Re: complaint ID [redacted] Our office received a referral from Ms***’s primary care physician and the diagnosis was due to a medical condition, not for screening purposes When Ms [redacted] called our office to schedule her procedure she was given a diagnosis code and a procedure code We instruct patients to call their insurance company to check on their benefits We also mail the patient instructions and on that instruction packet it also gives the procedure code and the diagnosis code It also informs the patients the difference between a screening vs diagnostic procedure Since Ms [redacted] came in with a diagnostic issue, which is always subject to the patient’s deductible and/or coinsurance The date of her procedure was 6/11/ We billed to her insurance company on 7/2/ and her insurance paid their portion on 7/11/ Patient has a balance of $ We mailed her statements on 7/17/2014, 8/21/2014, 9/25/10/30/and 11/21/ Since we did not get payment, her account was placed in collections on 12/2/ Ms [redacted] called our office on 9/9/and we did explain this all to her We explained the difference between a screening and a diagnostic procedureWe also told her that we did code her procedure appropriately We follow the ICD-coding guidelines that are mandated Ms [redacted] at that time demanded that we change the coding We told her we couldn’t do that since that is insurance fraud We gave her the tools necessary to try to file an appeal with her insurance company and she had said that she didn’t care if her account went into collections and that she would not be filing an appeal with her insurance because she didn’t want to help us get the money owed to us Ms [redacted] primary care physician did not change her referral as to why the patient came to our office like Ms [redacted] said she did If you have any further questions, please feel free to contact me ###-###-#### Sincerely, [redacted] Billing Supervisor
Re: complaint ID [redacted] Our office received a referral from Ms***’s primary care physician and the diagnosis was due to a medical condition, not for screening purposes When Ms [redacted] called our office to schedule her procedure she was given a diagnosis code and a procedure code We instruct patients to call their insurance company to check on their benefits We also mail the patient instructions and on that instruction packet it also gives the procedure code and the diagnosis code It also informs the patients the difference between a screening vs diagnostic procedure Since Ms [redacted] came in with a diagnostic issue, which is always subject to the patient’s deductible and/or coinsurance The date of her procedure was 6/11/ We billed to her insurance company on 7/2/ and her insurance paid their portion on 7/11/ Patient has a balance of $ We mailed her statements on 7/17/2014, 8/21/2014, 9/25/10/30/and 11/21/ Since we did not get payment, her account was placed in collections on 12/2/ Ms [redacted] called our office on 9/9/and we did explain this all to her We explained the difference between a screening and a diagnostic procedureWe also told her that we did code her procedure appropriately We follow the ICD-coding guidelines that are mandated Ms [redacted] at that time demanded that we change the coding We told her we couldn’t do that since that is insurance fraud We gave her the tools necessary to try to file an appeal with her insurance company and she had said that she didn’t care if her account went into collections and that she would not be filing an appeal with her insurance because she didn’t want to help us get the money owed to us Ms [redacted] primary care physician did not change her referral as to why the patient came to our office like Ms [redacted] said she did If you have any further questions, please feel free to contact me ###-###-#### Sincerely, [redacted] Billing Supervisor