Metropolitan Pathologists

MetroPath response as follows: I have sent documentation showing the patient was sent statements on 11/23/and 12/23/ On 12/23/a call was received from the patient's clinic [redacted] asking why [redacted] had denied tests and had paid other tests at 100% for same date of serviceOur representative explained that according to the charges not paid, [redacted] had denied as non covered due to patient's age and the reported diagnosis was not covered, even though they had paid the other two tests in full with the same diagnosisThe explanations of benefits are also included in the documents I have sent On On 1/5/patient called our phone line giving insurance infoOn 1/8/our representative called [redacted] and the voice mail box was fullLater that same day another call was made to the patient and there was no answerA statement was sent on 1/22/notifying the patient collection action would be taken if not responded to in days The patient needs to contact [redacted] as to why they denied services MetroPath is not responsible for the diagnosis codes, those must be received from the physician We billed according to the diagnosis code that was sent on the requisition from the doctor.Patient's account was not turned to collection until March 15, 2016.Sincerely, [redacted] Revenue Service Manager

Complaint: [redacted] I am rejecting this response because:This is still not settled and not our faultI wasn't contacted for a year that there was a problem and was just sent a bill in the mail by this company insteadAfter many attempts to resolve this I hung up on one of the calls because I tried over and over to give them my correct insurance information and they refused to take itThey kept telling me I had Medicaid which I didn't and that I had to pay for it anywayI will be satisfied when it is settled with my insurance or the bill to me is removed Sincerely, [redacted]

To whom it may concern:The claim that is at the heart of this dispute was actually incorrectly processed by [redacted] We apologize for the confusion caused by our outside customer service divisionWe have since informed them that if a patient, or parent of a patient, is upset and hangs up on a call they are to inform the billing manager here at MetroPath so we can work on resolving the issue in a more timely manner The timeline of what has happened with this claim is as follows, and the documents attached to this statement are provided to support this timeline- MetroPath billed out a claim for the services rendered to the patients insurance, using the ID as listed on the patient information sheet received from the clinic [redacted] - [redacted] processed the claim 12/31/and denied for CO140/N(Patient/Insured health ID# and name do not match/Do not resubmit claim).-The remark code Nis significant because when that appears on a claim in conjunction with COor OAit means that [redacted] has changed the patient’s alpha prefix on their ID number and will correct and reprocess the claim internally without any input from the billing provider.- [redacted] reprocessed claim on 1/13/and changed ID to ZEBZECM13686684, but still denied it for CO140/Nmeaning that they still needed to correct the alpha prefix.- [redacted] reprocessed claim again on 1/16/and changed ID to ZECM13686684, and denied it for OA(impact of prior payer adjudication).- The claim was left alone until 6/9/when it was rebilled to [redacted] under the original ID that was billed.- [redacted] processed the rebilled claim and denied for OA133/N(Disposition of claim is pending further review/Do not resubmit claim), which as stated earlier means that [redacted] is changing the alpha prefix of the ID and will reprocess internally.- [redacted] reprocessed claim on 7/15/and changed ID to ZECM13686684, and denied the claim for CO(time limit for filing has expired).- A phone call was then placed on 8/10/to [redacted] to discuss the COdenial because MetroPath has days from the date of service to file claims for ***, and the claim was sent back for reprocessing.- [redacted] reprocessed claim on 8/13/under ID ZECMand denied for PR(Service is not covered under patients benefit plan).- Another phone call was placed to [redacted] on 8/24/to find out why the service wasn’t covered, and an inquiry was sent back to the benefit department at [redacted] to furnish this information.- In response to the inquiry sent back [redacted] actually reprocessed the claim again on 8/27/and denied for PR(Services not authorized by network), which is the denial given when a provider is processed as out-of-network.- MetroPath is an in-network provider with [redacted] so another phone call was made to them on 9/10/to correct the mistake in processing and to have the claim reprocessed.- No response was received from [redacted] in regards to the previous inquiry, so a follcall was made 10/1/to find out if the claim had been successfully reprocessed.- On the 10/1/phone call MetroPath was informed that the patients plan was a state-funded Medicaid plan in Tennessee and that authorization was needed because no contract existed between MetroPath and that particular [redacted] plan.- The patient’s parents were then billed for the services since they were deemed not covered by the insurance.- In January of a series of calls were made between MetroPath and the referring clinic regarding this claim, and it came to light that an incorrect ID was originally billed.- The clinic then faxed over a copy of the insurance card showing the correct ID, and the claim balance was removed from the patient’s parent’s responsibility and billed to [redacted] under the correct ID on 1/14/16.- [redacted] processed the claim with the correct ID on 1/18/and denied for CO(time limit for filing has expired).- An appeal was sent to [redacted] on 1/26/for the COdenial and as of 2/4/the claim is pending/being reviewed by ***In essence what this timeline shows is that MetroPath billed [redacted] using the ID provided by the referring clinic, which was incorrect, and [redacted] ended up processing the claim under another patient’s ID

To whom it may concern:*** *** *** has reprocessed this claimAn explanation of benefits should have already been sent to the consumer and any further questions regarding the claim can be directed to the insurance company

MetroPath response as follows:  I have sent documentation showing the patient was sent statements on 11/23/15 and 12/23/15.  On 12/23/15 a call was received from the patient's clinic [redacted] asking why [redacted] had denied  2 tests and had paid 2 other tests at 100% for same date...

of service. Our representative explained that according to the charges not paid, [redacted] had denied as non covered due to patient's age and the reported diagnosis was not covered, even though they had paid the other two tests in full with the same diagnosis. The explanations of benefits are also included in the documents I have sent.  On On 1/5/16 patient called our phone line giving insurance info. On 1/8/16 our representative called [redacted] and the voice mail box was full. Later that same day another call was made to the patient and there was no answer. A statement was sent on 1/22/16 notifying the patient collection action would be taken if not responded to in 10 days.  The patient needs to contact [redacted] as to why they denied services.  MetroPath is not responsible for the diagnosis codes, those must be received from the physician.  We billed according to the diagnosis code that was sent on the requisition from the doctor.Patient's account was not turned to collection until March 15, 2016.Sincerely, [redacted]Revenue Service Manager

Complaint: [redacted]
I am rejecting this response because:This is still not settled and not our fault. I wasn't contacted for a year that there was a problem and was just sent a bill in the mail by this company instead. After many attempts to resolve this I hung up on one of the calls because I tried over and over to give them my correct insurance information and they refused to take it. They kept telling me I had Medicaid which I didn't and that I had to pay for it anyway. I will be satisfied when it is settled with my insurance or the bill to me is removed.
Sincerely,
[redacted]

To whom it may concern:The claim that is at the heart of this dispute was actually incorrectly processed by [redacted]. We apologize for the confusion caused by our outside customer service division. We have since informed them that if a patient, or parent of a patient, is upset...

and hangs up on a call they are to inform the billing manager here at MetroPath so we can work on resolving the issue in a more timely manner.  The timeline of what has happened with this claim is as follows, and the documents attached to this statement are provided to support this timeline. - MetroPath billed out a claim for the services rendered to the patients insurance, using the ID as listed on the patient information sheet received from the clinic [redacted] processed the claim 12/31/14 and denied for CO140/N185 (Patient/Insured health ID# and name do not match/Do not resubmit claim).-The remark code N185 is significant because when that appears on a claim in conjunction with CO140 or OA133 it means that [redacted] has changed the patient’s alpha prefix on their ID number and will correct and reprocess the claim internally without any input from the billing provider.- [redacted] reprocessed claim on 1/13/15 and changed ID to ZEBZECM13686684, but still denied it for CO140/N185 meaning that they still needed to correct the alpha prefix.- [redacted] reprocessed claim again on 1/16/15 and changed ID to ZECM13686684, and denied it for OA23 (impact of prior payer adjudication).- The claim was left alone until 6/9/15 when it was rebilled to [redacted] under the original ID that was billed.- [redacted] processed the rebilled claim and denied for OA133/N185 (Disposition of claim is pending further review/Do not resubmit claim), which as stated earlier means that [redacted] is changing the alpha prefix of the ID and will reprocess internally.- [redacted] reprocessed claim on 7/15/15 and changed ID to ZECM13686684, and denied the claim for CO29 (time limit for filing has expired).- A phone call was then placed on 8/10/15 to [redacted] to discuss the CO29 denial because MetroPath has 365 days from the date of service to file claims for [redacted], and the claim was sent back for reprocessing.- [redacted] reprocessed claim on 8/13/15 under ID ZECM13686684 and denied for PR204 (Service is not covered under patients benefit plan).- Another phone call was placed to [redacted] on 8/24/15 to find out why the service wasn’t covered, and an inquiry was sent back to the benefit department at [redacted] to furnish this information.- In response to the inquiry sent back [redacted] actually reprocessed the claim again on 8/27/15 and denied for PR243 (Services not authorized by network), which is the denial given when a provider is processed as out-of-network.- MetroPath is an in-network provider with [redacted] so another phone call was made to them on 9/10/15 to correct the mistake in processing and to have the claim reprocessed.- No response was received from [redacted] in regards to the previous inquiry, so a follow-up call was made 10/1/15 to find out if the claim had been successfully reprocessed.- On the 10/1/15 phone call MetroPath was informed that the patients plan was a state-funded Medicaid plan in Tennessee and that authorization was needed because no contract existed between MetroPath and that particular [redacted] plan.- The patient’s parents were then billed for the services since they were deemed not covered by the insurance.- In January of 2016 a series of calls were made between MetroPath and the referring clinic regarding this claim, and it came to light that an incorrect ID was originally billed.- The clinic then faxed over a copy of the insurance card showing the correct ID, and the claim balance was removed from the patient’s parent’s responsibility and billed to [redacted] under the correct ID on 1/14/16.- [redacted] processed the claim with the correct ID on 1/18/16 and denied for CO29 (time limit for filing has expired).- An appeal was sent to [redacted] on 1/26/16 for the CO29 denial and as of 2/4/16 the claim is pending/being reviewed by [redacted]. In essence what this timeline shows is that MetroPath billed [redacted] using the ID provided by the referring clinic, which was incorrect, and [redacted] ended up processing the claim under another patient’s ID.

Complaint: [redacted]
I am rejecting this response because:
This is YOUR issue.  The age code you entered was wrong according to [redacted].  They told us you Only one letter was received from MetroPath.  No letter was received after I called to question the issue, no follow up at all.  Only other letter was a letter from the collection agency.Voice Mail is not and was not full and no missed calls showed up for your business.Bottom line: Communication is non-existent.  These issues were never explained at.  I want MetroPath to work with my Doctor office to get the correct codes and send a proper detailed statement with ALL communication.  And I want proof that this account has been pulled back from the collection agency and that no negative information will be put on any reports.Your staff on the phone is rude and unprofessional which is why we are going through Revdex.com.,
Sincerely,
[redacted]