To Whom It May Concern: This is my response to the complaint against my companyThe patient [redacted] was seen at my office on October 24, and November 7, She was a n [redacted] patient who had a mainland insurance, AetnaHer insurance card stated that for specialist visits, the copay would be and for PCP visits, As an OBGYN, I am considered specialist according to most insurances here in Hawaii and on the mainlandWe charged her for each visitIn January, [redacted] called our biller, Michael L**, for a refundShe had received a statement from Aetna stating that the copay was for each visitMichael then stated he would gladly refund the money, but it would not be The amount would be minus the applicable general excise tax based on the eligible charges that Aetna has contracted with our office for the two office visits [redacted] was rude and demanding to Michael of which he suggested to involve Aetna to avoid escalation of the conversationShe was insistent the error was ours and that there was no possibility that the information from Aetna was incorrect therefore making my biller incorrectOn January 17, 2017, [redacted] initiated a three way call involving AetnaAt the conclusion of this conversation, the Aetna representative further reinforced that the refund should be When my biller asked for the provider contracts to document Aetna’s exemption from general excise tax for the state of Hawaii, the Aetna representative stated she did not have access to such contractsAt the conclusion of this conversation, my biller stated that further research and documentation needed to be done in order to issue the refundMy biller was given another phone number for provider services at Aetna to get the contracts and confirm whether there was a tax exemption for Aetna and the state of HawaiiHe also was not comfortable issuing a refund without having the proper documentation to do soMy biller attempted to contact provider services twice but was unsuccessful in receiving back a phone callSeveral weeks later, Aurora K [redacted] from Aetna called and left a message for our billerEssentially Aetna is NOT tax exempt and general excise tax must be paidDespite our efforts to contact Aurora, we have never been able to personally speak with herThe following is a verbatim account of her research: Most of the following is documented in my outbound activity under ASD SR ID [redacted] : The member had called in and we opened a task because she paid $upfront and our claims showed she should only owe her $copayAt first when I was trying to call billing I didn’t remember about Hawaii tax is allowable, but I found it in contract exceptions either on or just before [redacted] , which was before I actually spoke to Michael (think I kept getting his voicemail box) Once I found the contract exception I sent the claims for r**ork, let member and provider know the claims were being r**orked, and then began the fight with processors to allow it properly ( I ended up having to email claim sup)I left a message for Michael on to say that DOS was r**orked to allow the taxes and payment was issued 020317, but was still working on DOS 102416, and asked him to note account so he could maybe send member back her overpayment on the dateI also left a message for the member that day that one date was corrected but the other date was still being worked onMichael had called and left me voicemail one day asking for way, but each time I’d called the member it went to her voicemail, so way is not possibleThe last message left for Michael on 02/22/I do remember stating that I’m leaving a similar message for the member: “adv the way Hawaii sales tax works is that it applies towards the coinsurance so on mm total responsibility was $but since they paid $are owed back $and on still working on getting fixed but 20% of tax should be $so should be pay back $to mmso true total owed back will be $36.37.” I believe I also left a comment, just on Michael’s message to the effect that I’m advocating for the member and this issue should have been between Aetna and the Provider not the provider and member On the member I think I also left a specific comment about seeing the adjusted claims on the Aetna NavigatorLastly, I got the reply back from the claim Supervisor on 02/25/that the 10/24/claim was now processed correctly and payment was sent to the provider on 02/27/2017; I noted my contact on 03/01/and closed the task because I’d already made attempts to call provider and my last call to mm and provider contained all the correct info on what the member was owed backSincerely, Aurora K [redacted] Health Concierge Bright Ideas Representative National Businesses Customer Service Fresno - National Accounts K [redacted] [email protected] [redacted] T [redacted] F EShaw Avenue Fresno, CA In the meantime, [redacted] sends me a letter on 2/4/demanding her refundShe threatened to make a RICO complaint if she did not get her refund in a timely mannerMichael called her upon receiving the letter telling