[redacted] ***'s complaint against my office is misplacedHis complaint should be lodged against his insurance company, [redacted] [redacted] representatives told my insurance staff members that they would cover the cost of one pair of eyeglasses after cataract surgeryHowever, their final "coverage" amounted to about one-third of the cost of the glasses [redacted] had chosen [redacted] , (who had mistakenly not been charged a customary deposit on the glasses so he had paid nothing), was asked to pay his responsible balance according to [redacted] He refusedHe was told by me that he had to pay what had been determined by [redacted] to be his patient responsibility, or I would give him the option of returning the glasses to my officeHe chose to return the glassesI am sorry for the mis-communication, but my office is not responsible for paying [redacted] ***'s insurance balances, deductibles or co-paymentsWe were only conveying the information we were told by [redacted] It is the ultimate responsibility of every person to understand their own insurance coveragesWe are not in the business of giving away free eyewearWe are responsible for having fine eyewear made accurately for a reduced price [redacted] is clearly in the wrong in that they did not clearly define the limits of their coverageIt took almost six months for them to come to a final determination on their coverageThey had denied the claim at first and my staff had to be refile itThis case took a lot of my staffs time as [redacted] was not easy to work withFor example, they required detailed proof of the cataract surgeryMy staff should not have been told that there would be full coverageThey only conveyed to [redacted] the coverage that [redacted] told themI understand [redacted] being upset upon learning of his balanceHowever, he handled it poorlyHe called my office on August and was very rude and bullying according to my office insurance administratorHe told her that, "I am not going to pay this balanceI was told my glasses would be freeThis is between your office and the insurance companyI'm not involved and I do not have to call my insurance company." I understand he also unfortunately threatened us with legal actionMy office has provided very professional, high quality eye care to the [redacted] , area for the past yearsWe have a large and loyal patient baseWe strive to provide excellent customer service, including the very difficult job of explaining benefits to people who often know little about their insurance and what it coversThese days our job is made even more difficult by the many different plans of many different companies, all having different coverages, co-payments, etcWe are dependent upon the insurance company to give us accurate and timely informationOccasionally they do notMy staff did make the mistake to not charging [redacted] a deposit on the glasses and this may have contributed to his assumption that they would be free [redacted] took a long six months to process the claim, was difficult for us to work with, and apparently gave us incorrect or misleading informationSo I understand the sticker shock, but my business loss is our costs of having the glasses made, the cost of the frame and lenses, not to mention my optician and staff expensesSo I am not happy with [redacted] either [redacted] should contact [redacted] for a detailed explanation of his coverages so that he understands them, take his eyeglass prescription to another [redacted] provider, choose eyewear to fit his budget, expect to put down a deposit, and I think he will be fine.Thank, [redacted] ***
Complaint: ***
I am rejecting this response because: I had a verbal agreement with *** ***. I went to to *** *** because my insurance company told me that they would pay the full cost of the glasses if I went to an in-network provider. *** *** was in-network. After checking with, ***, *** *** told me that my insurance company was paying for the glasses. I asked to be sure, "So there won't be a charge to me?" "That is correctYou won't be charged", was the response from *** ***. This company does not honor their promise. *** *** has been in business for years and still doesn't know how to deal with insurance companies or hasn't trained his staff to deal with insurance companies. *** *** may want to stop taking *** insurance. I want my original statement posted on the *** *** ***, so that other customers won't experience the same problem I had with *** ***, where they will be told one thing one day--then, seven months later, get a big bill in the mail and an angry phone call from *** *** demanding payment for an incorrect bill to be paid the next day
Regards,
*** ***
[redacted]'s complaint against my office is misplaced. His complaint should be lodged against his insurance company, [redacted] representatives told my insurance staff members that they would cover the cost of one pair of eyeglasses after cataract surgery. However, their final "coverage"...
