April 10, 2017Dear [redacted] This is in response to [redacted] 's rejection to my response dated April 4, f have attached the Code of Federal Regulations with regard to protecting a patient's privacyThis is not "bs" as [redacted] states, I would be happy to respond once written approval is received from the patient.Without discussing the particular issue, the number of health care insurance plans is voluminous with many, major plans having "offshoot" plansIt is impossible for us to verify insurance participation for each plan, specifically when it comes to medications and laboratory expensesI have included a copy of our Financial Policy which states some procedures may not be coveredThere is a signed copy of the Financial Policy in the patient's medical record,Should the patient have any concerns with regard to treatment, I would be happy to arrange an appointment with the provider to discuss,Sincerely,Colleen B.Administrator
April 4, 2017Dear *** ***,received the complaint submitted by *** *** ***Due to patient privacy, I am not permitted to discuss this case without the written Consent of the patient*** ***r is not listed as a permitted contact on the Communication Consent form signed by *** ***
on 8/5/16.Maggie G*** is no longer with Valley Oral SurgeryPlease update your records with my contact information provided below.Sincerely,Colleen BAdministrator
April 10, 2017Dear *** ***This is in response to *** ***'s rejection to my response dated April 4, f have attached the Code of Federal Regulations with regard to protecting a patient's privacyThis is not "bs" as *** *** states, I would be happy to respond once written approval is received from the patient.Without discussing the particular issue, the number of health care insurance plans is voluminous with many, major plans having "offshoot" plansIt is impossible for us to verify insurance participation for each plan, specifically when it comes to medications and laboratory expensesI have included a copy of our Financial Policy which states some procedures may not be coveredThere is a signed copy of the Financial Policy in the patient's medical record,Should the patient have any concerns with regard to treatment, I would be happy to arrange an appointment with the provider to discuss,Sincerely,Colleen B.Administrator
[To assist us in bringing this matter to a close, you must give us a reason why you are rejecting the responseIf no reason is received your complaint will be closed as Answered]
Complaint: ***
I am rejecting this response because:
It is typical BS response about patient privacyThere was not an issue when it came to accepting payment from MY health insurance providerMy wife is covered under my policy but it is MY insurance and the issue was concerning payments made through MY insurance.The Valley Oral Surgery doctor had a consultation with my wife where he expressed concerns about a spot on the inside of her cheekIt was determined that a tissue sample should be taken from the suspicious spot for lab analysisAfter my wife was prepped with an IV and oxygen mask which seemed a bit extreme for a simple tissue sample removal (although I am not a doctor so not qualified to question procedures) the doctor determined that the spot on her cheek was no longer there so decided to sample something else which was not a concern during the original consultationThen apparently my wife was asked to sign an additional consent form for this change which she didI thought that this was probably an unnecessary procedure but again I am not qualified to make that determination.Since there is a $deductible amount on my insurance policy for each of us my wife was required to pay this out of her pocket for the surgeryMy health insurance apparently paid the remainder of the billThe $out of pocket charge was a lot of money for us to have to pay but we agreed to accept the thing even though the procedure seemed like it was unnecessaryThankfully the results of the lab analysis were negative so we were relieved by that.At some point I received a check from my insurance provider in the amount of $I was not sure what this was for until my wife received a bill from *** for $My wife did not know anything about an additional lab fee which should have been covered by my health insurance especially after the payment of the $out of pocket expenseI finally figured out that the $check that I received was for the allowable amount paid by my insurance for the laboratory workOn the bottom of the Explanation Of Benefits section that came with the insurance check it stated that this "non-participating provider may bill you for the difference". I was totally confused by thisI could not understand why Valley Oral Surgery would send the tissue sample to a non-participating laboratory when they had all of my insurance information available as was evident when they immediately demanded the $deductible payment from my wifeI telephoned the *** office to try to sort this outI was instructed to send the $payment to them and then wait to see if they would accept that amount as payment in fullI deposited the insurance check into my bank account and sent *** a personal check for the same amountI did not get a response for some time until another bill came from *** in the amount of $118.99.I telephoned the Valley Oral Surgery office to ask what was going on with the additional bill and also voiced my concerns about the entire procedureWhile I was on the phone with one representative supposedly another representative telephoned the *** officeI