HI Dayton Inc

Hi Michelle,Bridget has forwarded this complaint to me for reviewMr***’s insurance is a *** *** planThe referral his PCP sent over to us indicated he had *** *** insurance but did not specific that it was the *** productBarnet Dulaney Perkins is contracted with *** *** but not the *** productIt is the patient’s responsibility to know which providers are in network with their health plan but we could have also done a better job of advising him of that when he presented to our office with his insurance card copyWe have reviewed and determined that we will adjust the charges for his visitWe understand the complexity of understanding insurance benefits and prefer to proactively assist our patients through the process. Please let me know if you need anything additional. ThanksAmy G***

My apologies you have had to experience the situation you explained Please contact me at *** so that I may assist you in resolving the issue. Thank you, Bridget T***

This just a clarification from my previous claim or note that I wrote trying to explainMy
self I apologized for ant confusionAny professional business managed by a train staff will know how to go by administrating the right procedures, if not then you are run a business just to make money an a dirty way.the bottom line when my doctor send the referral you at the eye center should have check my coverage with my insurance then I should have been told and give me a choice to continuously with my appointment or visit *** *** *** that used my insurance.You fail to do that so you did not lose a customer but the if I would have know I would have gone to one that it did that's why I have insurance.I contact my insurance and I was informed by them too that you have check too with them if I had coverage under my policy.If the eye center operates like this again you are not been honest to those that have insurance for that purpose so we don't have to paid all that money in the first place we are already paying a lot for medicine.I appreciated if this matter can be resolved in a professional way.I also asking to take the claim off my credit report . Thank you

I will look into this matter as soon as possible to resolve. Thank you, Bridget T*** ###-###-####

We apologize for any confusion and or miscommunication.  We will get this resolved as soon as possible to satisfy the patients request.  Thank you, Bridget T[redacted]

This particular patient is insured by [redacted] UHC Military. [redacted] UHC Military benefits require the patient’s Primary Care Physician to send a referral directly to [redacted] for both routine vision and for medical services for services to be considered in network. We have called [redacted] and confirmed again that there is no referral on file from the patient’s Primary Care Physician for this visit so [redacted] is processing as point of service (out of network benefits) is correct. [redacted] has applied $115.44 towards the patient’s annual deductible and is indicating the patient is responsible for paying that amount. If the patient disagrees with how [redacted] processed their claim or the amount indicated they owe, they should reach out to [redacted] to discuss further.  [redacted] has explained to us that they send their subscribers annual education material on their benefits including specifics regarding the need for a referral from their Primary Care Physician that must be received by [redacted] to have services processed as in network.

I sent the dissatisfaction statement to the Director of Revenue Cycle Management and they are going to contact the patient to get a better understanding of what happened with the patient's account. Thank you

When the business responded to the complaint their statement basically stated that they would investigate and resolve...

this matter as soon as possible. When I received the email to respond to this, the prepared format basically states to accept if I'm in agreement with the response from the business. I accepted and my response also included my statement that I would await the result of further action by the business to resolve this issue. I accepted understanding that I was basically acknowledging their response to receiving the complaint. Based on the context of my messages and that of the business there is no indication that anything was resolved. If it was my mistake for "accepting" their response I accept that responsibility, but to me this issue remains open and pending because of no other action taken by the business to remedy the situation other than acknowledging the inital complaint.I still seek the refund of the $103.00 payment I made.  Please let me know if this will suffice or if I need to take further action.Thank you.
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