MajesticLuxuryLinens.Com

Initial Business Response / [redacted] (1000, 5, 2018/01/04) */ After looking further into this matter the patient will be refunded the $

Case # [redacted] The complainant was referred to and seen at the Cataract and Laser Institute Clinic for a new cataract evaluation on 2/1/2017 for her right eye. During the visit, different vision correcting options were discussed during the exam process culminating with a discussion of... costs associated with the surgery option that was chosen by the patient and scheduled. Appropriate paperwork was prepared and signed by the patient including Advance Beneficiary Notices for laser guided options that would not be covered by the patient’s insurance. After meeting with the surgeon on 3/10/2017 in the clinic, the patient was referred to the CLI Surgery Center for surgery, again appropriate paperwork was prepared and signed by the patient regarding services provided by the surgery center. On 4/14/2017 the patient presented for evaluation of the 2nd eye with the Cataract and Laser institute and cleared for surgery of the left eye. Again, appropriate paperwork was prepared and signed by the patient including Advance Beneficiary Notices for laser guided options that would not be covered by the patient’s insurance. The patient was referred to the CLI Surgery Center for surgery. Again, appropriate paperwork was prepared and signed by the patient regarding services provided by the surgery center. In accordance with the services that were agreed upon and provided at the respective dates of service for both the Cataract and Laser Institute and the CLI Surgery Center insurances were properly billed for the covered services and the patient responsible balance were billed to the patient. It should be noted that there was a large balance that was applied to the patient’s deductible by the patient’s insurance company. In summary, upon review of the account it appears that appropriate discussions were held with the complainant on the dates of service, the patient’s insurance was appropriately billed for services provided and the outstanding balance is the responsibility of the patient. The complainant may contact our billing office for a detailed explanation and understanding of the charges billed for services provided at both the Cataract and Laser Institute and the CLI Surgery Center.

Initial Business Response / [redacted] (1000, 5, 2015/09/14) */ Contact Name and Title: [redacted] , Compliance The patient was seen at Summit Eye Care office 4/21/and returned for the Contact lens follon 5/4/She was informed she would not be eligible for materials at that time because she had ordered contact lenses in June of the previous year with the officeThe office also obtained an online authorization for the exam stating the date she would be eligible for materials and referenced this when talking to the patientUnfortunately, the online authorizations are never a guarantee of paymentWhen the office submitted the claim on 5/18/it was deniedOn 6/2/15, the claim was resubmitted, in which the office received another denial on 6/22/On 8/10/15, the Central Billing department notified Summit Eye Care that the patient was not eligible and that she had received glasses with her material benefits elsewhereOur policy states that the bill then becomes the responsibility of the insured at this point and the patient began to receive statementsAfter the patient's initial phone call, the staff began to contact her insurance for a resolutionOn 9/7, the insurance company stated the patient had used her benefits on glassesBased on conversations with the patients insurance, as noted above, it appears that her claim for glasses was processed prior to that of her contact lenses and resulted in the claim from Summit Eye Care being denied OFFER: Because the patients inconvenience and Summit Eye Care's lack of a timely resolution, the patients balance has been adjusted off and she will no longer receive statements

Initial Business Response /* (1000, 5, 2018/01/04) */
After looking further into this matter the patient will be refunded the $

Initial Business Response /* (1000, 5, 2018/01/04) */
After looking further into this matter the patient will be refunded the $

Case #*** The complainant was referred to and seen at the Cataract and Laser Institute Clinic for a new cataract evaluation on 2/1/for her right eye. During the visit, different vision correcting options were discussed during the exam process culminating with a discussion of costs associated with the surgery option that was chosen by the patient and scheduled. Appropriate paperwork was prepared and signed by the patient including Advance Beneficiary Notices for laser guided options that would not be covered by the patient’s insuranceAfter meeting with the surgeon on 3/10/in the clinic, the patient was referred to the CLI Surgery Center for surgery, again appropriate paperwork was prepared and signed by the patient regarding services provided by the surgery centerOn 4/14/the patient presented for evaluation of the 2nd eye with the Cataract and Laser institute and cleared for surgery of the left eyeAgain, appropriate paperwork was prepared and signed by the patient including Advance Beneficiary Notices for laser guided options that would not be covered by the patient’s insuranceThe patient was referred to the CLI Surgery Center for surgery. Again, appropriate paperwork was prepared and signed by the patient regarding services provided by the surgery centerIn accordance with the services that were agreed upon and provided at the respective dates of service for both the Cataract and Laser Institute and the CLI Surgery Center insurances were properly billed for the covered services and the patient responsible balance were billed to the patient. It should be noted that there was a large balance that was applied to the patient’s deductible by the patient’s insurance companyIn summary, upon review of the account it appears that appropriate discussions were held with the complainant on the dates of service, the patient’s insurance was appropriately billed for services provided and the outstanding balance is the responsibility of the patient. The complainant may contact our billing office for a detailed explanation and understanding of the charges billed for services provided at both the Cataract and Laser Institute and the CLI Surgery Center

