LRS Management

This patient was seen on 4/25/for a consultationWhen the patient had called to schedule her appointment, she had asked if we accepted her insuranceOur patient care coordinator replied yes, because we DO accept her insuranceWe are an Orthopaedic Spinal Surgeon specializing in Robotic Spinal Surgery, and we are an out-of-network providerNot once did the patient ask whether we were in-network or out-of-networkIt is the patient's responsibility to contact their insurance company and verify if a provider is in-network (if that is the only type of provider they wish to see)Upon scheduling the appointment, our patient care coordinator confirmed the patient's out-of-network benefits, which the patient does haveWhen the patient arrived for her appointment, she paid $towards her co-insurance/deductible (as we have all patients do at the time of their visit)The claim was submitted to her insuranceOnce the claim was processed, a copy of the Explanation of Benefits was sent to us as well as the patientSince the patient had not satisfied her deductible at the time of the visit, the allowed amount was applied towards her deductibleWe then sent a patient a bill for the remaining balance on the claimWhen the patient called (obviously distressed), she was extremely rudeAs a healthcare professional, she should be fully aware of all the information I have previously statedAs a courtesy, I offered to settle out her account with a very generous 69% discountThe patient agreed to the arrangement, but then began arguing with the patient care coordinator that I had transferred her to in order to make the paymentThe patient was then transferred back to me and began threatening to bad mouth us on social media, report us to the Revdex.com, etcGiven that we are an out-of-network provider (as most Orthopaedic Spinal Surgeons are), the patient is responsible for the unpaid balanceI apologized incessantly to the patient for the miscommunication and I am still willing to honor the discount, but I cannot allow for a patient to be seen for freeI have a copy of the Explanation of Benefits if it is needed

Complaint: [redacted]
I am rejecting this response because: The office clearly stated in their response that they believe it is the patient's responsibility to call the insurance to find out if the doctor is out of network.  I called my insurance to verify if this was true and I was informed it is not. In fact, in New Jersey, there is a state law (The Out-of-Nework Consumer Protection, Transparency and Cost Containment and Accountability Act) that requires doctors to disclose their network status to patients before treatment.  In my past experience, when I've visited an out of network provider, the office verifies the insurance and then advises the patient on the cost of the visit.  When I called to schedule with this physician, there was no such information given to me, I was told that the office accepts my insurance. I was lead to believe that I had to pay a $25 copay.  If I had known the doctor was out of network, I would not have made the appointment. I received the surprise remainder of the bill in the mail 6 months later. The manager offered to reduce the fee but that is still 10x the amount of the copay.  I believe this practice needs to be more transparent with their network status.  The manager and the billing administration staff were both unprofessional and inflammatory in their responses to my concerns which is why I got upset and found it necessary to contact the  Revdex.com to file a complaint.  
Regards,
[redacted]

This patient was seen on 4/25/17 for a consultation. When the patient had called to schedule her appointment, she had asked if we accepted her insurance. Our patient care coordinator replied yes, because we DO accept her insurance. We are an Orthopaedic Spinal Surgeon specializing in Robotic Spinal...

Surgery, and we are an out-of-network provider. Not once did the patient ask whether we were in-network or out-of-network. It is the patient's responsibility to contact their insurance company and verify if a provider is in-network (if that is the only type of provider they wish to see). Upon scheduling the appointment, our patient care coordinator confirmed the patient's out-of-network benefits, which the patient does have. When the patient arrived for her appointment, she paid $25.00 towards her co-insurance/deductible (as we have all patients do at the time of their visit). The claim was submitted to her insurance. Once the claim was processed, a copy of the Explanation of Benefits was sent to us as well as the patient. Since the patient had not satisfied her deductible at the time of the visit, the allowed amount was applied towards her deductible. We then sent a patient a bill for the remaining balance on the claim. When the patient called (obviously distressed), she was extremely rude. As a healthcare professional, she should be fully aware of all the information I have previously stated. As a courtesy, I offered to settle out her account with a very generous 69% discount. The patient agreed to the arrangement, but then began arguing with the patient care coordinator that I had transferred her to in order to make the payment. The patient was then transferred back to me and began threatening to bad mouth us on social media, report us to the Revdex.com, etc. Given that we are an out-of-network provider (as most Orthopaedic Spinal Surgeons are), the patient is responsible for the unpaid balance. I apologized incessantly to the patient for the miscommunication and I am still willing to honor the discount, but I cannot allow for a patient to be seen for free. I have a copy of the Explanation of Benefits if it is needed.