at 100%.
He asked for the ref# we received from BCBS I gave him ref# ***.
He is going to call BCBS and try to get this figured outI explained if he wants to do a 3-way call we can do that. If the insurance company reprocesses his claim to cover the amount he believes should be covered a refund will be issued. We cannot do anything until the insurance company finishes this process
Prior to providing medical
services our clinic contacts the appropriate insurance company to obtain
eligibility and benefit information for the patient. At that time the
insurance company will tell us the estimated copay/co-insurance/...
deductible amount
to be paid by the patient. Unfortunately insurance companies make
incorrect payments. If the payment made by the insurance company does not
match the information given to the clinic at time of service, it must be fully
researched. In numerous cases the insurance carrier will return to the
medical provider and recover payments made on a case months or even years after the payment was processed with instructions for the medical provider to collect additional payment from
the patient. The medical provider must obtain confirmation from the
insurance provider regarding which amount the patient was actually responsible
to pay. This does take some time, but is a necessary step. At this time a refund has been made to the [redacted] account.
Revdex.com:
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.
I am quite disappointed that you are closing this claim as resolved, I read the last response form the company and at this point I did not feel like I needed to respond since as you can see from below we are waiting on a response from [redacted]..
Regards,
Revdex.com:
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. [Provide details of why you are not satisfied with this resolution.]
Regards,
This resolution as they call it will NOT be resolved until the check for 240.00 is in my hand AND has cleared the bank!!! Just don"t understand what the problem is? And why can't they pick up the phone and call me and explain whats going on and keep me informed. I do not believe that is asking too much. But this company has just cooked it's goose with me. NEVER AGAIN will myself or my family or anyone I know do business with this company. SO NO THIS IS NOT RESOLVED YET!!!! UNTIL I GET A CHECK FOR MY REFUND IN THE AMOUNT OF 240.00 AND IT HAS CLEARED THE BANK, THEN NO THIS IS RESOLVED PERIOD>
Part of the problem here is that [redacted] uses an outside vendor to process all imaging claims. So our team is working with both [redacted] and [redacted] (the outside vendor [redacted] employs for claims management). We spoke to [redacted] and [redacted] again today. They have requested another week to reprocess the claim under the $45 copay. This is not our decision. As for the patient being told the exam is not subject to a $45 copay we can only abide with the benefit information given to us at the time of service and the insurance direction we are being given now. I am not sure if the patient spoke to exactly the same representative we have been talking to, but I do know the representatives both at [redacted] and [redacted] have instructed us to wait for the decision. If the claim is not subject to the copay and [redacted] along with [redacted] sends the documentation to confirm this we will happily refund any overpayment.
No refund is due. On January 29, 2014 [redacted] representative [redacted] ref#[redacted] stated the claim was processed in error and will be reprocessed to reflect the correct benefit level for X-Rays. This service is covered @ 100% after a $45 copay. The...
rep confirmed that this claim was in fact processed incorrectly and it is being sent back to reprocess with a copay. Our staff called patient to inform her no refund will be issued and that [redacted] is reprocessing her claim at this time. She did not answer. A voice mail was left for her to call for details. Unfortunately this happens with insurance companies. They process a claim in error and it takes months for them to audit the case and reprocess with the correct patient responsibility. We apologize for the delay, but sometimes we have no control over the time the process takes.
No refund is due On January 29, [redacted] representative [redacted] ref# [redacted] stated the claim was processed in error and will be reprocessed to reflect the correct benefit level for X-Rays This service is covered @ 100% after a $copayThe rep confirmed that this claim was in fact processed incorrectly and it is being sent back to reprocess with a copayOur staff called patient to inform her no refund will be issued and that [redacted] is reprocessing her claim at this timeShe did not answerA voice mail was left for her to call for details Unfortunately this happens with insurance companies They process a claim in error and it takes months for them to audit the case and reprocess with the correct patient responsibility We apologize for the delay, but sometimes we have no control over the time the process takes
Revdex.com: 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 I am quite disappointed that you are closing this claim as resolved, I read the last response form the company and at this point I did not feel like I needed to respond since as you can see from below we are waiting on a response from *** Regards,
Part of the problem here is that [redacted] uses an outside vendor to process all imaging claims. So our team is working with both [redacted] and [redacted] (the outside vendor [redacted] employs for claims management). We spoke to [redacted] and [redacted] again today. They have requested another week to reprocess the claim under the $45 copay. This is not our decision. As for the patient being told the exam is not subject to a $45 copay we can only abide with the benefit information given to us at the time of service and the insurance direction we are being given now. I am not sure if the patient spoke to exactly the same representative we have been talking to, but I do know the representatives both at [redacted] and [redacted] have instructed us to wait for the decision. If the claim is not subject to the copay and [redacted] along with [redacted] sends the documentation to confirm this we will happily refund any overpayment.