Case #*** The complainant was referred to and seen at the Cataract and Laser Institute Clinic for a new cataract evaluation on 2/1/for her right eye. During the visit, different vision correcting options were discussed during the exam process culminating with a discussion of
costs associated with the surgery option that was chosen by the patient and scheduled. Appropriate paperwork was prepared and signed by the patient including Advance Beneficiary Notices for laser guided options that would not be covered by the patient’s insuranceAfter meeting with the surgeon on 3/10/in the clinic, the patient was referred to the CLI Surgery Center for surgery, again appropriate paperwork was prepared and signed by the patient regarding services provided by the surgery centerOn 4/14/the patient presented for evaluation of the 2nd eye with the Cataract and Laser institute and cleared for surgery of the left eyeAgain, appropriate paperwork was prepared and signed by the patient including Advance Beneficiary Notices for laser guided options that would not be covered by the patient’s insuranceThe patient was referred to the CLI Surgery Center for surgery. Again, appropriate paperwork was prepared and signed by the patient regarding services provided by the surgery centerIn accordance with the services that were agreed upon and provided at the respective dates of service for both the Cataract and Laser Institute and the CLI Surgery Center insurances were properly billed for the covered services and the patient responsible balance were billed to the patient. It should be noted that there was a large balance that was applied to the patient’s deductible by the patient’s insurance companyIn summary, upon review of the account it appears that appropriate discussions were held with the complainant on the dates of service, the patient’s insurance was appropriately billed for services provided and the outstanding balance is the responsibility of the patient. The complainant may contact our billing office for a detailed explanation and understanding of the charges billed for services provided at both the Cataract and Laser Institute and the CLI Surgery Center

Initial Business Response /* (1000, 5, 2015/10/05) */
Contact Name and Title: Dana ***, Compliance
The patient had an exam on Monday, August 10, At that time she decided to order a new pair of glasses and also order new lenses for the frames that she was wearing A tracing was done and
the patient was informed that we prefer to send the frames as there is always a slight chance that the lenses may not fit perfectly because lens tracings are not always accurate for a new frame The patient stated that she was unable to do so since she needs her glasses for school
The lenses that came back from the lab did not fit the patient's frame The patient opted to do another tracing In error, this tracing was sent from our office with missing information but not lost When we reached out to the patient again, the patient's mother told the Optician that the patient would bring in the frames to sendWe then attempted to wait for the patient to bring in her frame We eventually made the decision to use a frame off our frame board in the office (also not considered 100% accurate) to try and get the lens completedWe also asked the lab to rush themPatient came in on October 3rd to receive the glasses
OFFER:
We gave the patient a 20% patient satisfaction discount on the lens for the delay and inconvenience

Initial Business Response /* (1000, 5, 2017/09/18) */
In reading the patient's complaint, we can see how some misunderstandings could have occurredTypically, anyone who is diabetic is asked by their family physician to have their eyes checked by an eye doctor to look for diabetic retinopathy
With this patient's exam occurring over nine months ago, we cannot give specifics of any conversations that took placeHowever, for most patients when it is determined that a patient is diabetic, the conversation turns to the importance of a medical examination of the eye to watch for diabetic retinopathyAs part of that type of exam, we typically perform retinal photos to document the retinal appearanceThese photos are not sent to the family physicians, but kept as a baseline image to compare future photosOur practice is to inform that patient that insurance will be billed, not that it will be coveredThe exam was billed in an appropriate manner to medical insurance; however, it appears while his insurance allows the charges, the patient had not yet met his deductible and therefore had an amount to pay out of pocketWe want the patient to be happy with his interaction with the doctor and the office, so we will do what we must to make this rightWe feel it reasonable to rebill his exam in the most cost efficient way (meaning we will compare charging him with and without insurance), along with removing the cost of the photos (since our goal of expressing the importance of these images obviously wasn't achieved)Our hope is that the patient has less of a sour taste about our office after this, but more importantly we hope we continues to get his eyes checked for diabetic changes
Initial Consumer Rebuttal /* (3000, 7, 2017/09/19) */
(The consumer indicated he/she DID NOT accept the response from the business.)
I would like to see what they are now charging me before I accept the responseI was barely in the office an hour from the time of arrival until the time I left that dayI had already paid for a annual eye examThere is no way this process required an additional 45+ minute Dr visit as was billed
Final Business Response /* (4000, 9, 2017/09/20) */
It was determined that they patient had routine vision coverage through another insurance which was not known or presented at the time of the visitIn keeping with what the patient originally intended to accomplish with this exam (a contact lens exam - not medical for his diabetes) the claim was refiled with the routine vision coverage and the medical insurance is in the process of being refundedThe remaining charges due from the patient have been adjusted off for patient satisfaction

