Downtown Women OB/GYN Associates, LLP

Review: I called Downtown Women to schedule an annual because I needed a refill of my [redacted] at a new office because I had moved due to Hurricane Sandy.

I went to my appointment as scheduled and was informed by the doctor who I saw that because of revised exam practices it was unnecessary for her to give me the routine pelvic/breast/pap exam.

I received a new prescription for my regular [redacted] from the doctor. I was under the impression that was considered my annual exam, paid my co-pay and was on my way. I later started receiving notices in the mail from the office about an unpaid bill. I was unaware that because the doctor never performed the exam that it was considered an extraneous "office visit" which is billed differently than an annual exam. As a result, my deductible was applied and I was billed for $185.23. Because I was misinformed, I had to pay this fee, instead just receiving my regular annual exam that would have been covered 100% by my insurance.Desired Settlement: I believe I was misinformed and as a result I ended up incurring an extra cost when if I had just gotten my regular annual exam like I thought I was going to get I would have not had to pay my deductible. I would like the billing codes to be adjusted so it reflects the fact that I should have gotten the annual exam which would have been covered 100% by my insurance.

Business

Response:

Dear [redacted],

Thank you for your letter dated August **,2013 regarding the above complaint. According to our records, the new patient appointment was booked properly.

Proper clinical procedural guidelines were followed at the time of service. The claim was submitted to our patient's insurance carrier based on the services provided and the carrier adjudicated the claim based on the patient's plan design and coverage benefits. Appropriate billing guidelines were followed and the patient was billed pursuant to her carrier's instructions.

In the interest of preserving our patient's privacy, we would be more than happy to discuss this matter with our patient.

Our billing department can be reached at ###-###-####,prompt *

Consumer

Response:

I have reviewed the response made by the business in reference to complaint ID# [redacted], and have determined that my complaint has NOT been resolved because: