Thank you for giving us the opportunity to respond to the recent complaint from Ms [redacted] As we stated in our initial letter, we understand how complicated insurance billing can be and this is the area in which most misunderstandings arise I would like to address each of Ms [redacted] ’s complaints point by point, in order to illustrate that this was a misunderstanding and not a conscious attempt to bamboozle her “At time of first visit I showed my supplemental insurance card, MODA, and was told that they accept it.” a Inner Gate Acupuncture does accept MODA insurance “My employer advised me that MODA could be billed directly and I would be responsible for 20%I paid $at each of my visits, to approximate my copay, which was their suggestions.” a We did indeed suggest that she pay a $copay at the time of the visit, as it is an approximationb Every plan pays slightly differently so we do not know how MODA will reimbursement until we receive the EOB (Estimate Of Benefits) that accompanies payment “In terms of cost—I asked specifically about first visit costs and subsequent visitsI was told or 120—don’t remember which—for first visit and follow ups would be less.” a This is where all of the misunderstanding stems from The above quote is our Time Of Service discount b We do our best to stress to every patient that this discount is offered to patients who do not have acupuncture coverage as part of their insurance and will be paying all costs This may not have been clearly explained to Ms [redacted] “The chargers to me were MUCH higher than quoted above, an there were additional unexpected charges as cited above.” a We are required, by law, to submit bills to the insurance companies that list codes for all the different procedures we perform during a patient visitb Because benefits vary from company to company, we have every patient sign a “Patient’s Financial Responsibility” formThe first point on this form specifically says that patients are responsible for any “deductibles, co-pay, co-insurance and non-covered services” I am including a copy of this form which Ms [redacted] signed From our point of view, it seems that this entire problem has resulted from a misunderstanding around a very complicated and convoluted process Ms [redacted] says as much in her letter when she writes, “No one mentioned additional costs like heat lamp or massage and I did not inquire since at all studios these services were included in their base price.” We are sorry that this has occurred and that Ms [redacted] is so upset, but I would wager that other studios “base price” was a Time Of Service discounts and not the cost associated with billing insurance I believe there is another issue at hand that is just as important and has not yet been addressed, and that is the perceived value of careMs [redacted] is very attached to the initial quote of $for an acupuncture treatment She must have felt that that was a reasonable amount for treatment otherwise she would not have come to our clinic When everything is all said and done, including paying for “additional unexpected charges”, Ms [redacted] paid $out of pocket for care That is $more than what she was initially quoted and that is for acupuncture treatments, not Furthermore, she still owes our clinic $for her 01/06/date of service She did pay the $co-pay at the time of service, but because her plan year renewed on 01/01/a $deductible, per her MODA insurance, had to be met before MODA would pay her billsWe mailed her a bill on 02/15/17, one day after she filed a complaint to the Revdex.comShe mailed back the bill with the response “no way” and included no money The above incident is important because it points out that Ms [redacted] has not fulfilled her financial responsibility to us, even though she signed a form promising to settle her accountWe WILL NOT send her another billWe WILL NOT send her to collectionsWe understand that confusion has led to her having an unfulfilling experience, and for that we are sorryBut we do not feel that this warrants an attack on our business and our reputation I am including with this letter an itemized bill from our clinic, Ms [redacted] ’s 3/25/letter which I reference above, and the signed “Patient Financial Responsibility” form Thank you for continuing to help identify a solution to this problem and please do no hesitate to reach out if you have any further questions Erik I [redacted]
Complaint: ***
I am rejecting this response because:I just reviewed your letter of 3/with enclosed response from business email f 2/I'm sorry for delayed response to you but I have been out of the area.I disagree with the entire report of their billing practice which was not what I experiencedAt time of first visit I showed my I showed my supplemental insurance card, MODA, and was told they accepted itMy employer advised me that MODA could be billed directly and I would be responsible for 20%I payed $at each of my visits, to approximate my copay, which was their suggestion.In terms of cost - - I asked specifically about first visit cost ans subsequent visitsI was told or - I don't remember which - for the first visit and follow ups would be lessthis seemed reasonable and in line with other acupuncture centers I've visitedNo one mentioned additional costs like heat lamp or massage, and I did not inquire since at all other studios I've been to these services were included in the base price.The charges to me were MUCH higher than quoted above and there were additional unexpected charges as cited above.Please do not hesitate to call me with questions.