Prior to providing medical services our clinic contacts the
appropriate insurance company to obtain eligibility and benefit information for
the patient At that time the insurance company will tell us
the
estimated copay/co-insurance/ deductible amount to be paid by the patient
In this patient case the insurance company paid the claim using very
different benefits than used at the time of service when they instructed the
clinic to collect the amount paid at time of service from the patient Unfortunately insurance
companies make incorrect payments If the payment made by the insurance
company does not match the information given to the clinic at time of service,
it must be fully researched In numerous cases the insurance carrier
will return to the medical provider and recover payments made on a case months
or even years old with instructions for the medical provider to collect
additional payment from the patient The medical provider must
obtain confirmation from the insurance provider regarding which amount the
patient was actually responsible to pay This does take some time, but is
a necessary step
Prior to providing medical services our clinic contacts the appropriate insurance company to obtain eligibility and benefit information for the patient At that time the insurance company will tell us the estimated copay/co-insurance/ deductible amount to be paid by the patient In this
patient case the insurance company paid the claim using very different benefits than used at the time of service when they instructed the clinic to collect the $from the patient Unfortunately insurance companies make incorrect payments If the payment made by the insurance company does not match the information given to the clinic at time of service, it must be fully researched In numerous cases the insurance carrier will return to the medical provider and recover payments made on a case months or even years old with instructions for the medical provider to collect additional payment from the patient The medical provider must obtain confirmation from the insurance provider regarding which amount the patient was actually responsible to pay This does take some time, but is a necessary step *** *** was refunded via credit card the original payment of $on 2/**/
Our collections manager spoke to the patient on 7/**/14. We understand the patient is very upset that a refund hasn't been issuedShe explained to him in detail that *** sent his claim back for reprocessing because they are showing the deductible has not been metHe said that is
correct, the deductible hasn't been met but he believes for radiology it should pay at 100%.
He asked for the ref# we received from BCBS I gave him ref# ***.
He is going to call BCBS and try to get this figured outI explained if he wants to do a 3-way call we can do that. If the insurance company reprocesses his claim to cover the amount he believes should be covered a refund will be issued. We cannot do anything until the insurance company finishes this process
Prior to providing medical
services our clinic contacts the appropriate insurance company to obtain
eligibility and benefit information for the patient. At that time the
insurance company will tell us the estimated copay/co-insurance/...
deductible amount
to be paid by the patient. Unfortunately insurance companies make
incorrect payments. If the payment made by the insurance company does not
match the information given to the clinic at time of service, it must be fully
researched. In numerous cases the insurance carrier will return to the
medical provider and recover payments made on a case months or even years after the payment was processed with instructions for the medical provider to collect additional payment from
the patient. The medical provider must obtain confirmation from the
insurance provider regarding which amount the patient was actually responsible
to pay. This does take some time, but is a necessary step. At this time a refund has been made to the [redacted] account.
Revdex.com:
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.
I am quite disappointed that you are closing this claim as resolved, I read the last response form the company and at this point I did not feel like I needed to respond since as you can see from below we are waiting on a response from [redacted]..
Regards,
Revdex.com:
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. [Provide details of why you are not satisfied with this resolution.]
Regards,
This resolution as they call it will NOT be resolved until the check for 240.00 is in my hand AND has cleared the bank!!! Just don"t understand what the problem is? And why can't they pick up the phone and call me and explain whats going on and keep me informed. I do not believe that is asking too much. But this company has just cooked it's goose with me. NEVER AGAIN will myself or my family or anyone I know do business with this company. SO NO THIS IS NOT RESOLVED YET!!!! UNTIL I GET A CHECK FOR MY REFUND IN THE AMOUNT OF 240.00 AND IT HAS CLEARED THE BANK, THEN NO THIS IS RESOLVED PERIOD>
Part of the problem here is that [redacted] uses an outside vendor to process all imaging claims. So our team is working with both [redacted] and [redacted] (the outside vendor [redacted] employs for claims management). We spoke to [redacted] and [redacted] again today. They have requested another week to reprocess the claim under the $45 copay. This is not our decision. As for the patient being told the exam is not subject to a $45 copay we can only abide with the benefit information given to us at the time of service and the insurance direction we are being given now. I am not sure if the patient spoke to exactly the same representative we have been talking to, but I do know the representatives both at [redacted] and [redacted] have instructed us to wait for the decision. If the claim is not subject to the copay and [redacted] along with [redacted] sends the documentation to confirm this we will happily refund any overpayment.
No refund is due. On January 29, 2014 [redacted] representative [redacted] ref#[redacted] stated the claim was processed in error and will be reprocessed to reflect the correct benefit level for X-Rays. This service is covered @ 100% after a $45 copay. The...
rep confirmed that this claim was in fact processed incorrectly and it is being sent back to reprocess with a copay. Our staff called patient to inform her no refund will be issued and that [redacted] is reprocessing her claim at this time. She did not answer. A voice mail was left for her to call for details. Unfortunately this happens with insurance companies. They process a claim in error and it takes months for them to audit the case and reprocess with the correct patient responsibility. We apologize for the delay, but sometimes we have no control over the time the process takes.