Dr. Bradley A. Fink

11/17/14Dear [redacted],Our practice provides medical specialty consultation services. Prior to [redacted]'s consultation, his insurance company verified that his consultation is a covered service. He was then seen in consultation at the request of him and his family physician. The...

consultation claim was billed to his insurance company according to the correct coding initiative supported by the American Medical Association. Our claims are accurately coded and properly submitted based on the services provided. In summary, a consultation was requested, a consultation was verified as a covered service, a consultation was performed and a consultation was billed. Moreover, the explanation of benefits sent to us by his insurance company showed that other services provided were also not paid and applied to his out-of-pocket expenses. It is recommended that patients understand the insurance plan that they select, including coverage, exclusions and out-of-pocket expenses. In addition, [redacted] signed a statement stating that he is financially responsible for any services not covered by his insurance company. In spite of several bills and telephone calls, [redacted]'s account is delinquent.Sincerely,Bradley A. Fink, D.O., PC

Review: On 12/23/2013 I had a doctor's visit with Dr. Fink due to pain in my right shoulder I was referred to Dr. Fink by my family physician Dr. [redacted] of [redacted] in [redacted], PA. During the visit Dr. Fink examined my shoulder and bas on the examination as well as the x-ray film I brought with me he recommended a steroid injection which I agreed to have.

Upon my visit an insurance claim was filed with my health insurance company ([redacted]) to collect payment for the services rendered. On January 31, 2014 I received an explanation of benefits from my insurer indicating that the visit as well as certain services will not be covered. Immediately I called [redacted] and asked for a reason of non-coverage. I was then informed that the claims was submitted by Dr. Fink's office as "CONSULTATION' and my policy does not cover such services, so in order to pay the claim Dr. Fink's billing department would have to submit the claim as "office visit". I then placed a phone call to Dr. Fink's billing office and asked that the claim is resubmitted according to my health insurance company guidelines. The person on the other end said that this is the way Dr. Fink bills for his services and no change will be made. On May 9, 2014 I wrote a letter to Dr. Fink's billing department asking again for the change in billing my insurance company. Following that, I received a phone call from the billing department advising me again the no change will be made. In mid October of 2014 I received a call from Dr. Fink's billing department asking about the balance due, I again explained the situation and was advised that the claim will be resubmitted as office visit. Hoping that this issue was finally resolved, few days later I received a notice from a collection agency asking to pay the balance due.Desired Settlement: Resubmit claim according to my health insurer's guidelines and stop collecting activity.

Business

Response:

11/17/14Dear [redacted],Our practice provides medical specialty consultation services. Prior to [redacted]'s consultation, his insurance company verified that his consultation is a covered service. He was then seen in consultation at the request of him and his family physician. The consultation claim was billed to his insurance company according to the correct coding initiative supported by the American Medical Association. Our claims are accurately coded and properly submitted based on the services provided. In summary, a consultation was requested, a consultation was verified as a covered service, a consultation was performed and a consultation was billed. Moreover, the explanation of benefits sent to us by his insurance company showed that other services provided were also not paid and applied to his out-of-pocket expenses. It is recommended that patients understand the insurance plan that they select, including coverage, exclusions and out-of-pocket expenses. In addition, [redacted] signed a statement stating that he is financially responsible for any services not covered by his insurance company. In spite of several bills and telephone calls, [redacted]'s account is delinquent.Sincerely,Bradley A. Fink, D.O., PC