Gentle Health and Wellness Center

I am writing in response to the above-referenced matter. *** *** has been a patient of mine without incident prior the issue she outlines in her complaint.She included communication held via text messaging between her and myself and I was, as I am with all my patients, honest and up front
about not only my office procedures, but administrative and billing matters as well. *** *** informed upon arrival that she had a different insurance policy that the one she had used previously, I use the services of ***, a standard medical industry resource for online inquiries regarding a patient's benefits and eligibility. *** does limit what a provider can view in terms of how much the patient has utilized their health insurance benefits, and insurance representatives are unable to disclose any information not pertaining to a patient's visits at other facilities. According to the resources available to me, it showed at the time of her visits that she had a deductible that had not yet been satisfied. It is common practice to collect payment at time of service, irregardless it that payment is a copay, deductible, or co-insurance. It is also common practice for different insurance plans to have different filing guidelines that can range any where from ten business days to one year post-visit. In my office, before I bring a patient into my treatment room, I personally go over their insurance benefits so that they are aware of what is covered in a visit, and what is their financial responsibility. I actually have had patients unaware of what their health insurance benefits covered, and some were uncomfortable incurring services to be applied towards their deductible. Two patients in all my years of practice decided to cancel their appointment after learning about their health insurance coverage. In my office, at my door I have a sign clearly displayed that states "copays, deductibles and co-insurances are due at time of service" Collection at the time of visit is a standard medical office administrative procedure, while the amount varies depending on if that provided is in-network or not with the insurance plan, how much their deductible is and other factors.After *** ***'s appointment, she texted me about billing, which was included in the letter I received from the Revdex.com. On May 2, 2017, she inquired if I had submitted billing to her insurance company and I responded that I had not as of that date. I was, in fact, somewhat delayed by filing taxes and meeting with my tax accountant. Her insurance company requires copies to either be mailed or submitted electronically and providers are contractually granted up to one year to file claims to be processed. Typically, as I informed *** ***, I generally process al my billing at the close of each month. These few months I did not an when asked shy, I was forthcoming in my responses with *** ***.In the nine years that I have worked in the field, I have always mailed claims to this particular insurance company. It is not uncommon for claims to be delayed, lost, or re-routed to a different processing facility no matter in what manner they are received. Almost every claim requires folland resubmission with the insurance company and many medical offices have one or more dedicated full-time employees to manage claims. Billing claims are rarely satisfied promptly by insurance companies.I printed *** ***'s claims and mailed them on the afternoon of Friday, May 5, 2017, I was aware that she was concerned about having her claims processed as quickly as possible. I contacted my provided coordinator at her insurance company on Monday, May 19, to see if they had received my claims and was informed that they had not. My provided coordinator suggested that I re-submit the claims, which I did on that very same day. There is no way of knowing what happened to the first set of claims that I submitted to *** ***'s insurance company.*** ***'s next text message was delivered to me on May 30, at 9:am. It was a holiday weekend. I ws scheduled to be in my office on Friday, June 2, and when I arrived at my office, I had a letter from the Revdex.com and by then, I recognized that *** *** had escalated the issue to a mediator as well as writing several nasty reviews about her recent experience with the delayed claims processing. I am including a screen shot of one site, because she posted the same wording on all sites.As I stated previously, I am hones a forthright about my communications with my patients, both on administrative and billing issues, as well as treatment. In the intake paperwork that I provide to all my patients, *** *** signed a form of financial responsibility in which it states that costs are estimates and not a guarantee of reimbursement by their insurance company. I have used this policy for nine years without incident.As soon as her insurance company processes the claims the received, I will apply their charges to her account. If she is due a refund, I will provide that in accordance as her health insurance plan directs me to do.Respectfully,DrAndrea ***, DC, MSA