was then told that *** was in fact a participating provider for my health insurance and that all I had to do was send them a copy of the Explanation Of Benefits form that I received with the original $paymentI did this immediately and assumed that the issue was resolvedA few months later I discovered a phone message on my answering machine instructing my wife to contact *** in order to set up a payment plan for the outstanding balanceThis was followed up by numerous threatening bills from a *** Collection Agency demanding immediate paymentI telephoned the *** office again to straighten out the issue and was somewhat rudely told that the issue was still "pending"I then telephoned the Valley Oral Surgery office and asked the representative what what going on as I was now totally disgusted with the harassmentI wanted to know how this mess came to be and more importantly why they would send a sample to a non-participating laboratory after my company pays about $30,per year for my health insuranceI also again questioned the entire proceedings and implored the representative to remedy the situationI was told that there was nothing that they could do about it.I was then forced to contact my insurance provider to make them aware of the issueI recently received another check from the insurance for $and also received another bill from *** for the same amountI forwarded that check to *** but still have no idea where that leaves us regarding the remainder of the billI'm once again waiting to see another harassing collection agency bill arrive from *** for the rest of the money.It is in my opinion that there was irresponsibility on the part of Valley Oral Surgery for sending the laboratory sample to a non-participating provider and that if my insurance payment was not satisfactory then Valley Oral Surgery should have covered the difference due to their shortsightedness in choosing the laboratory when they certainly had access to my wife's insurance records and could have chosen a participating labIn the meantime my wife and I have been continuously pestered with threatening bills and phone calls which have made us feel like we are being treated as some sort of low-life bill ignoring dirt bagsI pride myself in my ability to pay all of my bills in a timely fashion.As a result of this nonsense I refuse to pay any additional laboratory bills which have been generated by this foul up and it is also my opinion that Valley Oral Surgeons should never have performed the procedure to begin withMaybe it would be a nice gesture on their part to refund my wife's $deductible payment and if they feel the need to have my wife stick her signature somewhere to alleviate the patient privacy issue I'm certain that she would be happy to oblige
Regards,
*** ***
April 10, 2017Dear [redacted] This is in response to [redacted] 's rejection to my response dated April 4, f have attached the Code of Federal Regulations with regard to protecting a patient's privacyThis is not "bs" as [redacted] states, I would be happy to respond once written approval is received from the patient.Without discussing the particular issue, the number of health care insurance plans is voluminous with many, major plans having "offshoot" plansIt is impossible for us to verify insurance participation for each plan, specifically when it comes to medications and laboratory expensesI have included a copy of our Financial Policy which states some procedures may not be coveredThere is a signed copy of the Financial Policy in the patient's medical record,Should the patient have any concerns with regard to treatment, I would be happy to arrange an appointment with the provider to discuss,Sincerely,Colleen B.Administrator
April 4, 2017Dear *** ***,received the complaint submitted by *** *** ***Due to patient privacy, I am not permitted to discuss this case without the written Consent of the patient*** ***r is not listed as a permitted contact on the Communication Consent form signed by *** ***
on 8/5/16.Maggie G*** is no longer with Valley Oral SurgeryPlease update your records with my contact information provided below.Sincerely,Colleen BAdministrator
April 10, 2017Dear *** ***This is in response to *** ***'s rejection to my response dated April 4, f have attached the Code of Federal Regulations with regard to protecting a patient's privacyThis is not "bs" as *** *** states, I would be happy to respond once written approval is received from the patient.Without discussing the particular issue, the number of health care insurance plans is voluminous with many, major plans having "offshoot" plansIt is impossible for us to verify insurance participation for each plan, specifically when it comes to medications and laboratory expensesI have included a copy of our Financial Policy which states some procedures may not be coveredThere is a signed copy of the Financial Policy in the patient's medical record,Should the patient have any concerns with regard to treatment, I would be happy to arrange an appointment with the provider to discuss,Sincerely,Colleen B.Administrator
[To assist us in bringing this matter to a close, you must give us a reason why you are rejecting the responseIf no reason is received your complaint will be closed as Answered]
Complaint: ***
I am rejecting this response because:
It is typical BS response about patient privacyThere was not an issue when it came to accepting payment from MY health insurance providerMy wife is covered under my policy but it is MY insurance and the issue was concerning payments made through MY insurance.The Valley Oral Surgery doctor had a consultation with my wife where he expressed concerns about a spot on the inside of her cheekIt was determined that a tissue sample should be taken from the suspicious spot for lab analysisAfter my wife was prepped with an IV and oxygen mask which seemed a bit extreme for a simple tissue sample removal (although I am not a doctor so not qualified to question procedures) the doctor determined that the spot on her cheek was no longer there so decided to sample something else which was not a concern during the original consultationThen apparently my wife was asked to sign an additional consent form for this change which she didI thought that this was probably an unnecessary procedure but again I am not qualified to make that determination.Since there is a $deductible amount on my insurance policy for each of us my wife was required to pay this out of her pocket for the surgeryMy health insurance apparently paid the remainder of the billThe $out of pocket charge was a lot of money for us to have to pay but we agreed to accept the thing even though the procedure seemed like it was unnecessaryThankfully the results of the lab analysis were negative so we were relieved by that.At some point I received a check from my insurance provider in the amount of $I was not sure what this was for until my wife received a bill from *** for $My wife did not know anything about an additional lab fee which should have been covered by my health insurance especially after the payment of the $out of pocket expenseI finally figured out that the $check that I received was for the allowable amount paid by my insurance for the laboratory workOn the bottom of the Explanation Of Benefits section that came with the insurance check it stated that this "non-participating provider may bill you for the difference". I was totally confused by thisI could not understand why Valley Oral Surgery would send the tissue sample to a non-participating laboratory when they had all of my insurance information available as was evident when they immediately demanded the $deductible payment from my wifeI telephoned the *** office to try to sort this outI was instructed to send the $payment to them and then wait to see if they would accept that amount as payment in fullI deposited the insurance check into my bank account and sent *** a personal check for the same amountI did not get a response for some time until another bill came from *** in the amount of $118.99.I telephoned the Valley Oral Surgery office to ask what was going on with the additional bill and also voiced my concerns about the entire procedureWhile I was on the phone with one representative supposedly another representative telephoned the *** officeI was then told that *** was in fact a participating provider for my health insurance and that all I had to do was send them a copy of the Explanation Of Benefits form that I received with the original $paymentI did this immediately and assumed that the issue was resolvedA few months later I discovered a phone message on my answering machine instructing my wife to contact *** in order to set up a payment plan for the outstanding balanceThis was followed up by numerous threatening bills from a *** Collection Agency demanding immediate paymentI telephoned the *** office again to straighten out the issue and was somewhat rudely told that the issue was still "pending"I then telephoned the Valley Oral Surgery office and asked the representative what what going on as I was now totally disgusted with the harassmentI wanted to know how this mess came to be and more importantly why they would send a sample to a non-participating laboratory after my company pays about $30,per year for my health insuranceI also again questioned the entire proceedings and implored the representative to remedy the situationI was told that there was nothing that they could do about it.I was then forced to contact my insurance provider to make them aware of the issueI recently received another check from the insurance for $and also received another bill from *** for the same amountI forwarded that check to *** but still have no idea where that leaves us regarding the remainder of the billI'm once again waiting to see another harassing collection agency bill arrive from *** for the rest of the money.It is in my opinion that there was irresponsibility on the part of Valley Oral Surgery for sending the laboratory sample to a non-participating provider and that if my insurance payment was not satisfactory then Valley Oral Surgery should have covered the difference due to their shortsightedness in choosing the laboratory when they certainly had access to my wife's insurance records and could have chosen a participating labIn the meantime my wife and I have been continuously pestered with threatening bills and phone calls which have made us feel like we are being treated as some sort of low-life bill ignoring dirt bagsI pride myself in my ability to pay all of my bills in a timely fashion.As a result of this nonsense I refuse to pay any additional laboratory bills which have been generated by this foul up and it is also my opinion that Valley Oral Surgeons should never have performed the procedure to begin withMaybe it would be a nice gesture on their part to refund my wife's $deductible payment and if they feel the need to have my wife stick her signature somewhere to alleviate the patient privacy issue I'm certain that she would be happy to oblige
Regards,
*** ***