Fulmer Brothers, Inc.

[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 as Answered]
 Complaint: [redacted]
I am rejecting this response because:  The Insurance Company has stated to them that they cannot bill me directly.  They have to work directly with United as they are an in network provider and have a contract with them.  They have the necessary documents to submit to the Insurance company to make this happen.  They are in charge of resubmissions and to have the claim processed. 
Regards,
[redacted]

To Whom It May Concern,The patient referenced in the complaint ID #[redacted] scheduled an appointment with our Fair Oaks Imaging Center facility on 11/13/2015 and was seen that day. At the time of this patient's appointment the disclosure paperwork was signed that reviews payment information and the...

patient had no questions or problems at the time of service. After the patient's procedure was complete our imaging facility's operations manager, Crystal, received a phone call from the patient and Melissa, a representative from the patient's insurance carrier, [redacted]. While on this conference call Melissa with [redacted] explained to the patient the differences in facility charges and why there was a charge at our facility for the visit that day, and stated that the co-pay should have been $30 instead of $35. After the patient disconnected from the conversation, Melissa ([redacted]) explained to Crystal that the information the patient received from [redacted] when they called before their appointment was incorrect and she apologized, The patient then spoke with our billing department and CEO about the incorrect amount that was charged. After the billing department researched the situation, they determined there was an error made and promptly refunded $5 to the patient. We are unsure why the patient feels that there should be no deductible, since [redacted] has confirmed that it is $30. Patients, Insurance Carriers, and the providers are contractually bound to the terms of the insurance policy. And in this case, per the carrier, a copay was indeed due. The patient will receive an EOB (Explanation of Benefits) statement from [redacted] that will show this to be the case. This statement is the official document that explains:The procedure that was doneThe amount that was billed to the CarrierThe contractually allowed amount as stated in the contract between the provider and [redacted] The amount that [redacted] will pay the provider The amount owed by the patient to the provider (Any copays or deductibles)Medical Billing is very complex, and errors unfortunately do occur on all sides. Reston Radiology Consultants (Fair Oaks Imaging Center) is committed to the correct billing of our patients, and promptly returns any and all funds that are incorrectly collected. In this particular case, the $5 discrepancy was due to a clerical error by a staff member that is no longer employed at our company. We however did collect the remaining $30 correctly, and according to the patient's insurance policy with [redacted] which will reflect on their EOB.Sincerely, Dennis P[redacted]

After the patient was seen on 11/02/2015 and 11/03/2015 our billing department did not receive any phone calls about the patient’s balance that was due.  In February of 2016, after the patients balance was sent to collections, the patients spouse called in and provided their Anthem insurance...

information to bill for the procedures performed on November 2nd and 3rd.  Anthem denied the claim because they are not the patient’s primary insurance plan.  When our billing department finally received the patient’s primary insurance information, [redacted]), we once again submitted the claim. [redacted] has denied the claim due to untimely filing.  We are currently appealing [redacted]care’s denial and re-processing the claims to try and receive payment. Medical Billing is very complex, and errors unfortunately do occur on all sides.  Reston Radiology Consultants is committed to the correct billing of our patient’s claims, and ensuring that our patient’s credit status isn’t negatively affected.  In this particular case, the patient did not provide the insurance carrier that was to be billed at the time of service.  The patient did not respond to the three bills that were sent on November 12th, 2015, December 14th, 2015 and January 14th, 2015.  Once the patient’s outstanding bill was sent to collections, updated carrier information was provided. Due to the delay in receiving correct insurance information, the claims were denied leaving the patient responsible for the outstanding balance.  Our decision to bill the patient directly was not because we were “unable to get what we wanted,” it was due to the fact that the patient did not provide correct information in a timely manner for us to file a timely claim on their behalf. The patient may still have the ability to personally file a claim to his insurance for the services rendered.