her that her claim was being reprocessed and that the second claim was going to be processed laterThis is also clearly documented in Aurora’s words quoted aboveHe also wanted another way call with AuroraHe said once the second payment would be received, we would cut her a check for the correct refund amountHe stated to properly refund her money both payments from Aetna needed to be accounted for Writing one single refund check would be better than cutting checks [redacted] said okOn 2/23/2017, we received this complaint from the Revdex.com [redacted] filed the complaint prior to Aetna making any correction to the second claim Her anxiousness is also demonstrated in filing this complaint as the second payment adjustment from Aetna wasn’t received in our office until 3/8/ Upon receiving this second payment, my biller issued a refund check #in amount of $and mailed the next day It even covered the cost of her postage as she demanded from us [redacted] has since cashed this check on 3/15/ In conclusion, we had been cooperating and continued to move the refund process along as dictated by the insurance company It is not unusual to receive payments from insurance companies several months laterHowever, Ms [redacted] ’s lack of understanding and patience has led to a premature complaint My biller had specifically told her this process will take some time to finalize but the she was not being reasonable This complaint and the one made to the Department of Commerce and Consumer Affairs were unnecessary and another contributing factor for the rising costs of private practice The patient should have exercised better judgement to let the insurance company and the provider work out the discrepancy of general excise tax for the state of HawaiiHad the patient waited until the final payment was received from Aetna, a timely refund check would have been made to Ms [redacted] regardless of complaint This complaint was unfoundedIf any action should be taken, there should be a complaint against Aetna as they are not practicing fair business when it comes to reporting general excise tax for the state of Hawaii to their members in Hawaii They are being misinformed and it is causing practices like mine to lose patients like Ms [redacted] and waste our practice resources These missteps continue to make doing business in Hawaii expensive and difficult for private medical practitioners to take care of more pressing issues such as the health of their patients Sincerely, Lynette WTsai, MD
To Whom It May Concern: This is my response to the complaint against my companyThe patient [redacted] was seen at my office on October 24, and November 7, She was a n [redacted] patient who had a mainland insurance, AetnaHer insurance card stated that for specialist visits, the copay would be and for PCP visits, As an OBGYN, I am considered specialist according to most insurances here in Hawaii and on the mainlandWe charged her for each visitIn January, [redacted] called our biller, Michael L**, for a refundShe had received a statement from Aetna stating that the copay was for each visitMichael then stated he would gladly refund the money, but it would not be The amount would be minus the applicable general excise tax based on the eligible charges that Aetna has contracted with our office for the two office visits [redacted] was rude and demanding to Michael of which he suggested to involve Aetna to avoid escalation of the conversationShe was insistent the error was ours and that there was no possibility that the information from Aetna was incorrect therefore making my biller incorrectOn January 17, 2017, [redacted] initiated a three way call involving AetnaAt the conclusion of this conversation, the Aetna representative further reinforced that the refund should be When my biller asked for the provider contracts to document Aetna’s exemption from general excise tax for the state of Hawaii, the Aetna representative stated she did not have access to such contractsAt the conclusion of this conversation, my biller stated that further research and documentation needed to be done in order to issue the refundMy biller was given another phone number for provider services at Aetna to get the contracts and confirm whether there was a tax exemption for Aetna and the state of HawaiiHe also was not comfortable issuing a refund without having the proper documentation to do soMy biller attempted to contact provider services twice but was unsuccessful in receiving back a phone callSeveral weeks later, Aurora K [redacted] from Aetna called and left a message for our billerEssentially Aetna is NOT tax exempt and general excise tax must be paidDespite our efforts to contact Aurora, we have never been able to personally speak with herThe following is a verbatim account of her research: Most of the following is documented in my outbound activity under ASD SR ID [redacted] : The member had called in and we opened a task because she paid $upfront and our claims showed she should only