Marci Krop Cook, M.D. FACOG

[To assist us in bringing this matter to a close, you must give us a reason why you are rejecting the responseIf no reason is received your complaint will be closed Administratively Resolved] Complaint: [redacted] I am rejecting this response because: What happened exactly is, I went through a couple of office visit with DrKrop, after I have paid my deductible, the lady at the office specifically told me that procedure should be covered by my insuranceShe said she will contact [redacted] radiology for the HSG test, she also told that if it wasn't covered by my insurance that we can look for another place, but they prefer to use [redacted] radiologyI appreciate her taking the time to set up the appointment for the procedure, but had she informed me that she wasn't sure it would be covered and that I would have to contact my insurance to verify, I would have done my own search, but she never mentioned that being an issue I am going by what they told meHad I knew all this from the beginning, I would've made different choicesThe treatment is very expensive and everything counts Regards, [redacted]

November 7, Dear [redacted] This response is being provided in response to the claims made to you by MsXXX regarding an insurance billing matter between herself and the hospital's Radiology DepartmentI am disappointed that I have had to take the time away from my patients to address this matter, and I ask that you close it immediatelyAs I explain below, MsXXX (1) has mistakenly assumed that my office is responsible for managing her insurance policy, when in fact it is her responsibility, and (2) unfairly claims that my Staff gave her misleading information ahout her insurance coverage, when in fact her claim denial occurred as a result of an insurance billing error committed by the Radiology Department.As to the first point, it is a patient's responsibility to understand the bounds of her own insurance coverage, not the responsibility of me or my Staff, and consequently it is also the patient’s responsibility to contact a service provider (in this case, the Radiology Department at the hospital, not me) to resolve any billing issuesSimply put, this is not a matter between patient and doctor, and the Revdex.com's attention to it is mis-directed.As to the second point, my Staff did not provide any misleading information to MsXXX regarding her insurance coverageIt is true that my Staff will often as a courtesy for our patients try to verify their insurance coverages, and furthermore it is also true that in cases such as this involving a prescription for an X-ray, my Staff will typically undertake the scheduling of patients' appointments on their behalf, again as a courtesyFor some reason, MsXXX apparently believes that a courtesy offered to her somehow displaces her responsibility to manage Her own insurance; it does not.More importantly, my Staff did not mislead MsXXX; the simple explanation is that her claim was denied because the Radiology Department made an insurance billing error by failing to attach the necessary "authorization number" to the insurance claim that they submitted on her behalf(Had this patient contacted the Radiology Department rather than complaining to you about my Staff, this error would likely have been quickly discovered) In that regard, would point out that - notwithstanding MsXXX's actions - my Staff nevertheless undertook to contact the Radiology Department on her behalf, and it was my Staff who discovered the Radiology Department's billing errorWe understand that the claim has now been resubmitted by the Radiology Department, and that it should be paid.To summarize, we are not responsible for the billing procedures of an entity that is completely independent from us, i.e., the Radiology Department at the hospital, and we did not do anything misleadingI again ask that this matter be closed immediatelyAnd, as a final aside, I am hopeful that this patient will have the courtesy to call my staff and apologizeSincerely,

From: *** ***Date: Sat, Nov 22, at 6:AMSubject: Complaint # ***To: "[email protected]"
This is in regards to complaint # ***, I would like to close the complaintI don't see there Is anything that The Doctor can do to resolve this, but they should be careful what they tell patients and who they refer them tooAlso, I realized with the new insurances through the market place, most practices are not educated enough about it and that is why I was billed wrongPlease let me know what I need to do
Thanks
*** ***

November 7, 2014
Dear [redacted]This response is being provided in response to the claims made to you by Ms. XXX regarding an insurance billing matter between herself and the hospital's Radiology Department. I am disappointed that I have had to take the time away from my patients...

to address this matter, and I ask that you close it immediately. As I explain below, Ms. XXX (1) has mistakenly assumed that my office is responsible for managing her insurance policy, when in fact it is her responsibility, and (2) unfairly claims that my Staff gave her misleading information ahout her insurance coverage, when in fact her claim denial occurred as a result of an insurance billing error committed by the Radiology Department.As to the first point, it is a patient's responsibility to understand the bounds of her own insurance coverage, not the responsibility of me or my Staff, and consequently it is also the patient’s responsibility to contact a service provider (in this case, the Radiology Department at the hospital, not me) to resolve any billing issues. Simply put, this is not a matter between patient and doctor, and the Revdex.com's attention to it is mis-directed.As to the second point, my Staff did not provide any misleading information to Ms. XXX regarding her insurance coverage. It is true that my Staff will often as a courtesy for our patients try to verify their insurance coverages, and furthermore it is also true that in cases such as this involving a prescription for an X-ray, my Staff will typically undertake the scheduling of patients' appointments on their behalf, again as a courtesy. For some reason, Ms. XXX apparently believes that a courtesy offered to her somehow displaces her responsibility to manage Her own insurance; it does not.More importantly, my Staff did not mislead Ms. XXX; the simple explanation is that her claim was denied because the Radiology Department made an insurance billing error by failing to attach the necessary "authorization number" to the insurance claim that they submitted on her behalf. (Had this patient contacted the Radiology Department rather than complaining to you about my Staff, this error would likely have been quickly discovered) In that regard, 1 would point out that - notwithstanding Ms. XXX's actions - my Staff nevertheless undertook to contact the Radiology Department on her behalf, and it was my Staff who discovered the Radiology Department's billing error. We understand that the claim has now been resubmitted by the Radiology Department, and that it should be paid.To summarize, we are not responsible for the billing procedures of an entity that is completely independent from us, i.e., the Radiology Department at the hospital, and we did not do anything misleading. I again ask that this matter be closed immediately. And, as a final aside, I am hopeful that this patient will have the courtesy to call my staff and apologize.
Sincerely,

