Initial Business Response /* (1000, 8, 2017/02/08) */
Revdex.com of Northern Indiana [redacted]
Fort Wayne, IN XXXXX
XXX-XXX-XXXX
Re: Case XXXXXXXXX:
To whom it Concerns;
We received a letter from your office regarding a patient who listed that he was unhappy with several things...
related to his case. in the letter, it outlines what his complaints are I would like to take the opportunity to document our response to this letter for this case. As it states in the letter, we are not forwarding anything that will personally identify the patient. All documents will be redacted for his protection.
I have for better understanding of the situation; listed details of this case chronologically.
Date of Accident: 10/23/2012
Date patient first wee seen in your office: 11/20/2012
Date the attorney lien-was sent and to who: 01/28/2013 to Patients personal attorney's office
Date the patient self-released: 04/12/2013
After several attempts (via phone) to reschedule the patient, a letter of dismissal was mailed to patient on 5/16/2013. Dates that the attorney and insurance were contacted (via mail or phone): See Attachment
Date that the Med Pay payment was received and the dates that it paid on: See Attachment
What amount was left outstanding: [redacted]
We contacted the insurance company to see why the full amount was not paid. We are currently in talks with the tried pay and were Informed of the claims being reprocessed far payment and as of 2.2.17 (2) checks were mailed to pay for a portion of the balance on the account.
I have made contact with the insurance company on 1,19.17, and after a few calls to find the right adjuster; I fcund out that there was (Vied Pay available to pay for the patient's outstanding balance. In conversation with them I found out that they would pay the remaining amount, after they received patient notes for those services. We have since my conversation with them, sent the records on 1.30.17, I spoke with [redacted] on 2.3.17 who informed me that 4 of the 7 dates of service were paid on 2.2.17. She also mentioned that the other 3 dates were still in processing. I contacted them one more time to determine why we were not contacted prior to this date regarding the request for additional information. No one was able to explain to me why the claims were not paid prior to my calls. The only explanation I received was that the adjuster had changed a few times since the opening of claim We are currently in expectation of the claims to be paid off by the med pay very soon. We have received notification that a partial payment has already been made and on its way to the attorneys office.
The date of the settlement for the auto case was July 2016, the case settled and since then there has been a check for the account balance in the attorney's office. The patient did not want to sign off on the check because he was disputing the balance. I explained to him that he owed the balance on his account since his insurance hadn't paid that balance off prior to my last conversation with them. The settlement check in the attorney's office was explained to the patient as
part of his settlement to cover for his remaining medical bills. The attorneys office ([redacted]) said that they were waiting for the patient to sign off on the check (as part of the settlement) in order to send it to our office to pay off the account.
Since my conversation with the patient on 1.19.17 I have investigated and verified the account balance and the med pay availability as well as getting the claims reprocessed for payment for the outstanding balance. I contacted the attorney's office today to inform them of the payments that are on the way, they said they will get the checks signed by the patient and forwarded to the office and then release the original (settlement) check to the patient as soon as all the payments are received.
in the client's explanation, he states that he is expecting a [redacted] balance when this is all said and done. Our purpose is to be compliant and come to the same resolution. I have also included the Office Policy and Financial statement for our office with the patient's signature which ultimately shows that he knew he was responsible for all charges if his insurance company didn't pay. He also indicates that it was listed as "overdue", we do not charge any late or past due fees, since we didn't bill the patient due to waiting on the settlement with the attorney (attorney lien). It is not our policy to send statements to the patients that have an outstanding account when we know the case is in litigation and we are expecting payment upon settlement of the case. That is why we have the attorney lien signed by the attorney to protect the patients account in our office.
The letter states that he asked (verbally) before he self-released, if there was a balance and he was told no. I can not elaborate on this since I was not in the office when it happened. The factsare that the patient had an outstanding balance on his account that the med pay should have paid for him and when the attorney's office called to get the balance on the account (5.18.16) we informed them of the balance due to the med pay only partial paying for his services. Now that the med pay has reprocessed claims and payments are on the way for those services outstanding the patient should have a * balance. We will be able to verify that upon receipt of the checks from the med pay.
