Louis Sobel, MD

Dear [redacted] ***: I would like to respond to the complaint filed by one of our patients, [redacted] As this is not a secure site and we are not able to give specifics to protect the patient's privacy according to HIPPA laws, I will not give specifics regarding her diagnosis [redacted] was first seen and again on 714, and these routine services were correctly billed to her vision eye care provider, VSP [redacted] returned for her annual folleye exam on and asked that we bill VSP We tried to explain to her that Aetna was responsible for medical eye care and that VSP does not cover these type of tests, the same tests she had the year prior for the same diagnosis She called Aetna to complain and a representative conference-called our office and with us on the phone explained to her that her policy had changed on 1/*/and she now had a large in-network deductible The Aetna representative told the patient she was responsible for paying the doctor's officeAfter repeated bills and non-payment, we received a multi-page letter from the patient telling saying that she had nothing wrong with her eyes and she had no intention of paying Her account was sent to our collection agency She wrote a similar letter to the collection agency alledging that the diagnosis was and refusing to pay This was followed by this libelous and uncalled for complaint to your bureauI request that you remove this complaint from your records [redacted] has a documented medical eye condition that needs appropriate follby an ophthalmologist or doctor of optometry None of the services to [redacted] were unexpected (she had similar extensive testing the year prior) or all were medically necessary We were never paid for the medical care and testing she received in Thank you for your attention Please send written confirmation and adviseOffice of Louis S [redacted] MD

Dear [redacted]: I would like to respond to the complaint filed by one of our patients, [redacted].  As this is not a secure site and we are not able to give specifics to protect the patient's privacy according to HIPPA laws, I will not give specifics regarding her diagnosis.   ...

[redacted] was first seen 5/*/14 and was told that she had a finding in the "back of her eye" that was suspicious for a medical condition that needed to be followed and could potentially lead to [redacted] if it progressed.  At this time she had a comprehensive first visit exam and a dilated retinal examination.  She returned for a brief follow-up and pressure check on 5/**/14 and again on 7/*/14, at which time she had a follow-up examination, measurement of [redacted], and a computerized visual field examination.  None of these tests are "routine" eye exams, they are done for her particular diagnosis and the patient was fully aware that yearly screening was recommended.  None of these services are billable to vision insurance plans, as they were done for a medical diagnosis and are not considered "routine."  All of these services were reimbursed by her medical insurance carrier, Aetna.  She was also refracted and contact lenses were prescribed on 7/*/14, and these routine services were correctly billed to her vision eye care provider, VSP. [redacted] returned for her annual follow-up eye exam on 7/*/15, almost one year to the date of her extensive work-up for her medical eye condition.  Similar services were provided as one year prior: a comprehensive eye exam, computerized visual field exam, gonioscopy, indirect ophthalmoscopy to look at the retina and in addition a scanning laser examination of her retina/macula.  Her insurance provider, Aetna, was appropriately billed.  We were not paid for any of these services, as her policy had changed in 2015 and all the charges were applied to her unmet deductible.  We billed her the amount Aetna said she was responsible for, as per her contract with Aetna, $255.32.  She called our office on 8/**/15 and asked that we bill VSP.  We tried to explain to her that Aetna was responsible for medical eye care and that VSP does not cover these type of tests, the same tests she had the year prior for the same diagnosis.  She called Aetna to complain and a representative conference-called our office and with us on the phone explained to her that her policy had changed on 1/*/2015 and she now had a large in-network deductible.  The Aetna representative told the patient she was responsible for paying the doctor's office. After repeated bills and non-payment, we received a multi-page letter from the patient telling saying that she had nothing wrong with her eyes and she had no intention of paying.  Her account was sent to our collection agency.  She wrote a similar letter to the collection agency alledging that the diagnosis was false and refusing to pay.  This was followed by this libelous and uncalled for complaint to your bureau. I request that you remove this complaint from your records.  [redacted] has a documented medical eye condition that needs appropriate follow-up by an ophthalmologist or doctor of optometry.  None of the services to [redacted] were unexpected (she had similar extensive testing the year prior) or all were medically necessary.  We were never paid for the medical care and testing she received in 2015. Thank you for your attention.  Please send written confirmation and advise. Office of Louis S[redacted] MD

Dear [redacted]: I would like to respond to the complaint filed by one of our...

