The Details of the
matter involving the customer filing complaint ID[redacted] is as follows.
The patient presented
at our office on 12/7/2012 for a consultation with a chief complaint of
neck pain. The doctor met with him and a 20 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 $35.00 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 1/4/2013.
A minimal straight
forward exam was performed. The physical examination is a critical component to
the initial visit and is needed to form a diagnosis. The physical examination
is done to the specific area of complaint and can be determined by palpating
the specific area of the spine. The doctor will document the pain, asymmetry misalignment,
Range of motion abnormality, and tissue/tone changes. An exam must be performed
and a diagnosis must be given in order to bill insurance. The 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 normal position, which occurs when the articulating,
surfaces lose partial contact, this DX also includes segmental dysfunction:
somatic dysfunction. The next Diagnoses given was 723.1 Cervicalgia (Other
disorders of the cervical region which excludes: conditions due to:
intervertebral disc disorders and spondylosis). And the final diagnosis was
728.85 (disorders of muscle- Muscle spasms). The level of exam done was
coded as a 99201.25 and was billed to BCBS. The exam 99201-25 as explained in
the coding manual is approximately 10 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 $90.00 and was
billed to BCBS.
A 98940 the code for a
specific 1-2 area adjustment that was performed at the cervical region was
billed to BCBS. The amount for this service billed was $65.00. The
patient was to make an appointment if the problem persisted but did not make
any further appointments.
On 1-18-2013 we
submitted the claim to BCBS and on 2-11-2013 we received the explanation of
benefits stating that the charges would go to the patient’s deductible. A
$20.11 provider discount was taken on the exam (99201) and a $42.23 discount
was taken on the adjustment (98940) leaving the patient with a balance of
$92.66.
The patient was sent
his first bill on 2-6-2013 showing his charges and stating that this is being
billed to your insurance. On 3-21-2014
he was sent a bill stating and showing that provider discounts were taken and insurance
has left the $92.66 balance to his to him as part of his deductible.
A $5. Collection cost is
added for each month for open balances. The 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 $5.00 monthly costs by making minimum payments just
call out office to set them up. No response was ever received from the patient
nor was any mail ever returned. A call
was made and a message left on 5-12-2013 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 16 2013 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 him. We
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 sent. The 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 asked. We 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.
The Details of the
matter involving the customer filing complaint ID[redacted] is as follows.
The patient presented
at our office on 12/7/2012 for a consultation with a chief complaint of
neck pain. The doctor met with him and a 20 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 $35.00 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 1/4/2013.
A minimal straight
forward exam was performed. The physical examination is a critical component to
the initial visit and is needed to form a diagnosis. The physical examination
is done to the specific area of complaint and can be determined by palpating
the specific area of the spine. The doctor will document the pain, asymmetry misalignment,
Range of motion abnormality, and tissue/tone changes. An exam must be performed
and a diagnosis must be given in order to bill insurance. The 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 normal position, which occurs when the articulating,
surfaces lose partial contact, this DX also includes segmental dysfunction:
somatic dysfunction. The next Diagnoses given was 723.1 Cervicalgia (Other
disorders of the cervical region which excludes: conditions due to:
intervertebral disc disorders and spondylosis). And the final diagnosis was
728.85 (disorders of muscle- Muscle spasms). The level of exam done was
coded as a 99201.25 and was billed to BCBS. The exam 99201-25 as explained in
the coding manual is approximately 10 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 $90.00 and was
billed to BCBS.
A 98940 the code for a
specific 1-2 area adjustment that was performed at the cervical region was
billed to BCBS. The amount for this service billed was $65.00. The
patient was to make an appointment if the problem persisted but did not make
any further appointments.
On 1-18-2013 we
submitted the claim to BCBS and on 2-11-2013 we received the explanation of
benefits stating that the charges would go to the patient’s deductible. A
$20.11 provider discount was taken on the exam (99201) and a $42.23 discount
was taken on the adjustment (98940) leaving the patient with a balance of
$92.66.
The patient was sent
his first bill on 2-6-2013 showing his charges and stating that this is being
billed to your insurance. On 3-21-2014
he was sent a bill stating and showing that provider discounts were taken and insurance
has left the $92.66 balance to his to him as part of his deductible.
A $5. Collection cost is
added for each month for open balances. The 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 $5.00 monthly costs by making minimum payments just
call out office to set them up. No response was ever received from the patient
nor was any mail ever returned. A call
was made and a message left on 5-12-2013 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 16 2013 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 him. We
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 sent. The 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 asked. We 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]