Sincerely,
*** ***
Thank you for giving us the opportunity to respond to the recent complaint from Ms. [redacted]. As we stated in our initial letter, we understand how complicated insurance billing can be and this is the area in which most misunderstandings arise. I would like to address each of Ms. [redacted]’s complaints point by point, in order to illustrate that this was a misunderstanding and not a conscious attempt to bamboozle her. 1. “At time of first visit I showed my supplemental insurance card, MODA, and was told that they accept it.” a. Inner Gate Acupuncture does accept MODA insurance 2. “My employer advised me that MODA could be billed directly and I would be responsible for 20%. I paid $20 at each of my visits, to approximate my copay, which was their suggestions.” a. We did indeed suggest that she pay a $20 copay at the time of the visit, as it is an approximation. b. Every plan pays slightly differently so we do not know how MODA will reimbursement until we receive the EOB (Estimate Of Benefits) that accompanies payment. 3. “In terms of cost—I asked specifically about first visit costs and subsequent visits. I was told 115 or 120—don’t remember which—for first visit and follow ups would be less.” a. This is where all of the misunderstanding stems from. The above quote is our Time Of Service discount. b. We do our best to stress to every patient that this discount is offered to patients who do not have acupuncture coverage as part of their insurance and will be paying all costs. This may not have been clearly explained to Ms. [redacted] 4. “The chargers to me were MUCH higher than quoted above, an there were additional unexpected charges as cited above.” a. We are required, by law, to submit bills to the insurance companies that list codes for all the different procedures we perform during a patient visit. b. Because benefits vary from company to company, we have every patient sign a “Patient’s Financial Responsibility” form. The first point on this form specifically says that patients are responsible for any “deductibles, co-pay, co-insurance and non-covered services”. I am including a copy of this form which Ms. [redacted] signed. From our point of view, it seems that this entire problem has resulted from a misunderstanding around a very complicated and convoluted process. Ms. [redacted] says as much in her letter when she writes, “No one mentioned additional costs like heat lamp or massage and I did not inquire since …at all studios…these services were included in their base price.” We are sorry that this has occurred and that Ms. [redacted] is so upset, but I would wager that other studios “base price” was a Time Of Service discounts and not the cost associated with billing insurance. I believe there is another issue at hand that is just as important and has not yet been addressed, and that is the perceived value of care. Ms. [redacted] is very attached to the initial quote of $120 for an acupuncture treatment. She must have felt that that was a reasonable amount for 1 treatment otherwise she would not have come to our clinic. When everything is all said and done, including paying for “additional unexpected charges”, Ms. [redacted] paid $122 out of pocket for care. That is $2 more than what she was initially quoted and that is for 3 acupuncture treatments, not 1. Furthermore, she still owes our clinic $62.81 for her 01/06/17 date of service. She did pay the $20 co-pay at the time of service, but because her plan year renewed on 01/01/17 a $50 deductible, per her MODA insurance, had to be met before MODA would pay her bills. We mailed her a bill on 02/15/17, one day after she filed a complaint to the Revdex.com. She mailed back the bill with the response “no way” and included no money. The above incident is important because it points out that Ms. [redacted] has not fulfilled her financial responsibility to us, even though she signed a form promising to settle her account. We WILL NOT send her another bill. We WILL NOT send her to collections. We understand that confusion has led to her having an unfulfilling experience, and for that we are sorry. But we do not feel that this warrants an attack on our business and our reputation. I am including with this letter an itemized bill from our clinic, Ms. [redacted]’s 3/25/17 letter which I reference above, and the signed “Patient Financial Responsibility” form. Thank you for continuing to help identify a solution to this problem and please do no hesitate to reach out if you have any further questions. Erik I[redacted]
To Whom It May Concern: Thank you for reaching out and giving us the opportunity to respond to this complaint. We recognize that navigating health insurance is very complicated for patients, so we do the best we can to inform them of their benefits and their financial responsibilities....
The last thing we want to have is an upset patient whose insurance did not fully reimburse our office for care. In order to avoid the above scenario, as a courtesy to our patients, we ALWAYScall and verif y their acupuncture benefits prior to their initial visit. We then explain to patients what we anticipate their financial responsibility will be, especially patients that have complicated co-insurances. The understanding is that when we received the insurance company's Explanation of Benefits or Payments (EOE/EDP) we'll have a picture of what their actual responsibilities are. We do our best to estimate a patient's exact responsibility. The following two (2] reasons make it difficult to know the exact amount. Firstly, insurance companies often take 30- 60 days to reimburse us, and it is only then that we learn exactly what they are paying and what the patient is responsible to pay. Secondly, health insurance companies have a disclaimer that says "a quote of a benefits is not a guarantee of payment". It is unfortunate, but our practice has been burned on more than one occasion in this way, and when it happens we reach out to the patient and try to resolve the outstanding balance. In the case of the patient, she had a 20% co-insurance. We collected $20.00 up front to cover some of her responsibilities. When we received the insurance EOB it was indicated that she owed more than 820.00, and we billed her for the difference.
