Emergency Services

Dear [redacted] :Emergency Services PC (ESPC) received the complaint which was issued under ID [redacted] .After reviewing the complaint we feel it is necessary to spell out the chronology of actions associated with the account: Services were rendered to the member on 02/23/ The member was sent notification that their insurance was billed, the insurance did not participate with ESPC (this information is also relayed to the members in the benefits summary which is sent from their insurance), they would potentially receive a payment from their insurance, and that they were responsible fir the full balance of the charges aWhen an insurance does not participate with a provider group they do not communicate with the group and all correspondence, including payments/denials, are sent to the members The member is responsible for the full charge regardless of the payment processing of the insurance This was summarized in the first notice sent on 03/04/ 3.The member was sent payment, from their insurance, on 04/06/in the amount of $which also listed the member's responsibility of $ The explanation of benefits (EOB) clearly identifies Emergency Services PC as the provider of service along with the name of the physicianThis was the second notification the member received, albeit, from the insurance and not ESPCThis payment was not sent/forwarded to ESPC an at this time of this letter has not been receivedThe insurance does not communicate directly with the providers when they are non-participatingThis alone is why we engage the members in the billing process at such an early stageThe billing and follprocess tends to be lengthy with the insurance company with their lack of cooperationWe were eventually able to establish that the member did receive payment for these services and the follow up process went back to the member The member was sent a follnotification on 08/25/A final notification was sent to the member on 09/09/of pre-collection statusThe member's mother called and spoke with a r to her that the specifics of the account could nor member; however they were given the option (which is what ESPCs policy allows)There was no further communication from the from the member regarding the payment sent to them, from their insurance, nor any attempt at agreement of the proposed payment planOn October 11, without any further communication the account qualified, through the system, for collectionsThe account remains with the collection agency Sincerely,Steven P

Dear [redacted]:Emergency Services PC (ESPC) received the complaint which was issued under ID [redacted].After reviewing the complaint we feel it is necessary to spell out the chronology of actions associated with the account:  1.  Services were rendered to the member on...

02/23/2016.  2. The member was sent notification that their insurance was billed, the insurance did not participate with ESPC (this information is also relayed to the members in the benefits summary which is sent from their insurance), they would potentially receive a payment from their insurance, and that they were responsible fir the full balance of the charges.      a. When an insurance does not participate with a provider group they do not communicate with the group and all correspondence, including payments/denials, are sent to the members.  The member is responsible for the full charge regardless of the payment processing of the insurance.  This was summarized in the first notice sent on 03/04/2016.  3.The member was sent payment, from their insurance, on 04/06/2016 in the amount of $187.00 which also listed the member's responsibility of $191.00.  The explanation of benefits (EOB) clearly identifies Emergency Services PC as the provider of service along with the name of the physician. This was the second notification the member received, albeit, from the insurance and not ESPC. This payment was not sent/forwarded to ESPC an at this time of this letter has not been received.4. The insurance does not communicate directly with the providers when they are non-participating. This alone is why we engage the members in the billing process at such an early stage. The billing and follow-up process tends to be lengthy with the insurance company with their lack of cooperation. We were eventually able to establish that the member did receive payment for these services and the follow up process went back to the member.  5. The member was sent a follow-up notification on 08/25/2016.6. A final notification was sent to the member on 09/09/2016 of pre-collection status.7. The member's mother called and spoke with a r to her that the specifics of the account could nor member; however they were given the option (which is what ESPCs policy allows).8. There was no further communication from the from the member regarding the payment sent to them, from their insurance, nor any attempt at agreement  of the proposed payment plan. 9. On October 11, 2016 without any further communication the account qualified, through the system, for collections. The account remains with the collection agency.  Sincerely,Steven P

Review: I received services on 10/26/2012. I did not receive a bill or statement in a timely manner due to what was stated as a computer issue. I received a statement on 05/15/2013 stating that my account was 90+ days overdue. I received my first bill issued 5/20/2013. In the process of cashing the insurance check as required, I had to wait or 10 days due to the stale date of the check. During this time, I received a letter stating that I would be sent to a collections agency if the bill was not paid in 7 days. This letter was issued on 06/05/2013. In response to my phone call questioning the billing practices, I was told that while I had to wait 6 months to receive a bill and that it took 30 days to process the collections claim, there was nothing they could do about the system and that I had to pay the full amount in 7 days.Desired Settlement: I do not feel that I or anyone else or the associated credit line should be held responsible for the companies computer issues. I was told that a collections letter is sent out 15 days after any bill is sent. I not only find this hard to believe, but am insulted that I could not be given more time when the resulting issue was the companies fault.