patients, [redacted].  As this is not a secure site and we are not able to give specifics to protect the patient's privacy according to HIPPA laws, I will not give specifics regarding her diagnosis.   [redacted] was first seen 5/*/14 and was told that she had a finding in the "back of her eye" that was suspicious for a medical condition that needed to be followed and could potentially lead to [redacted] if it progressed.  At this time she had a comprehensive first visit exam and a dilated retinal examination.  She returned for a brief follow-up and pressure check on 5/**/14 and again on 7/*/14, at which time she had a follow-up examination, measurement of [redacted], and a computerized visual field examination.  None of these tests are "routine" eye exams, they are done for her particular diagnosis and the patient was fully aware that yearly screening was recommended.  None of these services are billable to vision insurance plans, as they were done for a medical diagnosis and are not considered "routine."  All of these services were reimbursed by her medical insurance carrier, Aetna.  She was also refracted and contact lenses were prescribed on 7/*/14, and these routine services were correctly billed to her vision eye care provider, VSP. [redacted] returned for her annual follow-up eye exam on 7/*/15, almost one year to the date of her extensive work-up for her medical eye condition.  Similar services were provided as one year prior: a comprehensive eye exam, computerized visual field exam, gonioscopy, indirect ophthalmoscopy to look at the retina and in addition a scanning laser examination of her retina/macula.  Her insurance provider, Aetna, was appropriately billed.  We were not paid for any of these services, as her policy had changed in 2015 and all the charges were applied to her unmet deductible.  We billed her the amount Aetna said she was responsible for, as per her contract with Aetna, $255.32.  She called our office on 8/**/15 and asked that we bill VSP.  We tried to explain to her that Aetna was responsible for medical eye care and that VSP does not cover these type of tests, the same tests she had the year prior for the same diagnosis.  She called Aetna to complain and a representative conference-called our office and with us on the phone explained to her that her policy had changed on 1/*/2015 and she now had a large in-network deductible.  The Aetna representative told the patient she was responsible for paying the doctor's office. After repeated bills and non-payment, we received a multi-page letter from the patient telling saying that she had nothing wrong with her eyes and she had no intention of paying.  Her account was sent to our collection agency.  She wrote a similar letter to the collection agency alledging that the diagnosis was false and refusing to pay.  This was followed by this libelous and uncalled for complaint to your bureau. I request that you remove this complaint from your records.  [redacted] has a documented medical eye condition that needs appropriate follow-up by an ophthalmologist or doctor of optometry.  None of the services to [redacted] were unexpected (she had similar extensive testing the year prior) or all were medically necessary.  We were never paid for the medical care and testing she received in 2015. Thank you for your attention.  Please send written confirmation and advise. Office of Louis S[redacted] MD

Review: In summary, a routine eye exam was coded to include medical diagnosis not disclosed to me resulting in a medical claim. I wrote two letters to Dr. S[redacted] office requesting an explanation of service in writing. Instead, I received two calls, in response to my letters, from combative employees within his office explaining the fee was a result of my deductible. The matter of a deductible was understood, what is not clear is why a routine exam noted additional screenings and services (not rendered) resulting in a medical claim.Desired Settlement: Note my July [redacted] office visit as a routine eye exam, removing erroneous medical claims.

Business

Response:

Dear [redacted]: I would like to respond to the complaint filed by one of our patients, [redacted]. As this is not a secure site and we are not able to give specifics to protect the patient's privacy according to HIPPA laws, I will not give specifics regarding her diagnosis. [redacted] was first seen 5/*/14 and was told that she had a finding in the "back of her eye" that was suspicious for a medical condition that needed to be followed and could potentially lead to [redacted] if it progressed. At this time she had a comprehensive first visit exam and a dilated retinal examination. She returned for a brief follow-up and pressure check on 5/**/14 and again on 7/*/14, at which time she had a follow-up examination, measurement of [redacted], and a computerized visual field examination. None of these tests are "routine" eye exams, they are done for her particular diagnosis and the patient was fully aware that yearly screening was recommended. None of these services are billable to vision insurance plans, as they were done for a medical diagnosis and are not considered "routine." All of these services were reimbursed by her medical insurance carrier, Aetna. She was also refracted and contact lenses were prescribed on 7/*/14, and these routine services were correctly billed to her vision eye care provider, VSP. [redacted] returned for her annual follow-up eye exam on 7/*/15, almost one year to the date of her extensive work-up for her medical eye condition. Similar services were provided as one year prior: a comprehensive eye exam, computerized visual field exam, gonioscopy, indirect ophthalmoscopy to look at the retina and in addition a scanning laser examination of her retina/macula. Her insurance provider, Aetna, was appropriately billed. We were not paid for any of these services, as her policy had changed in 2015 and all the charges were applied to her unmet deductible. We billed her the amount Aetna said she was responsible for, as per her contract with Aetna, $255.32. She called our office on 8/**/15 and asked that we bill VSP. We tried to explain to her that Aetna was responsible for medical eye care and that VSP does not cover these type of tests, the same tests she had the year prior for the same diagnosis. She called Aetna to complain and a representative conference-called our office and with us on the phone explained to her that her policy had changed on 1/*/2015 and she now had a large in-network deductible. The Aetna representative told the patient she was responsible for paying the doctor's office. After repeated bills and non-payment, we received a multi-page letter from the patient telling saying that she had nothing wrong with her eyes and she had no intention of paying. Her account was sent to our collection agency. She wrote a similar letter to the collection agency alledging that the diagnosis was false and refusing to pay. This was followed by this libelous and uncalled for complaint to your bureau. I request that you remove this complaint from your records. [redacted] has a documented medical eye condition that needs appropriate follow-up by an ophthalmologist or doctor of optometry. None of the services to [redacted] were unexpected (she had similar extensive testing the year prior) or all were medically necessary. We were never paid for the medical care and testing she received in 2015. Thank you for your attention. Please send written confirmation and advise. Office of Louis S[redacted] MD