amounted to about one-third of the cost of the glasses [redacted] had chosen. [redacted] , (who had mistakenly not been charged a customary deposit on the glasses so he had paid nothing), was asked to pay his responsible balance according to [redacted]. He refused. He was told by me that he had to pay what had been determined by [redacted] to be his patient responsibility, or I would give him the option of returning the glasses to my office. He chose to return the glasses. I am sorry for the mis-communication, but my office is not responsible for paying [redacted]'s insurance balances, deductibles or co-payments. We were only conveying the information we were told by [redacted]. It is the ultimate responsibility of every person to understand their own insurance coverages. We are not in the business of giving away free eyewear. We are responsible for having fine eyewear made accurately for a reduced price. [redacted] is clearly in the wrong in that they did not clearly define the limits of their coverage. It took almost six months for them to come to a final determination on their coverage. They had denied the claim at first and my staff had to be refile it. This case took a lot of my staffs time as [redacted] was not easy to work with. For example, they required detailed proof of the cataract surgery. My staff should not have been told that there would be full coverage. They only conveyed to [redacted] the coverage that [redacted] told them. I understand [redacted] being upset upon learning of his balance. However, he handled it poorly. He called my office on August 11 and was very rude and bullying according to my office insurance administrator. He told her that, "I am not going to pay this balance. I was told my glasses would be free. This is between your office and the insurance company. I'm not involved and I do not have to call my insurance company." I understand he also unfortunately threatened us with legal action. My office has provided very professional, high quality eye care to the [redacted], area for the past 35 years. We have a large and loyal patient base. We strive to provide excellent customer service, including the very difficult job of explaining benefits to people who often know little about their insurance and what it covers. These days our job is made even more difficult by the many different plans of many different companies, all having different coverages, co-payments, etc. We are dependent upon the insurance company to give us accurate and timely information. Occasionally they do not. My staff did make the mistake to not charging [redacted] a normal deposit on the glasses and this may have contributed to his assumption that they would be free. [redacted] took a long six months to process the claim, was difficult for us to work with, and apparently gave us incorrect or misleading information. So I understand the sticker shock, but my business loss is our costs of having the glasses made, the cost of the frame and lenses, not to mention my optician and staff expenses. So I am not happy with [redacted] either. [redacted] should contact [redacted] for a detailed explanation of his coverages so that he understands them, take his eyeglass prescription to another [redacted] provider, choose eyewear to fit his budget, expect to put down a deposit, and I think he will be fine.Thank,[redacted]
[redacted] ***'s complaint against my office is misplacedHis complaint should be lodged against his insurance company, [redacted] [redacted] representatives told my insurance staff members that they would cover the cost of one pair of eyeglasses after cataract surgeryHowever, their final "coverage" amounted to about one-third of the cost of the glasses [redacted] had chosen [redacted] , (who had mistakenly not been charged a customary deposit on the glasses so he had paid nothing), was asked to pay his responsible balance according to [redacted] He refusedHe was told by me that he had to pay what had been determined by [redacted] to be his patient responsibility, or I would give him the option of returning the glasses to my officeHe chose to return the glassesI am sorry for the mis-communication, but my office is not responsible for paying [redacted] ***'s insurance balances, deductibles or co-paymentsWe were only conveying the information we were told by [redacted] It is the ultimate responsibility of every person to understand their own insurance coveragesWe are not in the business of giving away free eyewearWe are responsible for having fine eyewear made accurately for a reduced price [redacted] is clearly in the wrong in that they did not clearly define the limits of their coverageIt took almost six months for them to come to a final determination on their coverageThey had denied the claim at first and my staff had to be refile itThis case took a lot of my staffs time as [redacted] was not easy to work withFor example, they required detailed proof of the cataract surgeryMy staff should not have been told that there would be full coverageThey only conveyed to [redacted] the coverage that [redacted] told themI understand [redacted] being upset upon learning of his balanceHowever, he handled it poorlyHe called my office on August and was very rude and bullying according to my office insurance administratorHe told her that, "I am not going to pay this balanceI was told my glasses would be freeThis is between your office and the insurance companyI'm not involved and I do not have to call my insurance company." I understand he also unfortunately threatened us with legal actionMy office has provided very professional, high quality eye care to the [redacted] , area for the past yearsWe have a large and loyal patient baseWe strive to provide excellent customer service, including the very difficult job of explaining benefits to people who often know