Druger Eye Care

I want to make this very clearKelvin took my insurance information, went to his computer and told me the following: because I had the cataract surgery my insurance would cover the new lensesWhen I asked how much I would be responsible for he told me between $and $No mention was made about the deductible being metIf he did not know that and as he says, the insurance company would not give him that, then he obviously pulled a number out of the airAt the very least this was deceptive and at most an outright lie to get me to make a purchase I would not have made there as I could have received that price at any eyeglass vendor not being given the so called medicaid rateAlso, he did not offer to let me keep the lenses while I got them elsewhere, but told me I could leave themAs far as the comment" that's on you" that was unprofessional, rude and insultingKelvin was not honest and did not give an honest priceI expect my bill to be adjusted immediately

[redacted] ,Thank you for sending a copy of the complaint (Id# [redacted] ) issued by our patient [redacted] As stated, [redacted] ordered eyeglass lenses from us 4/9/ [redacted] asked me if his health insurance had any benefit toward his lenses as he had his cataracts removedHe was told he should have a benefit as a resultWe do not verify eligibility nor will [redacted] give a Dollar amount without having a claimSubsequently per his request his lenses were made, dispensed and insurance billedOn or about 5/27/ [redacted] came in with an insurance denial and a bill from our office and wanted to know why his insurance didn’t payI asked him if he had contacted his insurance as to the reason and he said noI told him his insurance carrier would be the people to speak with as it is his insurance but I would check with our billing department to see if they had a reason why his claim was deniedThey stated per his insurance his deductible had not been metIn turn I asked [redacted] if his deductible had been met and he stated “probably not, I am sure it hasn’t.” I said well “ [redacted] that’s on youYou have to meet your insurance deductible before your insurance company will pay any claims.”(The Excellus patient website :“For services other than preventive care, you are responsible for paying out of your pocket until you meet your deductibleThe deductible amount will vary based on your plan, so make sure you know what that amount isOnce you reach your deductible, you will pay a percentage of cost, called coinsuranceCoinsurance is your share of the costs of a covered health care service, calculated as a percentYou will have to pay a percentage of that service and the health insurance company will pay the rest.” ) At this point [redacted] stated he could get his lenses cheaper elsewhereI told him if that’s what he wanted to do, he could leave the lenses I made with me and do that, but in fact he would still not meet his insurance deductible elsewhere [redacted] said he may do thatI offered to let him use the lenses for a few days until he received his new lenses made elsewhereNow 7+ weeks later it is clear that [redacted] chose to keep the lenses we made him and is responsible for his eyeglass lens bill Unfortunately, for patients as well as providers, insurance can sometimes be confusing especially knowing what your benefits are, if you’re eligible or where you may need to goAttached is a handout we have in our waiting room as well as the dispensing area stating insurance agreements are between an insurance carrier and the patientWhat an insurance carrier pays is not determined by us and any questions regarding this would best be answered by the insurance carrierBest Regards,Kelvin B [redacted] , Druger Eye Care ###-###-####

I want to make this very clear. Kelvin took my insurance information, went to his computer and told me the following: because I had the cataract surgery my insurance would cover the new lenses. When I asked how much I would be responsible for he told me between $100 and $110.00. No mention was made about the deductible being met. If he did not know that and as he says, the insurance company would not give him that, then he obviously pulled a number out of the air. At the very least this was deceptive and at most an outright lie to get me to make a purchase I would not have made there as I could have received that price at any eyeglass vendor not being given the so called medicaid rate. Also, he did not offer to let me keep the lenses while I got them elsewhere, but told me I could leave them. As far as the comment" that's on you" that was unprofessional, rude and insulting. Kelvin was not honest and did not give an honest price. I expect my bill to be adjusted immediately.

[redacted] ,Thank you for sending a copy of the complaint (Id#[redacted]) issued by our patient [redacted].   As stated, [redacted] ordered eyeglass lenses from us 4/9/15. [redacted] asked me if his health insurance had any benefit toward his lenses as he had his cataracts removed. He was told he should...

have a benefit as a result. We do not verify eligibility nor will [redacted] give a Dollar amount without having a claim. Subsequently per his request his lenses were made, dispensed and insurance billed. On or about 5/27/15 [redacted] came in with an insurance denial and a  bill from our office and wanted to know why his insurance didn’t pay. I asked him if he had contacted his insurance as to the reason and he said no. I told him his insurance carrier would be the people to speak with as it is his insurance but I would check with our billing department to see if they had a reason why his claim was denied. They stated per his insurance his deductible had not been met. In turn I asked [redacted] if his deductible had been met and he stated “probably not, I am sure it hasn’t.” I said well “[redacted] that’s on you. You have to meet your insurance deductible before your insurance company will pay any claims.”(The Excellus patient website :“For services other than preventive care, you are responsible for paying out of your pocket until you meet your deductible. The deductible amount will vary based on your plan, so make sure you know what that amount is. Once you reach your deductible, you will pay a percentage of cost, called coinsurance. Coinsurance is your share of the costs of a covered health care service, calculated as a percent. You will have to pay a percentage of that service and the health insurance company will pay the rest.” ) At this point [redacted] stated he could get his lenses cheaper elsewhere. I told him if that’s what he wanted to do, he could leave the lenses I made with me and do that, but in fact he would still not meet his insurance deductible elsewhere. [redacted] said he may do that. I offered to let him use the lenses for a few days until he received his new lenses made elsewhere. Now 7+ weeks later it is clear that [redacted] chose to keep the lenses we made him and is responsible for his eyeglass lens bill.   Unfortunately, for patients as well as providers, insurance can sometimes be confusing especially knowing what your benefits are, if you’re eligible or where you may need to go. Attached is a handout we have in our waiting room as well as the dispensing area stating insurance agreements are between an insurance carrier and the patient. What an insurance carrier pays is not determined by us and any questions regarding this would best be answered by the insurance carrier. Best Regards,Kelvin B[redacted], Druger Eye Care ###-###-####