Mary Ruth Buchness MD

[redacted] presented to our office in June, requesting treatment with excimer laser, which had worked successfully for her in the pastWe routinely call the insurance company as a courtesy to the patient to get prior authorization for this procedurePrior authorization does not mean that the patient is not obligated to pay co-pays, co-insurance, or deductibles, which we are contractually obligated to collect from the patient to avoid being in breach of contractWhen we contacted [redacted] ’s insurance company for prior authorization, we were told that prior authorization was not necessary for either code, so her dispute with the perceived coding error is irrelevantShe would have been responsible for the same copay for either code and at any physician’s office Co-pays vary from patient to patient, and some insurance companies charge a different copay for laser treatment than for doctor’s visitsWe typically are not informed by the insurance company about the patient’s obligation for a month, by which time, they may have had treatmentsAt no time, does the staff tell patients that they do not have a copay In this case, we tried to work out a payment plan with [redacted] so that she would not be responsible for the entire bill at once, but she does not feel that she should have to payShe sent us her monthly cable, phone, and rent bills to demonstrate that she is unable to payUnfortunately, what she does not realize is that her insurance company requires us to collect these feesThey are not set by this officeWe share her frustration in navigating the world of medical insurance

[redacted] presented to our office in June, 2013 requesting treatment with excimer laser, which had worked successfully for her in the past. We routinely call the insurance company as a courtesy to the...

patient to get prior authorization for this procedure. Prior authorization does not mean that the patient is not obligated to pay co-pays, co-insurance, or deductibles, which we are contractually obligated to collect from the patient to avoid being in breach of contract. When we contacted [redacted]’s insurance company for prior authorization, we were told that prior authorization was not necessary for either code, so her dispute with the perceived coding error is irrelevant. She would have been responsible for the same copay for either code and at any physician’s office.
Co-pays vary from patient to patient, and some insurance companies charge a different copay for laser treatment than for doctor’s visits. We typically are not informed by the insurance company about the patient’s obligation for a month, by which time, they may have had 8 treatments. At no time, does the staff tell patients that they do not have a copay.
In this case, we tried to work out a payment plan with [redacted] so that she would not be responsible for the entire bill at once, but she does not feel that she should have to pay. She sent us her monthly cable, phone, and rent bills to demonstrate that she is unable to pay. Unfortunately, what she does not realize is that her insurance company requires us to collect these fees. They are not set by this office. We share her frustration in navigating the world of medical insurance

This is a busy office where we do dozens of phototherapy
treatments a week, and there are policies and procedures in place.  The copay for a phototherapy visit may be
less than the copay for an office visit, so patients are informed that they can
pay their normal copay and be reimbursed by the office if they overpay, or they
can pay when we get the information on the copay amount from the insurance
company.  I’m very sorry that this was
misinterpreted as “you never have to pay”. 
This is the first time that this has happened in this office, so I know
that it was not a staff problem. With regards to the assertion that the staff
could have called her insurance company, please see the attached intake
form,  of which there is a signed copy in
[redacted]’s chart.  Please note the
bold faced sentence ”It must be your responsibility to know and advise us of
your program’s requirements in advance, each and every time we provide a
service,” and the second bold faced sentence “These are not our regulations,
they are your insurance company’s…”
An invoice for $200 was mailed from the office on
7/**/13.  Yet, [redacted] continued
to come for treatment after this would have been received, I estimate 5 more
treatments.  There is no correspondence
from her questioning this bill.  I know
that she claims not to have received the invoices or the EOB’s from her
insurance company, but  I don’t know how
this is possible if she gave us the correct address.
I spoke with my attorney, who told me that it is insurance
fraud not to charge a copay.  So my hands
are tied.  We can do a payment plan, or
[redacted] can go to collections.

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID [redacted], and find that this resolution is satisfactory to me and the matter has been resolved but I would like to respond to the business' previous message.
 
1) I never claimed to not receive a bill. In fact, I received the bill at the office on my 8th visit, refused treatment, and then cancelled all future appointments. I also talked to the nurse who gave me treatment that day about the bill who informed me that the office got it authorized under the wrong code. After each time I received a bill, I called your office, but conveniently your billing department is outsourced and I talked to [redacted], who told me she would get back to me and never did. I probably called 3 times after that too to question the bill.
 
2) Being a 24 year old girl,  I feel taken advantage of completely by your office. I asked all the questions upfront to avoid the situation I am in and look where that got me. If hundreds of patients receive this treatment, then you should have known to ask for a copay on my first visit- not ask for all my missed copays on my 8th visit. 
 
3) I spoke to my insurance company who informed me multiple times that it is up to the doctors office to charge a copay since that is the money the doctor's office puts in their pocket. It is not insurance fraud, but I will be sure to print your message and give it to my insurance company to see if they agree. Your office also told me copays could be waived if you show financial hardship - but it follows the theme of your office - I get different information every time I talk to someone. 
 
4) I will accept a payment plan of $25.00 a month and you can send a monthly bill to my address on file. 
Sincerely,
[redacted]

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID# [redacted], and have determined that my complaint has NOT been resolved because:

[Your Answer Here]
 
 I asked your office upfront about a co pay multiple times and was told each time there was no copay. The insurance company also told me they would have told you this on the phone about the copay so someone clearly forgot to relay the information to me. I made it clear I could not afford treatment if I had to pay a copay of $50 two times a week and if I knew it would cost me that I wouldn't have accepted treatment. You office said sorry for the miscommunication but clearly you are doing nothing to rectify it. A payment plan is still giving you $450 I was originally told I would not have to pay and still taking money from me that I do not have. It's on principle that your office wrongly conveyed information to me on a bill that I wasn't expecting to receive based on my conversation with the office. I think the office should accept some responsibility and pay half the bill and call it a done deal. 
 
