Revdex.com Case ID [redacted] The patient, [redacted] came in for cataract surgery on October 10, 2016. It is the practice of the Center to collect up front when a patient has been scheduled to have a "specialty lens" and not the standard lens. The type of lens to be implanted is...
determined by the patient's surgeon and sent to us prior to the surgery so we can "special order" this specialty lens. Some insurance companies/plans will allow for the specialty lens and some of them do not, therefore the practice is to collect the difference in the specialty lens and the standard lens at the time of the surgical procedure and if the insurance company/plan does allow and pay for the lens, the difference is refunded to the patient. A standard lens costs us $150 and the Torie lens that the patient had implanted cost us $495 for a difference of $345. In this particular case, the specialty lens cost us $495 ($345 of which was collected from the patient on the DOS). Our contract with [redacted] is to bill [redacted] the cost of any implant (in this case the intraocular lens) plus 2%. This resulted in billing [redacted] $504.90. [redacted] allowed $504.90 and paid us 80% or $403.92 and shows the patient is responsible for 20% or $100.98 per the patient's plan. The patient paid $345 for the lens on the DOS and owes $100.98 per the [redacted] EOB so the balance due to the patient as a refund is $244.02. Mr. [redacted]'s claim that the lens was "upcharged" is not true. We billed [redacted] for the cost of the lens plus 2%. When we tried to refund the credit card on 11/29/16 as requested by the patient's wife, we were unable to do a refund for that amount. I spoke with Mr. [redacted] on 11/30 and explained why the refund was for $244.02 and not $345, explained that we were unable to refund the credit card and told him we had sent a requisition to the home office to cut a check for $244.02, which would be received back in our office on Monday 12/5 or Tuesday 12/6 and told him he could stop by and pick it up or I would mail it. He asked that Imail this check to him and he also expressed understanding as to why the refund was for $244.02. As far as we are concerned, this issue has been resolved and no further action should be necessary. I have enclosed a copy of the implant log showing the type of lens implanted for this patient, a copy of the claim form we sent to [redacted], a copy of the EOB from [redacted] and a copy of the refund check and refund letter sent to the patient. If you need any additional information or have any questions,please let me know. Thank you, Nancy P[redacted] Business Office Manager Indiana Specialty Surgery Center Enclosures
Revdex.com Case ID [redacted] The patient, [redacted] came in for cataract surgery on October 10, 2016. It is the practice of the Center to collect up front when a patient has been scheduled to have a "specialty lens" and not the standard lens. The type of lens to be implanted is...
determined by the patient's surgeon and sent to us prior to the surgery so we can "special order" this specialty lens. Some insurance companies/plans will allow for the specialty lens and some of them do not, therefore the practice is to collect the difference in the specialty lens and the standard lens at the time of the surgical procedure and if the insurance company/plan does allow and pay for the lens, the difference is refunded to the patient. A standard lens costs us $150 and the Torie lens that the patient had implanted cost us $495 for a difference of $345. In this particular case, the specialty lens cost us $495 ($345 of which was collected from the patient on the DOS). Our contract with [redacted] is to bill [redacted] the cost of any implant (in this case the intraocular lens) plus 2%. This resulted in billing [redacted] $504.90. [redacted] allowed $504.90 and paid us 80% or $403.92 and shows the patient is responsible for 20% or $100.98 per the patient's plan. The patient paid $345 for the lens on the DOS and owes $100.98 per the [redacted] EOB so the balance due to the patient as a refund is $244.02. Mr. [redacted]'s claim that the lens was "upcharged" is not true. We billed [redacted] for the cost of the lens plus 2%. When we tried to refund the credit card on 11/29/16 as requested by the patient's wife, we were unable to do a refund for that amount. I spoke with Mr. [redacted] on 11/30 and explained why the refund was for $244.02 and not $345, explained that we were unable to refund the credit card and told him we had sent a requisition to the home office to cut a check for $244.02, which would be received back in our office on Monday 12/5 or Tuesday 12/6 and told him he could stop by and pick it up or I would mail it. He asked that Imail this check to him and he also expressed understanding as to why the refund was for $244.02. As far as we are concerned, this issue has been resolved and no further action should be necessary. I have enclosed a copy of the implant log showing the type of lens implanted for this patient, a copy of the claim form we sent to [redacted], a copy of the EOB from [redacted] and a copy of the refund check and refund letter sent to the patient. If you need any additional information or have any questions,please let me know. Thank you, Nancy P[redacted] Business Office Manager Indiana Specialty Surgery Center Enclosures