Also, in his explanation, he expresses several attempts to contact the office, or speak to the provider. We have on every occasion offered to discuss the case with him and explain the situation, The patient would get upset about the fact that he still had a balance. I gave him the opportunity to provide authorization to discuss these issues with his wife, which is what he would ask for, I explained the procedure for that with a Hipaa authorization form, in which there was no follow up from him. We have done everything in our power to resolve this for him. I hope this helps in resolving this case and I hope we provided in detail enough information for you to review this case and respond favorably towards our office
Sincerely,
[redacted]
Initial Business Response /* (1000, 8, 2017/02/08) */
Revdex.com of Northern Indiana [redacted]
Fort Wayne, IN XXXXX
XXX-XXX-XXXX
Re: Case XXXXXXXXX:
To whom it Concerns;
We received a letter from your office regarding a patient who listed that he was unhappy with several things...
related to his case. in the letter, it outlines what his complaints are I would like to take the opportunity to document our response to this letter for this case. As it states in the letter, we are not forwarding anything that will personally identify the patient. All documents will be redacted for his protection.
I have for better understanding of the situation; listed details of this case chronologically.
Date of Accident: 10/23/2012
Date patient first wee seen in your office: 11/20/2012
Date the attorney lien-was sent and to who: 01/28/2013 to Patients personal attorney's office
Date the patient self-released: 04/12/2013
After several attempts (via phone) to reschedule the patient, a letter of dismissal was mailed to patient on 5/16/2013. Dates that the attorney and insurance were contacted (via mail or phone): See Attachment
Date that the Med Pay payment was received and the dates that it paid on: See Attachment
What amount was left outstanding: [redacted]
We contacted the insurance company to see why the full amount was not paid. We are currently in talks with the tried pay and were Informed of the claims being reprocessed far payment and as of 2.2.17 (2) checks were mailed to pay for a portion of the balance on the account.
I have made contact with the insurance company on 1,19.17, and after a few calls to find the right adjuster; I fcund out that there was (Vied Pay available to pay for the patient's outstanding balance. In conversation with them I found out that they would pay the remaining amount, after they received patient notes for those services. We have since my conversation with them, sent the records on 1.30.17, I spoke with [redacted] on 2.3.17 who informed me that 4 of the 7 dates of service were paid on 2.2.17. She also mentioned that the other 3 dates were still in processing. I contacted them one more time to determine why we were not contacted prior to this date regarding the request for additional information. No one was able to explain to me why the claims were not paid prior to my calls. The only explanation I received was that the adjuster had changed a few times since the opening of claim We are currently in expectation of the claims to be paid off by the med pay very soon. We have received notification that a partial payment has already been made and on its way to the attorneys office.
The date of the settlement for the auto case was July 2016, the case settled and since then there has been a check for the account balance in the attorney's office. The patient did not want to sign off on the check because he was disputing the balance. I explained to him that he owed the balance on his account since his insurance hadn't paid that balance off prior to my last conversation with them. The settlement check in the attorney's office was explained to the patient as
part of his settlement to cover for his remaining medical bills. The attorneys office ([redacted]) said that they were waiting for the patient to sign off on the check (as part of the settlement) in order to send it to our office to pay off the account.
Since my conversation with the patient on 1.19.17 I have investigated and verified the account balance and the med pay availability as well as getting the claims reprocessed for payment for the outstanding balance. I contacted the attorney's office today to inform them of the payments that are on the way, they said they will get the checks signed by the patient and forwarded to the office and then release the original (settlement) check to the patient as soon as all the payments are received.
in the client's explanation, he states that he is expecting a [redacted] balance when this is all said and done. Our purpose is to be compliant and come to the same resolution. I have also included the Office Policy and Financial statement for our office with the patient's signature which ultimately shows that he knew he was responsible for all charges if his insurance company didn't pay. He also indicates that it was listed as "overdue", we do not charge any late or past due fees, since we didn't bill the patient due to waiting on the settlement with the attorney (attorney lien). It is not our policy to send statements to the patients that have an outstanding account when we know the case is in litigation and we are expecting payment upon settlement of the case. That is why we have the attorney lien signed by the attorney to protect the patients account in our office.
The letter states that he asked (verbally) before he self-released, if there was a balance and he was told no. I can not elaborate on this since I was not in the office when it happened. The factsare that the patient had an outstanding balance on his account that the med pay should have paid for him and when the attorney's office called to get the balance on the account (5.18.16) we informed them of the balance due to the med pay only partial paying for his services. Now that the med pay has reprocessed claims and payments are on the way for those services outstanding the patient should have a * balance. We will be able to verify that upon receipt of the checks from the med pay.
Also, in his explanation, he expresses several attempts to contact the office, or speak to the provider. We have on every occasion offered to discuss the case with him and explain the situation, The patient would get upset about the fact that he still had a balance. I gave him the opportunity to provide authorization to discuss these issues with his wife, which is what he would ask for, I explained the procedure for that with a Hipaa authorization form, in which there was no follow up from him. We have done everything in our power to resolve this for him. I hope this helps in resolving this case and I hope we provided in detail enough information for you to review this case and respond favorably towards our office
Sincerely,
[redacted]