 
In order for the Revdex.com to appropriately process your response, you MUST answer the question above.
Sincerely,
[redacted]

Review: I came to this office and saw [redacted] (who is no longer at the office) for vitiligo. She recommended laser treatments and said the office would check with my insurance company to see if the treatments were covered. When I spoke to the receptionist about treatment, I was informed that insurance would cover treatment and when I asked about the co-pay, I was told there was no copay. This was one of the many reasons I chose to go to this practice because as a 24 year old I cannot afford spending $100 a week on laser treatments. I came to the office 7 times, not once was I asked for a copay. Then on my 8th visit I was then given a bill for $350. I was shocked because I had asked several times if I had to pay a copay and numerous times I was told no. When I spoke to the person at the desk who looked further into this, she told me the office got preauthorization under the wrong code (the code was for a larger skin area and I was being treated for the smaller area) and then the office billed my insurance company under the code for the smaller treatment area , which required a copay. The larger area did not. I was very upset by this as I stated before treatment I could not afford to pay this. If I was properly informed by the office I would have asked for an alternate, less costly treatment option or chosen to not proceed. I also dont think its fair to be held accountable for these co-pays when the error of getting pre-authorization under the wrong code was made by this office.I contacted my insurance company to see how this should have been handled. They said they would have told the office over the phone that there was a copay with this treatment so someone was clearly misinformed and now I was being charged for all the missed copays. The office said the only way to get cleared of copays is to show you financially can't pay. I submitted all my financal papers and was told basically they were sorry for the miscommunication and I could be put in a payment planDesired Settlement: I don't think I should be held accountable for this bill - it was an error made by the doctor's office and now I have to pay for a "miscommunication." It's really not fair - I was under the assumption that there were no copays and went to the office 7 times before I got this bill for copays! Now, the bill went up to $450 based on two visits not in the initial bill.

Business

Response:

[redacted] presented to our office in June, 2013 requesting treatment with excimer laser, which had worked successfully for her in the past. We routinely call the insurance company as a courtesy to the patient to get prior authorization for this procedure. Prior authorization does not mean that the patient is not obligated to pay co-pays, co-insurance, or deductibles, which we are contractually obligated to collect from the patient to avoid being in breach of contract. When we contacted [redacted]’s insurance company for prior authorization, we were told that prior authorization was not necessary for either code, so her dispute with the perceived coding error is irrelevant. She would have been responsible for the same copay for either code and at any physician’s office.

Co-pays vary from patient to patient, and some insurance companies charge a different copay for laser treatment than for doctor’s visits. We typically are not informed by the insurance company about the patient’s obligation for a month, by which time, they may have had 8 treatments. At no time, does the staff tell patients that they do not have a copay.

In this case, we tried to work out a payment plan with [redacted] so that she would not be responsible for the entire bill at once, but she does not feel that she should have to pay. She sent us her monthly cable, phone, and rent bills to demonstrate that she is unable to pay. Unfortunately, what she does not realize is that her insurance company requires us to collect these fees. They are not set by this office. We share her frustration in navigating the world of medical insurance

Consumer

Response:

I have reviewed the response made by the business in reference to complaint ID# [redacted], and have determined that my complaint has NOT been resolved because:

[Your Answer Here]

I asked your office upfront about a co pay multiple times and was told each time there was no copay. The insurance company also told me they would have told you this on the phone about the copay so someone clearly forgot to relay the information to me. I made it clear I could not afford treatment if I had to pay a copay of $50 two times a week and if I knew it would cost me that I wouldn't have accepted treatment. You office said sorry for the miscommunication but clearly you are doing nothing to rectify it. A payment plan is still giving you $450 I was originally told I would not have to pay and still taking money from me that I do not have. It's on principle that your office wrongly conveyed information to me on a bill that I wasn't expecting to receive based on my conversation with the office. I think the office should accept some responsibility and pay half the bill and call it a done deal.

In order for the Revdex.com to appropriately process your response, you MUST answer the question above.

Sincerely,

Business

Response:

This is a busy office where we do dozens of phototherapy

treatments a week, and there are policies and procedures in place. The copay for a phototherapy visit may be

less than the copay for an office visit, so patients are informed that they can

pay their normal copay and be reimbursed by the office if they overpay, or they

can pay when we get the information on the copay amount from the insurance

company. I’m very sorry that this was

misinterpreted as “you never have to pay”.

This is the first time that this has happened in this office, so I know

that it was not a staff problem. With regards to the assertion that the staff

could have called her insurance company, please see the attached intake

form, of which there is a signed copy in

[redacted]’s chart. Please note the

bold faced sentence ”It must be your responsibility to know and advise us of

your program’s requirements in advance, each and every time we provide a

service,” and the second bold faced sentence “These are not our regulations,

they are your insurance company’s…”

An invoice for $200 was mailed from the office on

7/**/13. Yet, [redacted] continued

to come for treatment after this would have been received, I estimate 5 more

treatments. There is no correspondence

from her questioning this bill. I know

that she claims not to have received the invoices or the EOB’s from her

insurance company, but I don’t know how

this is possible if she gave us the correct address.

I spoke with my attorney, who told me that it is insurance

fraud not to charge a copay. So my hands

are tied. We can do a payment plan, or

[redacted] can go to collections.

Consumer

Response:

I have reviewed the response made by the business in reference to complaint ID [redacted], and find that this resolution is satisfactory to me and the matter has been resolved but I would like to respond to the business' previous message.