Eyetech Optometry

Review: The [redacted] office billed me for the wrong date of service, used my medical insurance rather than my eye insurance upon telling me my eye insurance has a co-pay, which it does not (confirmed with eye insurance) and I refused to pay the co-pay due to having a company health fund. I was told that my medical insurance would be cheaper than my eye insurance and therefore they were going to submit to my medical insurance to see what happens. When I received my claim from my medical insurance the office billed for the incorrect date of service. They have not responded to three voicemail messages or my medical insurance to resubmit the claim for the proper date of service as well as change the billing code to a "routine eye exam" vice an "office visit" that equates to a medical visit - which my eye insurance would reject. My eye insurance only pays 100% for routine visits. Prior to seeing the doctor, the office manager, [redacted] told me I had a $42 co-pay for each of us. I refused to pay as I had the health fund that should have been used. At that time I was told she would run it through [redacted]. Additionally, my husband was seen on the same day and time as I was and with the same probing questions (am I having any trouble with my eyes that the doctor needed to answer questions about? We had filled out paperwork stating we have some issues but we chalked them up as normal as they come and go and are not consistent with every day or every week problems those with allergies experience) from the doctor coded him as routine and my claim as medical, double charging me for services. Finally my medical insurance was able to get a hold of this office after nearly 3 months of calling. They were told by [redacted] that I had filled out paperwork indicating I had problems. I was simply check marking answers as I would at any doctor's office for a routine exam. I did not go to this office with chief compliants, I was simple a new patience having a routine eye exam. I feel I was set up with their questions and they are using this as a way to get more money out of me. If I had a medical condition why wasn't I given a prescription for relief? Why doesn't this office send an itemized bill? I've requested three times through voicemail to send me an itemized bill and I have not heard back from them in over 2 1/2 months.Desired Settlement: I would be willing to allow Dr. [redacted]'s office to reverse my medical insurance claim and file with my eye insurance once my medical insurance rejects the claim and have Dr. [redacted]'s office file correctly with my eye insurance w/NO COPAYMENT. Plus send in the corrected billing code of routine eye exam for both myself and husband, refund my health fund of $100 to my medical insurance and call it a day. No presciption would be required nor desired. No apology, just a simple reversal of routine eye exam billing code and a corrected date of service for myself.

Business

Response:

[redacted]:I am writing in response to [redacted]'s complaint regarding her visit on 8/26/2013, ID #[redacted].We did bill [redacted]’s visit to her [redacted] medical plan because she did come in with medical complaints. Attached is a copy of her medical history form that she filled out in advance stating that she was experiencing problems with dryness and tearing. During her work up before she saw the doctor she stated that her eye actually “drips This is considered a medical visit, this was confirmed by an [redacted] representative as well. This same representative also contacted the patient to let her know that the claim was billed correctly.As [redacted] stated she knew the claim was being submitted to [redacted]. She was fully aware that her visit was being submitted to her medical plan . [redacted] coordinates the claim and payment with her health fund.Several weeks ago, in an effort to appease [redacted], we sent in a new claim to [redacted] to reverse her office visit charge and rebilled her visit to her vision insurance. [redacted] closed this case some time ago and the patient is not being billed anything for her visit.

Consumer

Response:

[To assist us in bringing this matter to a close, you must give us a reason why you are rejecting the response. If no reason is received your complaint will be closed Administratively Resolved] Review: [redacted]I am rejecting this response because:

[redacted] is not telling the whole story. Yes, she did say she was going to submit my claims through my medical insurance because she said it was denied or not authorized through my eye insurance and mentioned "…it would be cheaper and let’s see what happens" to go through my medical insurance. Seeing how she works with insurance daily, I believed her. Boy, how I was wrong! [redacted] never mentioned my time with her establishment was going to be any different than my husband's appointment (which was at the same time). She never mentioned my claim was going to be billed medically, which my eye insurance won't pay for. My eye insurance will only pay 100% of a routine eye exam which is what I went in there for.