owe her $copayAt first when I was trying to call billing I didn’t remember about Hawaii tax is allowable, but I found it in contract exceptions either on or just before [redacted] , which was before I actually spoke to Michael (think I kept getting his voicemail box) Once I found the contract exception I sent the claims for r**ork, let member and provider know the claims were being r**orked, and then began the fight with processors to allow it properly ( I ended up having to email claim sup)I left a message for Michael on to say that DOS was r**orked to allow the taxes and payment was issued 020317, but was still working on DOS 102416, and asked him to note account so he could maybe send member back her overpayment on the dateI also left a message for the member that day that one date was corrected but the other date was still being worked onMichael had called and left me voicemail one day asking for way, but each time I’d called the member it went to her voicemail, so way is not possibleThe last message left for Michael on 02/22/I do remember stating that I’m leaving a similar message for the member: “adv the way Hawaii sales tax works is that it applies towards the coinsurance so on mm total responsibility was $but since they paid $are owed back $and on still working on getting fixed but 20% of tax should be $so should be pay back $to mmso true total owed back will be $36.37.” I believe I also left a comment, just on Michael’s message to the effect that I’m advocating for the member and this issue should have been between Aetna and the Provider not the provider and member On the member I think I also left a specific comment about seeing the adjusted claims on the Aetna NavigatorLastly, I got the reply back from the claim Supervisor on 02/25/that the 10/24/claim was now processed correctly and payment was sent to the provider on 02/27/2017; I noted my contact on 03/01/and closed the task because I’d already made attempts to call provider and my last call to mm and provider contained all the correct info on what the member was owed backSincerely, Aurora K [redacted] Health Concierge Bright Ideas Representative National Businesses Customer Service Fresno - National Accounts K [redacted] [email protected] [redacted] T [redacted] F EShaw Avenue Fresno, CA In the meantime, [redacted] sends me a letter on 2/4/demanding her refundShe threatened to make a RICO complaint if she did not get her refund in a timely mannerMichael called her upon receiving the letter telling her that her claim was being reprocessed and that the second claim was going to be processed laterThis is also clearly documented in Aurora’s words quoted aboveHe also wanted another way call with AuroraHe said once the second payment would be received, we would cut her a check for the correct refund amountHe stated to properly refund her money both payments from Aetna needed to be accounted for Writing one single refund check would be better than cutting checks [redacted] said okOn 2/23/2017, we received this complaint from the Revdex.com [redacted] filed the complaint prior to Aetna making any correction to the second claim Her anxiousness is also demonstrated in filing this complaint as the second payment adjustment from Aetna wasn’t received in our office until 3/8/ Upon receiving this second payment, my biller issued a refund check #in amount of $and mailed the next day It even covered the cost of her postage as she demanded from us [redacted] has since cashed this check on 3/15/ In conclusion, we had been cooperating and continued to move the refund process along as dictated by the insurance company It is not unusual to receive payments from insurance companies several months laterHowever, Ms [redacted] ’s lack of understanding and patience has led to a premature complaint My biller had specifically told her this process will take some time to finalize but the she was not being reasonable This complaint and the one made to the Department of Commerce and Consumer Affairs were unnecessary and another contributing factor for the rising costs of private practice The patient should have exercised better judgement to let the insurance company and the provider work out the discrepancy of general excise tax for the state of HawaiiHad the patient waited until the final payment was received from Aetna, a timely refund check would have been made to Ms [redacted] regardless of complaint This complaint was unfoundedIf any action should be taken, there should be a complaint against Aetna as they are not practicing fair business when it comes to reporting general excise tax for the state of Hawaii to their members in Hawaii They are being misinformed and it is causing practices like mine to lose patients like Ms [redacted] and waste our practice resources These missteps continue to make doing business in Hawaii expensive and difficult for private medical practitioners to take care of more pressing issues such as the health of their patients Sincerely, Lynette WTsai, MD