Internal Medicine Associates

Revdex.com: I have reviewed the response made by the business in reference to complaint ID [redacted] , and have determined that this does not resolve my complaint For your reference, details of the offer I reviewed appear below Thanks for writing off the balance Nonetheless, the office also discharged me from seeing [redacted] all together, and that's wrongConsequently, I require the business to reverse the expulsion, for it does not have sufficient reasons to deprive my right; besides, I still think [redacted] is a good doctor For all the three service billings/rejections referenced in the response, I need to see the exact procedure names or the current procedural terminology (CPT) codes, whichever the officer attempted to bill to Aetna, so I can learn whether these service bills to Aetna were indeed accurate according to Aetna's guidelinePlease don't assume that either Revdex.com or I have no knowledge of medical billing Without the needed factual support, that business makes generalized statement or denial is not acceptable, and I hope that it can provide the necessary details in subsequent responses

I am responding to the complaint filed by Mr*** *** on 8/13/2014., ID ***
Mr*** *** initially contacted our office on May 8, He spoke with *** ***'s secretary *** who scheduled him for a New Patient appointment on May 10, at II :amThis
appointment was schedule for minutes as a New Patient for a physical and concern of sleep apnea (see attached)
As such, *** *** *** did a physical examination on this new patient, made recommendations (lab work was ordered), started him on medications for insomnia and rashDuring this visit patient did not want an exam on prostate and colon cancer screening
Performing a complete PE is protocol for our office on a new patient upon entering our practice so we know as much as we can about them Our office billed the service correctly and the patient's health insurance rejected the bill We initially billed the service as a new patient PE, then as an established patient PE (at the patient's request), then as an Office visit (per the patient,s request) and all were rejected by the insurance company After the 3rd rejectionwe had no choice but to send the bill to the patient directly Because the patient is dissatisfied with our service and he did not follow up with his lab work nor the recommendations from *** *** ***, we will write off the balance and discharge him from our practice
However., we remain confident that nothing was done inappropriately in the care of *** ***Everything that we could do concerning submitting his charges to the insurance company was done appropriately

I am again responding to the complaint filed by M r*** *** on 8/13/2014, ID * *** His accusation of Dr*** *** trying to make more money by his billing met hods is ludicrous and outrageous
Since Mr*** *** is still dissatisfied with our billing and practice protocol within our office, I will outline the billing process performed by our office and the denials from his Aetna Insurance Company
5/ 0/visit CPT code Medical Evaluation
Patient paid copay of $via credit card ;
Denied by Aetna
Diagnosis: Physical, insomnia, rash
Rebilled as CPT code Preventive Office visit Diagnosis: Physical, insomnia, rash
Denied by Aetna
Rebilled as CPT code Establish ed Patient visit Diagnosis: Insomnia
Denied by Aetna
As you can see, we never received payment for any of the CPT codes used for the original service date, therefore we h ad no choice but to bill the patient directlySince then we have provided ** * *** * a courtesy adjustment on his account
Due to hi s dissatisfaction with our practice, *** *** 's medical records will be forwarded to another provider of his choice when he has selected one Please note that physicians have the right to discharge any patient from their practice with a 30-day emergency only care Since MrChun received notice of this discharge back on August 18, 2014, hi s 30-day period has lapsed

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID [redacted], and have determined that this does not resolve my complaint.  For your reference, details of the offer I reviewed appear below.
Thanks for writing off the balance.
Nonetheless, the office also discharged me from seeing [redacted] all together, and that's wrong. Consequently, I require the business to reverse the expulsion, for it does not have sufficient reasons to deprive my right; besides, I still think [redacted] is a good doctor.
For all the three service billings/rejections referenced in the response, I need to see the exact procedure names or the current procedural terminology (CPT) codes, whichever the officer attempted to bill to Aetna, so I can learn whether these 3 service bills to Aetna were indeed accurate according to Aetna's guideline. Please don't assume that either Revdex.com or I have no knowledge of medical billing.
Without the needed factual support, that business makes generalized statement or denial is not acceptable, and I hope that it can provide the necessary details in subsequent responses.

Review: Title: Inappropriate Billing. Description:It was meant to be a regular office visit; instead, it was billed as a wellness checkup. I went to see [redacted] on May 10, 2013 for a minor issue. During the visit, he asked me if it's ok to give me a physical checkup. Since I just had a physical a month ago, I told him that I didn't need one; besides, my insurance company only pays for a wellness physical once every three year and it won't pay for another one within a year. But the doctor insisted and said that if the insurance company did not pay for the procedure, he would go back to bill as if a routine office visit. He asked me a list of questions, checked blood pressures and temperature etc. Sure enough, he billed the insurance carrier for this visit as a wellness physical exam! Regardless, he did not check my prostate since I was over 50 years old male, its required to get it done, and its part of the wellness checkup. Instead of bill as a regular office visit, why did he bill for a wellness exam? He can get more money for a wellness checkup than a regular office visit.As expected, my insurance company refused to pay the doctor for this visit. Despite his office submitted the claim for two more times, both were rejected. I do not understand the exact reason or the detail of the denials, but what I do know is that it's an inappropriate billing to start with, so its destined to fail. Nonetheless, instead of asking the insurance company for the money, now his office keeps asking me for the money. He billed me a full cost of a wellness physical exam rather than a negotiated charge with the insurance company as if paid by the insurance. What's more? He ignored my copay that was paid at the visit entirely. Obviously, it seems to me that no one should be liable for this inappropriate billing but the practitioner himself, for it's a direct consequence of his billing miscalculation.Desired Settlement: Dismiss the charge.

Business

Response:

I am responding to the complaint filed by Mr. [redacted] on 8/13/2014., ID [redacted]

Mr. [redacted] initially contacted our office on May 8, 2013. He spoke with [redacted]'s secretary [redacted] who scheduled him for a New Patient appointment on May 10, 2013 at II :00 am. This appointment was schedule for 45 minutes as a New Patient for a physical and concern of sleep apnea (see attached).

As such, [redacted] did a physical examination on this new patient, made recommendations (lab work was ordered), started him on medications for insomnia and rash. During this visit patient did not want an exam on prostate and colon cancer screening.

Performing a complete PE is normal protocol for our office on a new patient upon entering our practice so we know as much as we can about them. Our office billed the service correctly and the patient's health insurance rejected the bill. We initially billed the service as a new patient PE, then as an established patient PE (at the patient's request), then as an Office visit (per the patient,s request) and all were rejected by the insurance company. After the 3rd rejection. we had no choice but to send the bill to the patient directly Because the patient is dissatisfied with our service and he did not follow up with his lab work nor the recommendations from [redacted], we will write off the balance and discharge him from our practice.

However., we remain confident that nothing was done inappropriately in the care of [redacted]. Everything that we could do concerning submitting his charges to the insurance company was done appropriately