The Details of the matter involving the customer filing complaint ID [redacted] is as follows The patient presented at our office on 12/7/for a consultation with a chief complaint of neck painThe doctor met with him and a minute appointment was reserved this consultation was no charge The patient wanted to keep the cost low because at that time he did not have insurance It was explained to him if he wanted treatment at that time he could go on our cash plan and pay $for a visit but it had to be paid on the date of service The patient choose that he wanted to have it billed to his insurance and the appointment was set as 1/4/ A minimal straight forward exam was performedThe physical examination is a critical component to the initial visit and is needed to form a diagnosisThe physical examination is done to the specific area of complaint and can be determined by palpating the specific area of the spineThe doctor will document the pain, asymmetry misalignment, Range of motion abnormality, and tissue/tone changesAn exam must be performed and a diagnosis must be given in order to bill insuranceThe Diagnosis the doctor found after the exam and set was as follows 739.1: Nonallopatiic lesions not elsewhere classified which includes subluxation or displacement of the joint from its position, which occurs when the articulating, surfaces lose partial contact, this DX also includes segmental dysfunction: somatic dysfunctionThe next Diagnoses given was Cervicalgia (Other disorders of the cervical region which excludes: conditions due to: intervertebral disc disorders and spondylosis)And the final diagnosis was (disorders of muscle- Muscle spasms) The level of exam done was coded as a and was billed to BCBSThe exam 99201-as explained in the coding manual is approximately minutes, is for a minor severity problem, the history of problem is focused as is the exam and the decision making is straightforward the cost for this level of exam is $and was billed to BCBS A the code for a specific 1-area adjustment that was performed at the cervical region was billed to BCBSThe amount for this service billed was $ The patient was to make an appointment if the problem persisted but did not make any further appointments On 1-18-we submitted the claim to BCBS and on 2-11-we received the explanation of benefits stating that the charges would go to the patient’s deductibleA $provider discount was taken on the exam (99201) and a $discount was taken on the adjustment (98940) leaving the patient with a balance of $ The patient was sent his first bill on 2-6-showing his charges and stating that this is being billed to your insurance On 3-21- he was sent a bill stating and showing that provider discounts were taken and insurance has left the $balance to his to him as part of his deductible A $Collection cost is added for each month for open balancesThe patient did not respond to his billing a note was written on his billing “to avoid a $5.collection cost please make a payment or call our office to set up a payment plan” Further billings each month along with notes stating he could avoid the $monthly costs by making minimum payments just call out office to set them upNo response was ever received from the patient nor was any mail ever returned A call was made and a message left on 5-12-to the patient in regards to his bill at our office and we asked him to call to make arrangement for payment no call was returned On September a collections letter was sent of which I have attached a copy We did try several times after this to reach the patient by phone but was unable to reach himWe at our office try every way to communicate to with the patient and work with them At no time did this patient call and voice displeasure with the care given or the billing being sentThe first time he has communicated is when we received this from you I am very sorry he feels this way but the fact of the matter is he came to our office and requested the treatment, asked us to bill his insurance and we did what we were askedWe gave him every opportunity to make this right and to work with us on the payment or he could of consulted with us if he was unhappy about the outcome of his treatment but he choose to do nothing until now Sincerely [redacted]
The Details of the matter involving the customer filing complaint ID [redacted] is as follows The patient presented at our office on 12/7/for a consultation with a chief complaint of neck painThe doctor met with him and a minute appointment was reserved this consultation was no charge The patient wanted to keep the cost low because at that time he did not have insurance It was explained to him if he wanted treatment at that time he could go on our cash plan and pay $for a visit but it had to be paid on the date of service The patient choose that he wanted to have it billed to his insurance and the appointment was set as 1/4/ A minimal straight forward exam was performedThe physical examination is a critical component to the initial visit and is needed to form a diagnosisThe physical examination is done to the specific area of complaint and can be determined by palpating the specific area of the spineThe doctor will document the pain, asymmetry misalignment, Range of motion abnormality, and tissue/tone changesAn exam must be performed and a diagnosis must be given in order to bill insuranceThe Diagnosis the doctor found after the exam and set was as follows 739.1: Nonallopatiic lesions not elsewhere classified which includes subluxation or displacement of the joint from its position, which occurs when the articulating, surfaces lose partial contact, this DX also includes segmental dysfunction: somatic dysfunctionThe next Diagnoses given was Cervicalgia (Other disorders of the cervical region which excludes: conditions due to: intervertebral disc disorders and spondylosis)And the final diagnosis was (disorders of muscle- Muscle spasms) The level of exam done was coded as a and was billed to BCBSThe exam 99201-as explained in the coding manual is approximately minutes, is for a minor severity problem, the history of problem is focused as is the exam and the decision making is straightforward the cost for this level of exam is $and was billed to BCBS A the code for a specific 1-area adjustment that was performed at the cervical region was billed to BCBSThe amount for this service billed was $ The patient was to make an appointment if the problem persisted but did not make any further appointments On 1-18-we submitted the claim to BCBS and on 2-11-we received the explanation of benefits stating that the charges would go to the patient’s deductibleA $provider discount was taken on the exam (99201) and a $discount was taken on the adjustment (98940) leaving the patient with a balance of $ The patient was sent his first bill on 2-6-showing his charges and stating that this is being billed to your insurance On 3-21- he was sent a bill stating and showing that provider discounts were taken and insurance has left the $balance to his to him as part of his deductible A $Collection cost is added for each month for open balancesThe patient did not respond to his billing a note was written on his billing “to avoid a $5.collection cost please make a payment or call our office to set up a payment plan” Further billings each month along with notes stating he could avoid the $monthly costs by making minimum payments just call out office to set them upNo response was ever received from the patient nor was any mail ever returned A call was made and a message left on 5-12-to the patient in regards to his bill at our office and we asked him to call to make arrangement for payment no call was returned On September a collections letter was sent of which I have attached a copy We did try several times after this to reach the patient by phone but was unable to reach himWe at our office try every way to communicate to with the patient and work with them At no time did this patient call and voice displeasure with the care given or the billing being sentThe first time he has communicated is when we received this from you I am very sorry he feels this way but the fact of the matter is he came to our office and requested the treatment, asked us to bill his insurance and we did what we were askedWe gave him every opportunity to make this right and to work with us on the payment or he could of consulted with us if he was unhappy about the outcome of his treatment but he choose to do nothing until now Sincerely [redacted]