little about their insurance and what it coversThese days our job is made even more difficult by the many different plans of many different companies, all having different coverages, co-payments, etcWe are dependent upon the insurance company to give us accurate and timely informationOccasionally they do notMy staff did make the mistake to not charging [redacted] a deposit on the glasses and this may have contributed to his assumption that they would be free [redacted] took a long six months to process the claim, was difficult for us to work with, and apparently gave us incorrect or misleading informationSo I understand the sticker shock, but my business loss is our costs of having the glasses made, the cost of the frame and lenses, not to mention my optician and staff expensesSo I am not happy with [redacted] either [redacted] should contact [redacted] for a detailed explanation of his coverages so that he understands them, take his eyeglass prescription to another [redacted] provider, choose eyewear to fit his budget, expect to put down a deposit, and I think he will be fine.Thank, [redacted] ***
Complaint: ***
I am rejecting this response because: I had a verbal agreement with *** ***. I went to to *** *** because my insurance company told me that they would pay the full cost of the glasses if I went to an in-network provider. *** *** was in-network. After checking with, ***, *** *** told me that my insurance company was paying for the glasses. I asked to be sure, "So there won't be a charge to me?" "That is correctYou won't be charged", was the response from *** ***. This company does not honor their promise. *** *** has been in business for years and still doesn't know how to deal with insurance companies or hasn't trained his staff to deal with insurance companies. *** *** may want to stop taking *** insurance. I want my original statement posted on the *** *** ***, so that other customers won't experience the same problem I had with *** ***, where they will be told one thing one day--then, seven months later, get a big bill in the mail and an angry phone call from *** *** demanding payment for an incorrect bill to be paid the next day
Regards,
*** ***
[redacted]'s complaint against my office is misplaced. His complaint should be lodged against his insurance company, [redacted] representatives told my insurance staff members that they would cover the cost of one pair of eyeglasses after cataract surgery. However, their final "coverage"...
amounted to about one-third of the cost of the glasses [redacted] had chosen. [redacted] , (who had mistakenly not been charged a customary deposit on the glasses so he had paid nothing), was asked to pay his responsible balance according to [redacted]. He refused. He was told by me that he had to pay what had been determined by [redacted] to be his patient responsibility, or I would give him the option of returning the glasses to my office. He chose to return the glasses. I am sorry for the mis-communication, but my office is not responsible for paying [redacted]'s insurance balances, deductibles or co-payments. We were only conveying the information we were told by [redacted]. It is the ultimate responsibility of every person to understand their own insurance coverages. We are not in the business of giving away free eyewear. We are responsible for having fine eyewear made accurately for a reduced price. [redacted] is clearly in the wrong in that they did not clearly define the limits of their coverage. It took almost six months for them to come to a final determination on their coverage. They had denied the claim at first and my staff had to be refile it. This case took a lot of my staffs time as [redacted] was not easy to work with. For example, they required detailed proof of the cataract surgery. My staff should not have been told that there would be full coverage. They only conveyed to [redacted] the coverage that [redacted] told them. I understand [redacted] being upset upon learning of his balance. However, he handled it poorly. He called my office on August 11 and was very rude and bullying according to my office insurance administrator. He told her that, "I am not going to pay this balance. I was told my glasses would be free. This is between your office and the insurance company. I'm not involved and I do not have to call my insurance company." I understand he also unfortunately threatened us with legal action. My office has provided very professional, high quality eye care to the [redacted], area for the past 35 years. We have a large and loyal patient base. We strive to provide excellent customer service, including the very difficult job of explaining benefits to people who often know little about their insurance and what it covers. These days our job is made even more difficult by the many different plans of many different companies, all having different coverages, co-payments, etc. We are dependent upon the insurance company to give us accurate and timely information. Occasionally they do not. My staff did make the mistake to not charging [redacted] a normal deposit on the glasses and this may have contributed to his assumption that they would be free. [redacted] took a long six months to process the claim, was difficult for us to work with, and apparently gave us incorrect or misleading information. So I understand the sticker shock, but my business loss is our costs of having the glasses made, the cost of the frame and lenses, not to mention my optician and staff expenses. So I am not happy with [redacted] either. [redacted] should contact [redacted] for a detailed explanation of his coverages so that he understands them, take his eyeglass prescription to another [redacted] provider, choose eyewear to fit his budget, expect to put down a deposit, and I think he will be fine.Thank,[redacted]