Doctors Express of Oceanside

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 For your reference, details of the offer I reviewed appear below Again, my main concern is the fact that the charge for the service is at a higher pay rate than had I paid cash At the time of service, I was not told that by using my insurance, I would be charged at a significantly higher rate $ [redacted] vs$*** I understand I am responsible for the payment regarding my deductible I do get how insurance works Again, my complaint is the discrepancy is rates charged Now, from my understanding, [redacted] gets a $ [redacted] deduction, but that does not change the fact that the initial charge was significantly higher From the bill I received, it looked as though the insurance had paid $ [redacted] If that is not the case, I am willing to pay the $ [redacted] co-pay already paid that would have been the charge had I paid cash on the date of service Regards, [redacted]

November 19, 2014,
Revdex.com Complaint Response
Patient Name: *** ***
Patient DOB: ***
Health Plan: *** ***
Date of Service: 06/18/
Re: Complaint
10: ***
Dear *** ***,
Oceanside Boulevard,
suite
Oceanside, CA
Phone: *** Fox: ***
Monday- Friday 8:ooam -8:00pm
Saturday - Sunday 8:00am-8:00pm
This letter serves as our formal response to the complaint fi led by *** *** *** (ID* ***)I want to thank you for forwarding me the actual complaint, as we just received it
today, November 19,I have read the complaint and discovered many statements
and I will enclose our proof along with this letterWe see two types of patient here; self- pay
patients (pay out of pocket) and insurance patientsThis patient was seen on June 06, 2014,
and at the time of service we took the patient's insurance, which is *** *** Self- pay
rates are only offered to those without insurance or those who decline the assignment of
benefits with their insurance at the time of serviceInsurance rates are higher due to
contractual reductionsBecause the patient was insured, and we have a contract with ***
***, we proceeded to see the patient through her insurance
On the patients insurance card it states the patient has a **% Co-insurance after the
deductible has been metWe billed the insurance a charge of $***, which was
contractually reduced by $*** *, leaving a balance of $*** for the patientThis balance
of $*** went to the patient's deductible and it is their responsibility to payThe insurance
reduced our bill and they have not paid us a centAt the time of service we collected $***
from the patient which goes toward the patient's deductible, yielding a new balance of
$*** as the patient responsibilityAgain, we received no payment from the insurance and
I have attached our billing paperwork that reflects this
Secondly, we have no Nurse Practitioners in our Urgent CareWe only employ MD's,
DO's and PA's {Physician Assistants) I
Thirdly, if the patient no longer has insurance, we can offer them our discounted selfpay
ratesIf you pay attention to the patient insurance card it states the benefits the patient
is entitled to after meeting the deductibleIn this case, had the patient satisfied their
deductible, the patient is only responsible for **%, which would have been approximately
$***It is beyond our control to determine patient deductiblesThat is between the patient
and their insurance companySome people have a small deductible and some patient have
a higher deductibleAgain, this is not our responsibility
Finally, we had our Medical Director review the case, and determined the patient was
provided excellent medical care
To summarize, we did not get any payment from the insuranceWe did not bill
improperly but instead as contractually obligatedThis issue comes down to the patient's
deductible, which is between her and her insurance carrierI do understand that she feels the
self-pay option, which is also due upfront at the time of service, is less that what she currently
owes; however, we face the same things depending on insurance carriersSome insurance
carriers contractually pay us more and some pay us less
Lastly, we did try to contact the patient to explain to her what had transpired and she
hung up on usPlease review the attached proof, which reveals that we have not received
any payment from the insurance and a copy of the patient's insurance card as well as our
communication notes with the patient
If you have any additional questions, please don't hesitate to contact me at the number
listed belowI would like to formally ask you to dismiss this case as we have done nothing
remotely wrong
Yours in health,
*** ***
Administrative Manager
Oceanside BlvdSuite
Oceanside, CA
P: ***
F: ***

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.  For your reference, details of the offer I reviewed appear below.
Again, my main concern is the fact that the charge for the service is at a higher pay rate than had I paid cash.  At the time of service, I was not told that by using my insurance, I would be charged at a significantly higher rate $[redacted] vs. $[redacted].  I understand I am responsible for the payment regarding my deductible.  I do get how insurance works.  Again, my complaint is the discrepancy is rates charged.  Now, from my understanding, [redacted] gets a $[redacted] deduction, but that does not change the fact that the initial charge was significantly higher.  
From the bill I received, it looked as though the insurance had paid $[redacted].  If that is not the case, I am willing to pay the $[redacted] co-pay already paid that would have been the charge had I paid cash on the date of service.
Regards,[redacted]