[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 Administratively Resolved]
 Complaint: [redacted]
I am rejecting this response because:
What happened exactly is, I went through a couple of office visit with Dr. Krop, after I have paid my deductible, the lady at the office specifically told me that procedure should be covered by my insurance. She said she will contact [redacted] radiology for the HSG test, she also told that if it wasn't covered by my insurance that we can look for another place, but they prefer to use [redacted] radiology. I appreciate her taking the time to set up the appointment for the procedure, but had she informed me that she wasn't sure it would be covered and that I would have to contact my insurance to verify, I would have done my own search, but she never mentioned that being an issue. 
I am going by what they told me. Had I knew all this from the beginning, I would've made different choices. The treatment is very expensive and everything counts. 
Regards,
[redacted]

November 24, 2014
Dear [redacted]I have reviewed the November 14 response. Unfortunately, I have nothing further to add. It does not appear that Ms. XXX has understood my earlier response. Let me repeat it. This was a billing error made by the Radiology Department not by us. Worse yet, the matter was only resolved (the bill will be paid by her insurance company) because my Staff did what the patient should have done in the first place: called the Radiology Department to resolve the matter. As I said earlier, my Staff will often as a courtesy try to help our patients figure out their insurance coverages, but ultimately it is the patient's responsibility to do so, Ms. XXX appears to believe that my Staff's statement "that [the] procedure should be covered" somehow eliminated her responsibility to investigate why her claim wasn't paid- That is simply not correct.Please close this file immediately before 1 am forced to consider what other action I need to take in response.
Sincerely,

Review: Dr. Marci Krop sent me to [redacted] Radiology after telling me the procedure that I needed done was covered by my Insurance. They also said that if [redacted] Radiology doesn't accept my insurance they will send me to another provider. but they called me a few days later and scheduled an appointment for me at [redacted] radiology saying it was covered by my insurance. 3 months later I receive a bill for $504.00. I wasn't given the choice to either accept or reject and was sent there under the impression it was covered.Desired Settlement: remove or assume responsibility for the charge of $504.00 from [redacted] Radiology

Business

Response:

November 7, 2014Dear [redacted]This response is being provided in response to the claims made to you by Ms. XXX regarding an insurance billing matter between herself and the hospital's Radiology Department. I am disappointed that I have had to take the time away from my patients to address this matter, and I ask that you close it immediately. As I explain below, Ms. XXX (1) has mistakenly assumed that my office is responsible for managing her insurance policy, when in fact it is her responsibility, and (2) unfairly claims that my Staff gave her misleading information ahout her insurance coverage, when in fact her claim denial occurred as a result of an insurance billing error committed by the Radiology Department.As to the first point, it is a patient's responsibility to understand the bounds of her own insurance coverage, not the responsibility of me or my Staff, and consequently it is also the patient’s responsibility to contact a service provider (in this case, the Radiology Department at the hospital, not me) to resolve any billing issues. Simply put, this is not a matter between patient and doctor, and the Revdex.com's attention to it is mis-directed.As to the second point, my Staff did not provide any misleading information to Ms. XXX regarding her insurance coverage. It is true that my Staff will often as a courtesy for our patients try to verify their insurance coverages, and furthermore it is also true that in cases such as this involving a prescription for an X-ray, my Staff will typically undertake the scheduling of patients' appointments on their behalf, again as a courtesy. For some reason, Ms. XXX apparently believes that a courtesy offered to her somehow displaces her responsibility to manage Her own insurance; it does not.More importantly, my Staff did not mislead Ms. XXX; the simple explanation is that her claim was denied because the Radiology Department made an insurance billing error by failing to attach the necessary "authorization number" to the insurance claim that they submitted on her behalf. (Had this patient contacted the Radiology Department rather than complaining to you about my Staff, this error would likely have been quickly discovered) In that regard, 1 would point out that - notwithstanding Ms. XXX's actions - my Staff nevertheless undertook to contact the Radiology Department on her behalf, and it was my Staff who discovered the Radiology Department's billing error. We understand that the claim has now been resubmitted by the Radiology Department, and that it should be paid.To summarize, we are not responsible for the billing procedures of an entity that is completely independent from us, i.e., the Radiology Department at the hospital, and we did not do anything misleading. I again ask that this matter be closed immediately. And, as a final aside, I am hopeful that this patient will have the courtesy to call my staff and apologize.Sincerely,

Consumer

Response:

[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 Administratively Resolved]

Review: [redacted]

I am rejecting this response because: