Lacina & Kenjura, PC

Thank you for notifying us of this complaint. We are aware of this patient from a negative survey he posted on social media and we had already contacted him and tried to explain our procedures and proper insurance procedures as well but we see he is still not satisfiedThis patient did come
to our office. He told the technician that his Optometrist (who is not a Medical Doctor) had seen something on his exam that made him/her suspect Glaucoma as a possibility. He did not bring records, a referral, any notes or any orders from a referring eye doctor. Indeed he was not referred at all by the Optometrist who saw him. The patient found us through *** which is a Primary care practice or urgent care center. When the patient arrived, he presented his insurance card for billing purposes. Our billing department called his *** insurance to verify his co-pay and was told the specialist co-pay is $60. Doctor G*** is an Ophthalmologist, a Medical Doctor. Ophthalmologists are specialists. Ophthalmologists do Medical eye exams and bill Medical insurances and the copays are typically higher than a vision exam done by an Optometrist, which are typically done for the purposes of prescribing glasses and contacts, a non-medical exam which may also “survey” for disease. More in-depth evaluations are done in a medical evaluation which typically take 1-hours to perform in our practice. Because of this, we generally have the patient return for the diagnostic testing which can also take 1-hours to complete. While an Optometrist who is properly trained can perform “medical evaluations” and therefore also bill medical insurances and not vision plans for the work up, this patient never presented any information regarding his visit with the optometrist, i.eexam notes, records, or a referral indicting he was diagnosed with having glaucoma. Our office staff proceeded to do a comprehensive exam to document the medical necessity for diagnostic glaucoma testing. Upon completion of the exam, the patient was scheduled to return for diagnostic glaucoma testingProper medical coding for any specialist to bill medical testing requires a “diagnosis” of the condition being tested for or the test will be considered a “screening”. From our years of experience with medical testing, screenings are typically not covered by insurance plans Patients cannot request testing on their own. Testing must be ordered by a licensed Physician after a proper diagnosis has been made. If the patient had brought in a referral from the prior doctor’s office stating the need for glaucoma testing due to his/her medical findings along with a copy of their complete exam, we could have proceeded to do the diagnostic testing for glaucoma, sent the testing results back to referring doctor, and properly submit the testing for payment The patient was not referred here by another Eye Doctor. Patient sought us out on his own. We do not agree that this patient is due a refund. It is unfortunate that some patients do not understand the intricacies medical practices face when meeting requirements of insurance providers. We often are faced with patients who take out their frustrations over increasingly onerous insurance burdens and requirements on our Practices

We have no additional response for this patient We followed our procedures and policies which are inline with industry standards

[To assist us in bringing this matter to a close, you must give us a reason why you are rejecting the response. If no reason is received your complaint will be closed as Answered]
 Complaint: [redacted]
I am rejecting this response because:I rejected and I havenot given any personal information of me or the eye center
Regards,
[redacted]