Family Allergy & Asthma Care of Montana

Agree with individual regarding the conversation about waiting for their insurance to process the claim for an office visit Insurance processed the claim a couple months later and sent an Explanation of Benefits (EOB) to both the individual and Family Allergy At that time, a statement was generated from our office through our EHR (electronic health record) to the individual As is our policy, statements are sent and if there is no payment, the accounts are sent to collections As there was no payment made, the account was turned over to collections Our collections company sends out a letter informing individuals that the account has been turned over, and as long as some payment arrangements are made through them, there is no note of collections on that person's account All of this could have been explained to this individual, and we would have sent her a copy of her statement so she had it for her files, but I wasn't given an opportunity to explain this process as I was cut off with yelling, demands, and accusations each time I tried to address her concerns Yelling, demands, and accusations are considered verbal harassment and bullying, and Family Allergy does not condone or accept this behavior from any individual

Complaint: ***I am rejecting this response because:
This account is inaccurate in regards to the office visit claim being submitted to insurance appropriately and after they spoke with me and confirmed they would re-submit the insurance since the first submission did not accurately reflect my insurance coverage I spoke with my insurance BCBS of Montana on 8/17/to review the claim that the Family Allergy and Asthma submitted on my behalf BCBS of Montana has on record and is in the process of sending me written verification of the following:
Family Allergy and Asthma clinic only submitted the claim one time in June of They never re-submitted the claim after I spoke with them explaining that the first submission was done inaccurately and my insurance will cover the cost of the visit
BCBS also verified that my insurance benefits during that time frame of June covered the entire cost of the office visit minus the $specialist co-pay
With this additional information verified, it was not a matter of myself as the client paying a late bill It comes down to the Office not submitting my insurance appropriately when they told me they would and state they will on all of their patient paperwork Never once did the office tell me I was the one responsible for submitting my insurance claim appropriately The reason this visit is unpaid is due to their internal insurance processing procedures not one of the client having an outstanding bill Unfortunately since they never contacted me after our conversation, I did not know or was not given the opportunity to help them navigate through my insurance To my knowledge it was all taken care of and they would bill me if I owed anything I never again received a bill, phone call or any form of contact Now, since it has been two years, it is too late for us to resubmit this claim to insurance I will happily pay and would have from the very beginning what I am responsible for, the $co-pay I have both a copy of the original EOB with the date of the June submission and the total amount the office is allowed to bill me, which is significantly less than what they sent me to collection for, by the way I plan to send both this and the written verification of the information above that BCBS is providing me to the office as soon as I receive it in addition to the collections company My goal still remains for them to bill me in whatever form they need to, through collections or a paper invoice as they had originally told me they would, for what I am responsible for a $co-pay only I do not feel it is my responsibility to pay for their internal mistakes in submitting my insurance for payment Had they told me they were having issues I would have gladly helped them at that time get paid.Sincerely,*** ***

Revdex.com:I have reviewed the response made by the business in reference to complaint ID ***, and find that this resolution is satisfactory to me.
Thank you for agreeing to send me a statement and retract the claim to collections However I would like to clarify a couple pieces and have the business bill me for what they feel I am responsible for I will then pay in full You should also be receiving a packet of information from me via USPS this week, that outlines why I am frustrated with being charged anything beyond my co-pay of $
1) You are correct our family did move to Big Sky, MT in the summer of However we forwarded all our mail to our new address and also still owned the property in Bozeman that was our previous mailing address So we would have received a statement either way if one had been sent to our Bozeman or Big Sky address
2) We both agree that a claim to insurance was submitted after the office visit in June Otherwise, neither of us would have a copy of an EOB However it was after the initial submission when I received the bill for the full amount of $that I called the insurance to question why this was not covered as a $co-pay as my benefits outlined At that time the insurance company pointed me towards the doctor's office to have them re-submit the insurance claim appropriately I then called the doctor's office and at that time, the individual I spoke with at the office agreed to re-submit and apologized as they had been having issues with other patients That individual also stated I would be billed if I still owed money after they re-submitted If I had been told at that time, that it was my responsibility to re-submit or talk further with the insurance agency then I happily would have Shoot, I had already gone out of my way to investigate it to this point. This scenario of my follphone call to request a resubmission was confirmed last week when I called to complain as to why I had been sent to collections for a debt that I was unaware of In fact the office manager stated I should have received a second EOB from when they re-submitted the claim and did not send further statements as that second EOB would have been verification of the amount due to their office The fact is I never received a second EOB after I spoke with them and this is the claim submission that I am referring to as being done inappropriately or incomplete, as BCBS of MT verified last week with a written letter that a second claim was never submitted and had it been submitted it would have been covered in full beyond my co-pay of $50.
Please take a moment to put yourself in the your client's shoes and understand how frustrating it was for me to understand that I was told something from your office that was never completed and then never contacted or given a chance to correct the situation in a timely manner I strongly feel I should only be billed what I am responsible for, a $co-payment I was never given the chance to help with the submission to insurance and make sure that the office was paid from both my insurance and myself I have always trusted the doctor's I have worked with to handle insurance as they have the expertise in this area, so had no reason to believe they never got paid without notification I respect the consideration.Sincerely, *** ***

I believe there needs to be some clarification of this issue at this point so there is no misunderstanding of the facts:
1) The claim was not submitted inappropriately to the insurance carrier When we contacted the carrier in early July, regarding the status of this June 5, claim, we were told the claim was being processed and would take some extra time as BCBS of MT was in the midst of converting all their systems because of being purchased by a larger BCBS organization
2) We received a paper EOB of this claim from BCBS of MT, of which I am attaching a copy to this complaint for verification and proof of said processed claim I have taken the first name of the patient off the claim to protect their privacy As you can tell by the processed BCBS claim, the amount due and owing for the patient is $
3) Because you also have the original EOB from BCBS of MT, it will contain the same information as the one attached to this response
4) Because of the uncertainty from the complainant surrounding the issue of sending statements back and forth between our office and the patient, we are willing to withdraw the collection services as long as the bill for services rendered is paid in full As a side note, the address given this week by the complainant and the address we were given are completely different and located in separate towns This may be the reason the statements were not received

Agree with individual regarding the conversation about waiting for their insurance to process the claim for an office visit.  Insurance processed the claim a couple months later and sent an Explanation of Benefits (EOB) to both the individual and Family Allergy.  At that time, a statement...

was generated from our office through our EHR (electronic health record) to the individual.  As is our policy, 3 statements are sent and if there is no payment, the accounts are sent to collections.  As there was no payment made, the account was turned over to collections.  Our collections company sends out a letter informing individuals that the account has been turned over, and as long as some payment arrangements are made through them, there is no note of collections on that person's account.
All of this could have been explained to this individual, and we would have sent her a copy of her statement so she had it for her files, but I wasn't given an opportunity to explain this process as I was cut off with yelling, demands, and accusations each time I tried to address her concerns.  Yelling, demands, and accusations are considered verbal harassment and bullying, and Family Allergy does not condone or accept this behavior from any individual.