Review: I took my son to this office while on vacation in Oceanside. He needed to be seen for possible [redacted]. They asked if we had insurance and I showed proof of insurance. I was never told up front that I had an option to pay cash. They did require a $** co-pay fee up front. When the bill arrived, they charged $[redacted] of which my insurance paid $[redacted], leaving me with the remainder of $[redacted]. I argued with the company that $[redacted] is a high charge for looking in my son's ear. In addition, he only saw a nurse practitioner as well, no Doctor. I asked what the cash price was had I not told them I had no insurance and the company said $[redacted]. I am outraged that I am required to pay more for a visit than a person paying cash. It seems wrong that I pay insurance premiums and pay more for office visits.Desired Settlement: I would like the bill settled as is. At this point, Doctors Express of Oceanside has been paid $[redacted] for the service rendered- $** from me and $[redacted] from my son's health insurance provider. That is more than they would have received if I had paid cash. I do not think I should be required to pay the additional $[redacted] they are requesting.

Business

Response:

November 19, 2014,

Revdex.com Complaint Response

Patient Name: [redacted]

Patient DOB: [redacted]

Health Plan: [redacted]

Date of Service: 06/18/2014

Re: Complaint

10: [redacted]

Dear [redacted],

4171 Oceanside Boulevard, suite109

Oceanside, CA 92056

Phone: [redacted] Fox: [redacted]

Monday- Friday 8:ooam -8:00pm

Saturday - Sunday 8:00am-8:00pm

This letter serves as our formal response to the complaint fi led by [redacted] (ID[redacted]). I want to thank you for forwarding me the actual complaint, as we just received it

today, November 19,2014. I have read the complaint and discovered many false statements

and I will enclose our proof along with this letter. We see two types of patient here; self- pay

patients (pay out of pocket) and insurance patients. This patient was seen on June 06, 2014,

and at the time of service we took the patient's insurance, which is [redacted] Self- pay

rates are only offered to those without insurance or those who decline the assignment of

benefits with their insurance at the time of service. Insurance rates are higher due to

contractual reductions. Because the patient was insured, and we have a contract with [redacted], we proceeded to see the patient through her insurance.

On the patients insurance card it states the patient has a **% Co-insurance after the

deductible has been met. We billed the insurance a charge of $[redacted], which was

contractually reduced by $[redacted], leaving a balance of $[redacted] for the patient. This balance

of $[redacted] went to the patient's deductible and it is their responsibility to pay. The insurance

reduced our bill and they have not paid us a cent. At the time of service we collected $[redacted]

from the patient which goes toward the patient's deductible, yielding a new balance of

$[redacted] as the patient responsibility. Again, we received no payment from the insurance and

I have attached our billing paperwork that reflects this.

Secondly, we have no Nurse Practitioners in our Urgent Care. We only employ MD's,

DO's and PA's {Physician Assistants) . I

Thirdly, if the patient no longer has insurance, we can offer them our discounted selfpay

rates. If you pay attention to the patient insurance card it states the benefits the patient

is entitled to after meeting the deductible. In this case, had the patient satisfied their

deductible, the patient is only responsible for **%, which would have been approximately

$[redacted]. It is beyond our control to determine patient deductibles. That is between the patient

and their insurance company. Some people have a small deductible and some patient have

a higher deductible. Again, this is not our responsibility.

Finally, we had our Medical Director review the case, and determined the patient was

provided excellent medical care.

To summarize, we did not get any payment from the insurance. We did not bill

improperly but instead as contractually obligated. This issue comes down to the patient's

deductible, which is between her and her insurance carrier. I do understand that she feels the

self-pay option, which is also due upfront at the time of service, is less that what she currently

owes; however, we face the same things depending on insurance carriers. Some insurance

carriers contractually pay us more and some pay us less.

Lastly, we did try to contact the patient to explain to her what had transpired and she

hung up on us. Please review the attached proof, which reveals that we have not received

any payment from the insurance and a copy of the patient's insurance card as well as our

communication notes with the patient.

If you have any additional questions, please don't hesitate to contact me at the number

listed below. I would like to formally ask you to dismiss this case as we have done nothing

remotely wrong.

Yours in health,

Administrative Manager

4171 Oceanside Blvd. Suite 1 09

Oceanside, CA 92056

P: [redacted]

F: [redacted]

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.

Again, my main concern is the fact that the charge for the service is at a higher pay rate than had I paid cash. At the time of service, I was not told that by using my insurance, I would be charged at a significantly higher rate $[redacted] vs. $[redacted]. I understand I am responsible for the payment regarding my deductible. I do get how insurance works. Again, my complaint is the discrepancy is rates charged. Now, from my understanding, [redacted] gets a $[redacted] deduction, but that does not change the fact that the initial charge was significantly higher.