Thank you for giving us the opportunity to respond to the recent complaint from Ms [redacted] As we stated in our initial letter, we understand how complicated insurance billing can be and this is the area in which most misunderstandings arise I would like to address each of Ms [redacted] ’s complaints point by point, in order to illustrate that this was a misunderstanding and not a conscious attempt to bamboozle her “At time of first visit I showed my supplemental insurance card, MODA, and was told that they accept it.” a Inner Gate Acupuncture does accept MODA insurance “My employer advised me that MODA could be billed directly and I would be responsible for 20%I paid $at each of my visits, to approximate my copay, which was their suggestions.” a We did indeed suggest that she pay a $copay at the time of the visit, as it is an approximationb Every plan pays slightly differently so we do not know how MODA will reimbursement until we receive the EOB (Estimate Of Benefits) that accompanies payment “In terms of cost—I asked specifically about first visit costs and subsequent visitsI was told or 120—don’t remember which—for first visit and follow ups would be less.” a This is where all of the misunderstanding stems from The above quote is our Time Of Service discount b We do our best to stress to every patient that this discount is offered to patients who do not have acupuncture coverage as part of their insurance and will be paying all costs This may not have been clearly explained to Ms [redacted] “The chargers to me were MUCH higher than quoted above, an there were additional unexpected charges as cited above.” a We are required, by law, to submit bills to the insurance companies that list codes for all the different procedures we perform during a patient visitb Because benefits vary from company to company, we have every patient sign a “Patient’s Financial Responsibility” formThe first point on this form specifically says that patients are responsible for any “deductibles, co-pay, co-insurance and non-covered services” I am including a copy of this form which Ms [redacted] signed From our point of view, it seems that this entire problem has resulted from a misunderstanding around a very complicated and convoluted process Ms [redacted] says as much in her letter when she writes, “No one mentioned additional costs like heat lamp or massage and I did not inquire since at all studios these services were included in their base price.” We are sorry that this has occurred and that Ms [redacted] is so upset, but I would wager that other studios “base price” was a Time Of Service discounts and not the cost associated with billing insurance I believe there is another issue at hand that is just as important and has not yet been addressed, and that is the perceived value of careMs [redacted] is very attached to the initial quote of $for an acupuncture treatment She must have felt that that was a reasonable amount for treatment otherwise she would not have come to our clinic When everything is all said and done, including paying for “additional unexpected charges”, Ms [redacted] paid $out of pocket for care That is $more than what she was initially quoted and that is for acupuncture treatments, not Furthermore, she still owes our clinic $for her 01/06/date of service She did pay the $co-pay at the time of service, but because her plan year renewed on 01/01/a $deductible, per her MODA insurance, had to be met before MODA would pay her billsWe mailed her a bill on 02/15/17, one day after she filed a complaint to the Revdex.comShe mailed back the bill with the response “no way” and included no money The above incident is important because it points out that Ms [redacted] has not fulfilled her financial responsibility to us, even though she signed a form promising to settle her accountWe WILL NOT send her another billWe WILL NOT send her to collectionsWe understand that confusion has led to her having an unfulfilling experience, and for that we are sorryBut we do not feel that this warrants an attack on our business and our reputation I am including with this letter an itemized bill from our clinic, Ms [redacted] ’s 3/25/letter which I reference above, and the signed “Patient Financial Responsibility” form Thank you for continuing to help identify a solution to this problem and please do no hesitate to reach out if you have any further questions Erik I [redacted]
Complaint: ***
I am rejecting this response because:I just reviewed your letter of 3/with enclosed response from business email f 2/I'm sorry for delayed response to you but I have been out of the area.I disagree with the entire report of their billing practice which was not what I experiencedAt time of first visit I showed my I showed my supplemental insurance card, MODA, and was told they accepted itMy employer advised me that MODA could be billed directly and I would be responsible for 20%I payed $at each of my visits, to approximate my copay, which was their suggestion.In terms of cost - - I asked specifically about first visit cost ans subsequent visitsI was told or - I don't remember which - for the first visit and follow ups would be lessthis seemed reasonable and in line with other acupuncture centers I've visitedNo one mentioned additional costs like heat lamp or massage, and I did not inquire since at all other studios I've been to these services were included in the base price.The charges to me were MUCH higher than quoted above and there were additional unexpected charges as cited above.Please do not hesitate to call me with questions.
