Eberle Eye Care

[redacted] ***Consumer Complaint No: [redacted] Dear Mrs [redacted] , I had the privilege to see Ms [redacted] for an annual comprehensive examination onNovember 9, During her examination, cataracts were noted in both eyes and herbest correctable vision with glasses or contact lenses was no longer achievable to 20/20in either eyeDue to the decrease in vision from the cataracts, I recommended thatMs [redacted] consider cataract extraction and referred her to Pacific Cataract and LaserInstitute (PCLI)Cataract surgery and all follvisits associated with the surgeryare medical procedures and medical insurance is billed appropriatelyAdditionally,follcare can be performed by the surgery provider or by the referring doctor, andit is common with uncomplicated cataract surgery for the referring doctor to provide thefollcareThe surgery was performed at PCLI on January 5, for the left eyeand January 6, for the right eyeThe surgery center provides their patients withinformation regarding the medical procedure and medical follcare by the Primarycare Optometrist We had the privilege of seeing Ms [redacted] for her follcare for the cataractsurgery on January 12, The follcare for most patients who have anuncomplicated recovery is three visits, but if their recovery is protracted there may beseveral visits required during the day global follperiodThe reimbursementfor all care related to the surgery during that day period is the same regardless ofthe number of visits requiredOn January 12, the billing for the medical follow-upcare was done and verbally stated to the patient at the time of check outThe CPTprocedure code for Cataract surgery as preformed by PCLI was In Ms***'sclaim to insurance the CPT code used was 66984-The "-55" is a modifier code whichindicates that only post-operative services of the global surgical package were renderedby said providerBilled charges towards medical insurance were $right eye and$left eye which would include all the visits necessary during the day recoveryperiodMs***'s medical insurance claim was appropriately billed and since the entireclaim was applied towards her deductible, a balance of $was owed by patientAstatement of the balance owed was sent out on April 27, In regards to the resolution sought by the patient for a refund amount of $800,there has been no payment made by the insurance company to Eberle Eyecare and nopayment made by the patient to Eberle Eyecare, so there isn't anything to refund.Attached is the HIPPA and Insurance responsibility form in which Ms [redacted] signed whenshe first became our patient 6/4/In addition, as Ms [redacted] was a contact lenswearer prior to her surgery, Eberle Eyecare provided her with contact lenses Novemberand December as a complementary service to support her before her surgery.Please let me know if there is anything further you may need from usThank you Sincerely,DrAndrea E***

Complaint: ***I am rejecting this response because: When I saw MsE*** in November and she suggested the cataract surgery I requested a referral to a "preferred provider" with my Medical insuranceShe is not a preferred provider, she did not have my authority to charge my medical insurance and she must have known the follow up visit would be under medicalI am not even sure how she received my medical insurance information, as I did not give it to her directlyYes the follcare can be performed by the referring doctor provided she is a "preferred provider" which she is notShe is a total liar when I left her office on January 12, I asked if I owed anything. Her office staff stated no, we will bill your insuranceIt was NOT verbally stated that my medical insurance would be billed! Had I been told before hand I would have refused the appointment and went to PCLI for my follvisits as they are preferred providers. I totally thought my vision insurance was covering these aftercare appointments as I did request a "preferred provider" for my medical coverageAs for payment, I did give MsE*** my credit card information but her office has not charged my credit card yetI am confused as to what this meansIs she saying she is no longer charging me the $800.01? Also, the contact lenses that MsE*** speaks of as complementary were returned to her office in January as I did not use themSincerely,*** ***

[redacted]Consumer Complaint No:[redacted]
Dear Mrs. [redacted],
I had the privilege to see Ms. [redacted] for an annual comprehensive examination onNovember 9, 2015. During her examination, cataracts were noted in both eyes and herbest correctable vision with glasses or contact lenses was no longer...

achievable to 20/20in either eye. Due to the decrease in vision from the cataracts, I recommended thatMs. [redacted] consider cataract extraction and referred her to Pacific Cataract and LaserInstitute (PCLI). Cataract surgery and all follow-up visits associated with the surgeryare medical procedures and medical insurance is billed appropriately. Additionally,follow-up care can be performed by the surgery provider or by the referring doctor, andit is common with uncomplicated cataract surgery for the referring doctor to provide thefollow-up care. The surgery was performed at PCLI on January 5, 2016 for the left eyeand January 6, 2016 for the right eye. The surgery center provides their patients withinformation regarding the medical procedure and medical follow-up care by the Primarycare Optometrist.
We had the privilege of seeing Ms. [redacted] for her follow-up care for the cataractsurgery on January 12, 2016. The follow-up care for most patients who have anuncomplicated recovery is three visits, but if their recovery is protracted there may beseveral visits required during the 90 day global follow-up period. The reimbursementfor all care related to the surgery during that 90 day period is the same regardless ofthe number of visits required. On January 12, 2016 the billing for the medical follow-upcare was done and verbally stated to the patient at the time of check out. The CPTprocedure code for Cataract surgery as preformed by PCLI was 66984. In Ms. [redacted]'sclaim to insurance the CPT code used was 66984-55. The "-55" is a modifier code whichindicates that only post-operative services of the global surgical package were renderedby said provider. Billed charges towards medical insurance were $400 right eye and$400 left eye which would include all the visits necessary during the 90 day recoveryperiod. Ms. [redacted]'s medical insurance claim was appropriately billed and since the entireclaim was applied towards her deductible, a balance of $800 was owed by patient. Astatement of the balance owed was sent out on April 27, 2016.
In regards to the resolution sought by the patient for a refund amount of $800,there has been no payment made by the insurance company to Eberle Eyecare and nopayment made by the patient to Eberle Eyecare, so there isn't anything to refund.Attached is the HIPPA and Insurance responsibility form in which Ms. [redacted] signed whenshe first became our patient 6/4/2014. In addition, as Ms. [redacted] was a contact lenswearer prior to her surgery, Eberle Eyecare provided her with contact lenses Novemberand December as a complementary service to support her before her surgery.Please let me know if there is anything further you may need from us. Thank you.
Sincerely,Dr. Andrea E[redacted]