Yes, I filled out a medical history form, but there wasn’t anything that stated “What brought you in today?” type question. A history tends to be things that occur but not every day. Therefore, this form is questionable as to what brought me into that that doctor’s office that day. It was a routine eye exam when I made the initial appointment, it was a routine eye exam when I walked in there and somehow by answering a form truthfully on things that may occur at different times of the year (such as seasons) I am now being conveyed as having a medical problem when I walked out of there, which has never been formally diagnosed nor a prescription has been written for.

When I inquired with my eye insurance if [redacted] had ever submitted a claim through them and it was rejected they said that was not true. My eye insurance never had a record of [redacted]'s office submitting a claim for authorization for myself or my husband before December 2013. Therefore, [redacted] took it upon herself to be dishonest with me and told me it would be cheaper to send through my medical insurance. When the claim went through for the wrong date, it took [redacted] to over 3 months to make a correction giving my medical insurance authorization to reject her original submittal to the tune of $195.24 (for which my medical insurance finally paid on Dec. 18, 2013). Let’s not forget the numerous attempts by myself and my medical insurance to get [redacted] to return phone calls with the multiple numbers we were given to call her with to make things right. If I was the office manager for any company I would have been fired. As I understand it, she’s the sister of the doctor who has his name on this business.

[redacted] finally submitted through my eye insurance after my medical insurance rejected her original submittal. But she had my eye insurance place a hold on my account so that no one else could submit a claim for my time on August 26, 2013. This was according to my eye insurance. When [redacted] submitted my claim as an office visit rather than a routine eye exam, my vision insurance rejected the claim and unbeknownst to me at the time, [redacted] resubmitted my claim (not my husband's) to my medical plan that finally paid it out on December 18, 2013. So based on [redacted]'s written letter that was faxed on January 9, 2014, she claimed and I quote, "Several weeks ago, in an effort to appease [redacted], we sent in a new claim to [redacted] to reverse her office visit charge and rebilled her visit to her vision insurance. [redacted] closed this case some time ago and the patient is not being billed anything for her visit." Oddly enough, Eyetech Optometry doesn't follow up on their records. I mentioned on December 18, 2013, [redacted]'s office was paid $195.24. Who is she trying to appease here? Certainly not me as she claims.

As for the matter of my medical history form [redacted] attached with her correspondence I have to wonder, were any HIPPA laws broken? Did I give my authorization for her to provide this information to a third party that was not my insurance company. a lawyer, or another medical provider? No, I don't think I did. The authorization was signed for release but made no mention to a third party that wasn’t prescribed in the previous sentences.

Drips? Yes, I said that to the doctor and to [redacted] but let’s finish my sentence. I said, “My right eye continues to drip when I am in the car and the air conditioner is blowing on me.” Seeing as [redacted] is not a doctor it’s not in her job description to diagnose me. A licensed medical professional would be the one to do that. When quoting me, I’d appreciate the whole story and not a pick-and-choose remark to embellish her standpoint.

My medical insurance representative stated to me that the reasoning for the change from a routine eye exam to an office visit was not for the reason of the medical form (which I dispute the generalization of it) which [redacted] claims was the reason but because I had spent more time with the doctor than my husband. A timestamp no one can provide actually happened. This was said early on in my dispute in October by my medical provider as to what an office assistant in Dr. [redacted]’s office told him. So now I have two stories, the one my medical provider issued from Dr. [redacted]’s office and the one [redacted] told my medical insurance after repeated phone calls that went unreturned until Dr. [redacted]’s office received a fraud letter by my insurance for the incorrect date that was originally submitted.

Finally, I am submitting a few Yelp comments, take them as you will but about the same time I had my appointment two other patients commented on the same fraudulent behavior this doctor’s office bestowed upon my family regarding medical insurance verses vision insurance, and added extras they recommend you buy at exorbitant prices:

[redacted]Dr. [redacted]’s office seems to have many problems, the same problems I’ve already listed above about charging my medical insurance instead of my vision plan. It seems to me that Dr. [redacted]’s office is more concerned with getting more money out of patients then actually helping them.

Regards,[redacted]