Initial Business Response /* (1000, 5, 2017/09/18) */
In reading the patient's complaint, we can see how some misunderstandings could have occurred Typically, anyone who is diabetic is asked by their family physician to have their eyes checked by an eye doctor to look for diabetic retinopathy
With this patient's exam occurring over nine months ago, we cannot give specifics of any conversations that took place However, for most patients when it is determined that a patient is diabetic, the conversation turns to the importance of a medical examination of the eye to watch for diabetic retinopathy As part of that type of exam, we typically perform retinal photos to document the retinal appearance These photos are not sent to the family physicians, but kept as a baseline image to compare future photos Our practice is to inform that patient that insurance will be billed, not that it will be covered The exam was billed in an appropriate manner to medical insurance; however, it appears while his insurance allows the charges, the patient had not yet met his deductible and therefore had an amount to pay out of pocket We want the patient to be happy with his interaction with the doctor and the office, so we will do what we must to make this right We feel it reasonable to rebill his exam in the most cost efficient way (meaning we will compare charging him with and without insurance), along with removing the cost of the photos (since our goal of expressing the importance of these images obviously wasn't achieved) Our hope is that the patient has less of a sour taste about our office after this, but more importantly we hope we continues to get his eyes checked for diabetic changes
Initial Consumer Rebuttal /* (3000, 7, 2017/09/19) */
(The consumer indicated he/she DID NOT accept the response from the business.)
I would like to see what they are now charging me before I accept the response I was barely in the office an hour from the time of arrival until the time I left that day I had already paid for a annual eye exam There is no way this process required an additional 45+ minute Dr visit as was billed
Final Business Response /* (4000, 9, 2017/09/20) */
It was determined that they patient had routine vision coverage through another insurance which was not known or presented at the time of the visit In keeping with what the patient originally intended to accomplish with this exam (a contact lens exam - not medical for his diabetes) the claim was refiled with the routine vision coverage and the medical insurance is in the process of being refunded The remaining charges due from the patient have been adjusted off for patient satisfaction

Initial Business Response /* (1000, 5, 2015/09/14) */
Contact Name and Title: [redacted], Compliance
The patient was seen at Summit Eye Care office 4/21/and returned for the Contact lens follon 5/4/She was informed she would not be eligible for materials at that time because she had
ordered contact lenses in June of the previous year with the officeThe office also obtained an online authorization for the exam stating the date she would be eligible for materials and referenced this when talking to the patient Unfortunately, the online authorizations are never a guarantee of payment When the office submitted the claim on 5/18/it was deniedOn 6/2/15, the claim was resubmitted, in which the office received another denial on 6/22/On 8/10/15, the Central Billing department notified Summit Eye Care that the patient was not eligible and that she had received glasses with her material benefits elsewhereOur policy states that the bill then becomes the responsibility of the insured at this point and the patient began to receive statements After the patient's initial phone call, the staff began to contact her insurance for a resolutionOn 9/7, the insurance company stated the patient had used her benefits on glasses Based on conversations with the patients insurance, as noted above, it appears that her claim for glasses was processed prior to that of her contact lenses and resulted in the claim from Summit Eye Care being denied
OFFER:
Because the patients inconvenience and Summit Eye Care's lack of a timely resolution, the patients balance has been adjusted off and she will no longer receive statements

Case #[redacted]   The complainant was referred to and seen at the Cataract and Laser Institute Clinic for a new cataract evaluation on 2/1/2017 for her right eye.  During the visit, different vision correcting options were discussed during the exam process culminating with a discussion of costs associated with the surgery option that was chosen by the patient and scheduled.  Appropriate paperwork was prepared and signed by the patient including Advance Beneficiary Notices for laser guided options that would not be covered by the patient’s insurance. After meeting with the surgeon on 3/10/2017 in the clinic, the patient was referred to the CLI Surgery Center for surgery, again appropriate paperwork was prepared and signed by the patient regarding services provided by the surgery center. On 4/14/2017 the patient presented for evaluation of the 2nd eye with the Cataract and Laser institute and cleared for surgery of the left eye. Again, appropriate paperwork was prepared and signed by the patient including Advance Beneficiary Notices for laser guided options that would not be covered by the patient’s insurance. The patient was referred to the CLI Surgery Center for surgery.  Again, appropriate paperwork was prepared and signed by the patient regarding services provided by the surgery center. In accordance with the services that were agreed upon and provided at the respective dates of service for both the Cataract and Laser Institute and the CLI Surgery Center insurances were properly billed for the covered services and the patient responsible balance were billed to the patient.  It should be noted that there was a large balance that was applied to the patient’s deductible by the patient’s insurance company. In summary, upon review of the account it appears that appropriate discussions were held with the complainant on the dates of service, the patient’s insurance was appropriately billed for services provided and the outstanding balance is the responsibility of the patient.   The complainant may contact our billing office for a detailed explanation and understanding of the charges billed for services provided at both the Cataract and Laser Institute and the CLI Surgery Center.