Sincerely,
*** ***
Thank you for giving us the opportunity to respond to the recent complaint from Ms. [redacted]. As we stated in our initial letter, we understand how complicated insurance billing can be and this is the area in which most misunderstandings arise. I would like to address each of Ms. [redacted]’s complaints point by point, in order to illustrate that this was a misunderstanding and not a conscious attempt to bamboozle her. 1. “At time of first visit I showed my supplemental insurance card, MODA, and was told that they accept it.” a. Inner Gate Acupuncture does accept MODA insurance 2. “My employer advised me that MODA could be billed directly and I would be responsible for 20%. I paid $20 at each of my visits, to approximate my copay, which was their suggestions.” a. We did indeed suggest that she pay a $20 copay at the time of the visit, as it is an approximation. b. Every plan pays slightly differently so we do not know how MODA will reimbursement until we receive the EOB (Estimate Of Benefits) that accompanies payment. 3. “In terms of cost—I asked specifically about first visit costs and subsequent visits. I was told 115 or 120—don’t remember which—for first visit and follow ups would be less.” a. This is where all of the misunderstanding stems from. The above quote is our Time Of Service discount. b. We do our best to stress to every patient that this discount is offered to patients who do not have acupuncture coverage as part of their insurance and will be paying all costs. This may not have been clearly explained to Ms. [redacted] 4. “The chargers to me were MUCH higher than quoted above, an there were additional unexpected charges as cited above.” a. We are required, by law, to submit bills to the insurance companies that list codes for all the different procedures we perform during a patient visit. b. Because benefits vary from company to company, we have every patient sign a “Patient’s Financial Responsibility” form. The first point on this form specifically says that patients are responsible for any “deductibles, co-pay, co-insurance and non-covered services”. I am including a copy of this form which Ms. [redacted] signed. From our point of view, it seems that this entire problem has resulted from a misunderstanding around a very complicated and convoluted process. Ms. [redacted] says as much in her letter when she writes, “No one mentioned additional costs like heat lamp or massage and I did not inquire since …at all studios…these services were included in their base price.” We are sorry that this has occurred and that Ms. [redacted] is so upset, but I would wager that other studios “base price” was a Time Of Service discounts and not the cost associated with billing insurance. I believe there is another issue at hand that is just as important and has not yet been addressed, and that is the perceived value of care. Ms. [redacted] is very attached to the initial quote of $120 for an acupuncture treatment. She must have felt that that was a reasonable amount for 1 treatment otherwise she would not have come to our clinic. When everything is all said and done, including paying for “additional unexpected charges”, Ms. [redacted] paid $122 out of pocket for care. That is $2 more than what she was initially quoted and that is for 3 acupuncture treatments, not 1. Furthermore, she still owes our clinic $62.81 for her 01/06/17 date of service. She did pay the $20 co-pay at the time of service, but because her plan year renewed on 01/01/17 a $50 deductible, per her MODA insurance, had to be met before MODA would pay her bills. We mailed her a bill on 02/15/17, one day after she filed a complaint to the Revdex.com. She mailed back the bill with the response “no way” and included no money. The above incident is important because it points out that Ms. [redacted] has not fulfilled her financial responsibility to us, even though she signed a form promising to settle her account. We WILL NOT send her another bill. We WILL NOT send her to collections. We understand that confusion has led to her having an unfulfilling experience, and for that we are sorry. But we do not feel that this warrants an attack on our business and our reputation. I am including with this letter an itemized bill from our clinic, Ms. [redacted]’s 3/25/17 letter which I reference above, and the signed “Patient Financial Responsibility” form. Thank you for continuing to help identify a solution to this problem and please do no hesitate to reach out if you have any further questions. Erik I[redacted]
To Whom It May Concern: Thank you for reaching out and giving us the opportunity to respond to this complaint. We recognize that navigating health insurance is very complicated for patients, so we do the best we can to inform them of their benefits and their financial responsibilities....
The last thing we want to have is an upset patient whose insurance did not fully reimburse our office for care. In order to avoid the above scenario, as a courtesy to our patients, we ALWAYScall and verif y their acupuncture benefits prior to their initial visit. We then explain to patients what we anticipate their financial responsibility will be, especially patients that have complicated co-insurances. The understanding is that when we received the insurance company's Explanation of Benefits or Payments (EOE/EDP) we'll have a picture of what their actual responsibilities are. We do our best to estimate a patient's exact responsibility. The following two (2] reasons make it difficult to know the exact amount. Firstly, insurance companies often take 30- 60 days to reimburse us, and it is only then that we learn exactly what they are paying and what the patient is responsible to pay. Secondly, health insurance companies have a disclaimer that says "a quote of a benefits is not a guarantee of payment". It is unfortunate, but our practice has been burned on more than one occasion in this way, and when it happens we reach out to the patient and try to resolve the outstanding balance. In the case of the patient, she had a 20% co-insurance. We collected $20.00 up front to cover some of her responsibilities. When we received the insurance EOB it was indicated that she owed more than 820.00, and we billed her for the difference.