The State of Alaska Department of LawCivil Division1031 West 4th Avenue, Suite 200Anchorage, Alaska 99501
June 14, 2016
[redacted]DOB: 08/25/1954Consumer Complaint No:2016-05-6524
Dear Mr. [redacted] and Mrs. [redacted],
In November 2015, Ms. [redacted] considered cataract extraction and I referred her toPacific Cataract and Laser Institute (PCLI). The surgery was performed at PCLI onJanuary 5, 2016 for the left eye and January 6, 2016 for the right eye. The surgerycenter provides their patients with information regarding the medical procedure andmedical follow-up care by the Primary care Optometrist.
We had the privilege of seeing Ms. [redacted] for her follow-up care for the cataractsurgery on January 12, 2016. The follow-up care for most patients who have anuncomplicated recovery is three visits, but if their recovery is protracted there may beseveral visits required during the 90 day global follow-up period. The reimbursementfor all care related to the surgery during that 90 day period is the same regardless ofthe number of visits required. On January 12, 2016 the billing for the medical follow-upcare was done and verbally stated to the patient at the time of check out.
Ms. [redacted] first became our patient June 4, 2014. At this time Ms. [redacted] provided uswith a copy of her Photo ID and Medical insurance card. Ms. [redacted] has vision benefitsthrough a company called Vision Service Plan which does not issue a card. At this timeMs. [redacted] also signed our HIPPA and Insurance Responsibility agreement.
As stated on the Vision Service Plans benefits within patients contracts andonline, they contribute towards a VSP WeiiVision Exam including refractive exam,dilation and prescription for glasses or contact lenses. It continues to state that "youreye doctor may ask for you medical ID card. The care provided by your eye doctor mayinvolve diagnosing medical eye conditions such as: Diabetic retinopathy, Cataracts,macular degeneration and glaucoma. In such cases, your eye doctor may be required tobill your medical insurance". Vision service plan does not contribute towards surgicalcare or post surgical care no matter location or service. On January 12, 2016 the billingfor the post surgical medical follow-up was performed after insurance verification wasmade with an estimate of patient copayments as an out of network provider. Theinsurance quotation stated the patient had not yet met their deductible and as thepatent had just completed surgery, it was inquired to if the surgical claim had comethrough at this time. This information was unable to be provided to us so we did notcollect anything for a co-payment at the time of this visit due to the initial claim ofsurgery not being processed at this time and all was quoted to go towards insurance.
Ms. [redacted]'s medical insurance claim was appropriately billed and since the entireclaim was applied towards her deductible, a balance of $800 was owed by patient. Astatement of the balance owed was sent out on April 27, 2016.
Duplicate certified letters were sent to both The State of Alaska department ofLaw and to Ms. [redacted] in response to the initial letter May 19, 2016. Ms. [redacted] sent theoffice a copy of her initial and only statement from the office regarding balance afterinsurance back with her full credit card information including eve number on June 2,2016. Ms. [redacted] was contacted on June 3rd to provide verbal authorization of amount tobe run on card and she acknowledged the full balance owed but stated intentions todispute the charges. Due to this response and not having written authority from Ms.[redacted], we have not charged the Credit card number provided for any fees.
In addition to the letter we received from your offices, Ms. [redacted] also filed anaddition complaint with the Revdex.com. In the body of her complaint, sheacknowledges being told by our office staff we were going to bill her insurance at thetime of the first cataract surgery post-op examination. On the day of appointment, itwas verbally stated how medical insurance was being billed for follow-up appointments.Inquiry was made as to whether she had met her medical deductible for the year, andshe implied as the surgery just happened it had all gone towards medical insurance. Assuch and with additional information already gathered by medical insurance, fees werenot collected from patient at the time of visit since full insurance payment wasexpected. Unfortunately, insurance payments and estimations before services are notalways accurate and follow-up care was all applied towards deductible. Ultimately,unpaid claims for services rendered become the patient's financial responsibility.
In regards to the payment, due to not having written authorization to run thecard for any dollar amount in which is owed by the patient, nothing has been done atthis time. The total balance of $800 is still outstanding as we have not received anypayments from insurance or patient.
Please let me know if there is anything further you may need from us. Thank you.
Sincerely,Dr. Andrea E[redacted]
 
[redacted]Please see attached documents[redacted]

Complaint: [redacted]I am rejecting this response because:Sincerely,[redacted]