Case #[redacted]   The complainant was referred to and seen at the Cataract and Laser Institute Clinic for a new cataract evaluation on 2/1/2017 for her right eye.  During the visit, different vision correcting options were discussed during the exam process culminating with a discussion of...

costs associated with the surgery option that was chosen by the patient and scheduled.  Appropriate paperwork was prepared and signed by the patient including Advance Beneficiary Notices for laser guided options that would not be covered by the patient’s insurance. After meeting with the surgeon on 3/10/2017 in the clinic, the patient was referred to the CLI Surgery Center for surgery, again appropriate paperwork was prepared and signed by the patient regarding services provided by the surgery center. On 4/14/2017 the patient presented for evaluation of the 2nd eye with the Cataract and Laser institute and cleared for surgery of the left eye. Again, appropriate paperwork was prepared and signed by the patient including Advance Beneficiary Notices for laser guided options that would not be covered by the patient’s insurance. The patient was referred to the CLI Surgery Center for surgery.  Again, appropriate paperwork was prepared and signed by the patient regarding services provided by the surgery center. In accordance with the services that were agreed upon and provided at the respective dates of service for both the Cataract and Laser Institute and the CLI Surgery Center insurances were properly billed for the covered services and the patient responsible balance were billed to the patient.  It should be noted that there was a large balance that was applied to the patient’s deductible by the patient’s insurance company. In summary, upon review of the account it appears that appropriate discussions were held with the complainant on the dates of service, the patient’s insurance was appropriately billed for services provided and the outstanding balance is the responsibility of the patient.   The complainant may contact our billing office for a detailed explanation and understanding of the charges billed for services provided at both the Cataract and Laser Institute and the CLI Surgery Center.

Initial Business Response /* (1000, 5, 2015/09/14) */
Contact Name and Title: [redacted], Compliance
The patient was seen at Summit Eye Care office 4/21/15 and returned for the Contact lens follow-up on 5/4/15. She was informed she would not be eligible for materials at that time because she had...

ordered contact lenses in June of the previous year with the office. The office also obtained an online authorization for the exam stating the date she would be eligible for materials and referenced this when talking to the patient. Unfortunately, the online authorizations are never a guarantee of payment. When the office submitted the claim on 5/18/15 it was denied. On 6/2/15, the claim was resubmitted, in which the office received another denial on 6/22/15. On 8/10/15, the Central Billing department notified Summit Eye Care that the patient was not eligible and that she had received glasses with her material benefits elsewhere. Our policy states that the bill then becomes the responsibility of the insured at this point and the patient began to receive statements. After the patient's initial phone call, the staff began to contact her insurance for a resolution. On 9/7, the insurance company stated the patient had used her benefits on glasses. Based on conversations with the patients insurance, as noted above, it appears that her claim for glasses was processed prior to that of her contact lenses and resulted in the claim from Summit Eye Care being denied.
OFFER:
Because the patients inconvenience and Summit Eye Care's lack of a timely resolution, the patients balance has been adjusted off and she will no longer receive statements.

Initial Business Response /* (1000, 5, 2015/10/05) */
Contact Name and Title: Dana [redacted], Compliance
The patient had an exam on Monday, August 10, 2015. At that time she decided to order a new pair of glasses and also order new lenses for the frames that she was wearing. A tracing was done and...

the patient was informed that we prefer to send the frames as there is always a slight chance that the lenses may not fit perfectly because lens tracings are not always accurate for a new frame. The patient stated that she was unable to do so since she needs her glasses for school.
The lenses that came back from the lab did not fit the patient's frame. The patient opted to do another tracing. In error, this tracing was sent from our office with missing information but not lost. When we reached out to the patient again, the patient's mother told the Optician that the patient would bring in the frames to send. We then attempted to wait for the patient to bring in her frame. We eventually made the decision to use a frame off our frame board in the office (also not considered 100% accurate) to try and get the lens completed. We also asked the lab to rush them. Patient came in on October 3rd to receive the glasses.
OFFER:
We gave the patient a 20% patient satisfaction discount on the lens for the delay and inconvenience.