First State Womens Care

Revdex.com: I have reviewed the response made by the business in reference to complaint ID [redacted] , and have determined that this does not resolve my complaint For your reference, details of the offer I reviewed appear below This is in reply to Women's First LLC response Form signed we would pay if Medicare did not Medicare, if they don't pay willstate who is responsibleThey stated we were not responsible & if we already paid then they would reimburse us & collect fromWomen's First LLCThey stated that no bill should be sent Dr [redacted] did tell my wife that the exam was covered under Medicare.The second mammogram was taken within a few days from the first, not six months as you have stated I have contactedMedicare & their Contract Department will send a notice to First State Women's Care informing them of a possible contract violation by sending us a bill after they stated in writing not to send us a bill Requesting a response from Women's FirstCare after they answer the notice from Medicare [redacted] ***

We received your follletter regarding Mr***'s complaint.1) Mr [redacted] states that he received a statement from Medicare statingthat they are not responsible for the billIf he reads that statement carefully, Medicare states that the patient is not responsible if they were not notified that the service may not be coveredWe provided Mrs [redacted] and Advanced Beneficiary Notice (ABN) form, which states that Medicare may not cover this serviceMrs [redacted] signed the form at the time of her visit -this constitutes notification.2) Mr [redacted] stated that DrOstrum told his wife the visit would be covered by MedicareOur physicians never make this statement as they have no idea what services are covered by which insurance carrier.3) Mr [redacted] references a mammogramA mammogram has nothing to do with Mrs***'s pap smear.We continue to feel that we provided this service in good faith and have followed Medicare's policy and procedures with regard to this serviceIf I can provide any further clarification, please call me at [redacted] .Thank you,

Dear Ms, ***,We received your complaint from Mr*** regarding his wife's services at our practiceWe have spoken with Mr*** on several occasions trying to explain why his wife is receiving a billI will try to address his concerns below:1} Mr*** states that he is not responsible because
no form was signed stating that Medicare would not payWe have the attached form signed by Mrs*** at the time of her visit acknowledging that Medicare may not pay for her annual examWe previously mailed a copy of this form to Mr***.2) Mr*** states that Dr*** told his wife that the visit would be coveredDue to the complexity of insurance policies,our physicians never tell a patient what is or is not covered by insuranceThat is the purpose of the ABN form that Mrs*** signed - to acknowledge that the service may or may not be covered.3) Mr*** states that Mrs*** required a second mammogram prior to her visitWithout divulging medical information, Mrs***'s previous mammogram results recommend that she have mammograms every six monthsThe frequency of her mammograms has nothing to do with her annual routine examinations.Unfortunately Mrs*** does not have any high risk condition that would allow Medicare to pay every yearWe cannot recode per Mr***'s suggestion as this would be fraud on our partOur billing service and our billing staff have sent documentation and have tried to explain the reason for the billto Mr*** without success We feel that we have provided the service in good faith and have followed Medicare's policy and procedures with regard to this service.If we can provide any further clarification, please feel free to call me at ***

Dear Ms, ***,We received your complaint from Mr*** regarding his wife's services at our practiceWe have spoken with Mr*** on several occasions trying to explain why his wife is receiving a billI will try to address his concerns below:1} Mr
*** states that he is not responsible because no form was signed stating that Medicare would not payWe have the attached form signed by Mrs*** at the time of her visit acknowledging that Medicare may not pay for her annual examWe previously mailed a copy of this form to Mr***.2) Mr*** states that Dr*** told his wife that the visit would be coveredDue to the complexity of insurance policies,our physicians never tell a patient what is or is not covered by insuranceThat is the purpose of the ABN form that Mrs*** signed - to acknowledge that the service may or may not be covered.3) Mr*** states that Mrs*** required a second mammogram prior to her visitWithout divulging medical information, Mrs***'s previous mammogram results recommend that she have mammograms every six monthsThe frequency of her mammograms has nothing to do with her annual routine examinations.Unfortunately Mrs*** does not have any high risk condition that would allow Medicare to pay every yearWe cannot recode per Mr***'s suggestion as this would be fraud on our partOur billing service and our billing staff have sent documentation and have tried to explain the reason for the billto Mr*** without success We feel that we have provided the service in good faith and have followed Medicare's policy and procedures with regard to this service.If we can provide any further clarification, please feel free to call me at ***

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID [redacted], and have determined that this does not resolve my complaint.  For your reference, details of the offer I reviewed appear below.

This is in reply to Women's First LLC response.  Form signed we would pay if Medicare did not.  Medicare, if they don't pay willstate who is responsible. They stated we were not responsible & if we already paid then they would reimburse us & collect fromWomen's First LLC. They stated that no bill should be sent.  Dr. [redacted] did tell my wife that the exam was covered under Medicare.The second mammogram was taken within a few days from the first, not six months as you have stated..  I have contactedMedicare & their Contract Department will send a notice to First State Women's Care informing them of a possible contract violation by sending us a bill after they stated in writing not to send us a bill.  Requesting a response from Women's FirstCare after they answer the notice from Medicare.  [redacted]

We received your follow-up letter regarding Mr. [redacted]'s complaint.1) Mr. [redacted] states that he received a statement from Medicare statingthat they are not responsible for the bill. If he reads that statement carefully, Medicare states that the patient is not responsible if they were not notified that the service may not be covered. We provided Mrs. [redacted] and Advanced Beneficiary Notice (ABN) form, which states that Medicare may not cover this service. Mrs. [redacted] signed the form at the time of her visit -this constitutes notification.2) Mr. [redacted] stated that Dr. Ostrum told his wife the visit would be covered by Medicare. Our physicians never make this statement as they have no idea what services are covered by which insurance carrier.3) Mr. [redacted] references a mammogram. A mammogram has nothing to do with Mrs. [redacted]'s pap smear.We continue to feel that we provided this service in good faith and have followed Medicare's policy and procedures with regard to this service. If I can provide any further clarification, please call me at [redacted].Thank you,

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID [redacted], and have determined that this does not resolve my complaint.  For your reference, details of the offer I reviewed appear below.

This is in reply to Women's First LLC response.  Form signed we would pay if Medicare did not.  Medicare, if they don't pay will
state who is responsible. They stated we were not responsible & if we already paid then they would reimburse us & collect from
Women's First LLC. They stated that no bill should be sent.  Dr. [redacted] did tell my wife that the exam was covered under Medicare.
The second mammogram was taken within a few days from the first, not six months as you have stated..  I have contacted
Medicare & their Contract Department will send a notice to First State Women's Care informing them of a possible contract violation by sending us a bill after they stated in writing not to send us a bill.  Requesting a response from Women's First
Care after they answer the notice from Medicare.  [redacted]