Michael Wissa MD

8.5pt;">9/26/ Revdex.com: Complaint Management: ID # [redacted] In reference to the complaint from Mr***, I would like to refute his assertionsWhen someone has surgery, they will be billed by three entities: the surgeon, the anesthesiologist, and the hospital/facilityAll three of these entities are separate and they are not privy to charges incurred by the other entitiesDr [redacted] is an inpatient physician that administered anesthesia for Mr [redacted] on 7-15-Mr [redacted] states in his complaint that he was told by the surgeon, Dr [redacted] 's office, that what he paid their office would be all that he owedThis would be correct for Dr [redacted] ' charges, but the surgeon would not be able to determine this on behalf of Dr***, who separate from the surgeonDr [redacted] has a contract with Mr***'s insurance, and it is the insurance that ultimately determines the amount Dr [redacted] is paid and the amount Mr [redacted] owesAfter processing of the claim, the insurance company, NALC, provided an Explanation of Benefits to Dr***'s office and to Mr***This explanation informs all parties of the amount paid, the amount that contractually has to be discounted and the amount Mr [redacted] owedThe co-insurance amount Mr [redacted] owed is $57.60, which is dictated by the terms of his planAccording to the provisions of his plan, surgical charges will pay at 80% and Mr [redacted] is responsible for 20%We billed Mr [redacted] four times for the amount his insurance determined was his responsibility, and we called him twice to resolve this balanceOur office policy is that if the patient does not respond to our effort to collect on the balance, then the account will be sent to a collection agencyMr***'s complaint is unfounded because we are obligated by the terms of our contract with his insurance company just as he is obligated to the terms of his policyWe tried to reach the patient multiple times, and Mr [redacted] had ample opportunity to contact Dr***'s office if he disagreed with our billingPlease be advised that Dr [redacted] rendered Mr [redacted] services; and therefore, he needs to be paid the coinsurance of $according to the contract with the patient's insuranceDr ***'s followed the rules set forth by the contract with Mr***'s insurance planWe did not violate this contract or any other provisions that warrants Mr***'s complaintPlease withdraw this complaintYour attention in this matter is greatly appreciatedMy contact phone number is [redacted] , should you need any additional informationThank you, [redacted] Business Manager

Complaint: ***
I am rejecting this response because:As previously stated the insurance documentation I recieved from my insurance provider is clear that what was negotiated was paid and that I owed $If Dr *** now has buyers remorse because he now wants more money than what was negotiated between himself and my insurance provider than Mr *** should take that up qith the insurance providerWhat Dr *** is claiming is not what was bargained for and nobody should have to pay beyond what was agrred toDr *** is trying to get compensation above and beyond what is allowablethis is unnaceptableRegards,
*** ***

9/26/2015 Revdex.com: Complaint
Management: ID #*** In reference to the complaint from Mr***, I would like to refute his assertionsWhen someone has surgery, they will be billed by three entities: the surgeon, the anesthesiologist, and the hospital/facilityAll three of these entities are separate and they are not privy to charges incurred by the other entitiesDr*** is an inpatient physician that administered anesthesia for Mr*** on 7-15-Mr*** states in his complaint that he was told by the surgeon, Dr ***'s office, that what he paid their office would be all that he owedThis would be correct for Dr***' charges, but the surgeon would not be able to determine this on behalf of Dr***, who separate from the surgeonDr*** has a contract with Mr***'s insurance, and it is the insurance that ultimately determines the amount Dr*** is paid and the amount Mr*** owesAfter processing of the claim, the insurance company, NALC, provided an Explanation of Benefits to Dr***'s office and to Mr***This explanation informs all parties of the amount paid, the amount that contractually has to be discounted and the amount Mr*** owedThe co-insurance amount Mr*** owed is $57.60, which is dictated by the terms of his planAccording to the provisions of his plan, surgical charges will pay at 80% and Mr*** is responsible for 20%We billed Mr*** four times for the amount his insurance determined was his responsibility, and we called him twice to resolve this balanceOur office policy is that if the patient does not respond to our effort to collect on the balance, then the account will be sent to a collection agencyMr***'s complaint is unfounded because we are obligated by the terms of our contract with his insurance company just as he is obligated to the terms of his policyWe tried to reach the patient multiple times, and Mr*** had ample opportunity to contact Dr***'s office if he disagreed with our billingPlease be advised that Dr*** rendered Mr*** services; and therefore, he needs to be paid the coinsurance of $according to the contract with the patient's insuranceDr ***'s followed the rules set forth by the contract with Mr***'s insurance planWe did not violate this contract or any other provisions that warrants Mr***'s complaintPlease withdraw this complaintYour attention in this matter is greatly appreciatedMy contact phone number is *** ***, should you need any additional informationThank you, *** *** Business Manager

Mr*** would not have been able to negotiate any rate with Dr*** prior to his surgery Dr *** is an hospital-based physician, and his office is independent from the surgeon's office Any agreement, Mr*** had with the surgeon's office would not have any effect on Dr***'s billing Dr*** did not bargain or agree to any rate prior to Mr*** surgeryDr*** is contracted with Mr***'s insurance company and our office is contractually obligated to accept exactly the what the insurance company says is dueDr*** does not expect anything above and beyond the contracted rateThis problem can be easily solved by reviewing the Explanation of Benefits from the insuranceWe have proof that Mr.*** is responsible for coinsurance, which amounts to $57.60.Be aware that Dr*** did not bargain or agree to any rate prior to surgery The balance will remain Mr***'s responsibility. Thank you, *** ***Business Manager*** ***

8.5pt;">9/26/2015                              ...⇄ Revdex.com: Complaint Management: ID #[redacted] In reference to the complaint from Mr. [redacted], I would like to refute his assertions. When someone has surgery, they will be billed by three entities: the surgeon, the anesthesiologist, and the hospital/facility. All three of these entities are separate and they are not privy to charges incurred by the other entities. Dr. [redacted] is an inpatient physician that administered anesthesia for Mr. [redacted] on 7-15-14. Mr. [redacted] states in his complaint that he was told by the surgeon, Dr [redacted]'s office, that what he paid their office would be all that he owed. This would be correct for Dr. [redacted]' charges, but the surgeon would not be able to determine this on behalf of Dr. [redacted], who separate from the surgeon. Dr. [redacted] has a contract with Mr. [redacted]'s insurance, and it is the insurance that ultimately determines the amount Dr. [redacted] is paid and the amount Mr. [redacted] owes. After processing of the claim, the insurance company, NALC, provided an Explanation of Benefits to Dr. [redacted]'s office and to Mr. [redacted]. This explanation informs all parties of the amount paid, the amount that contractually has to be discounted and the amount Mr. [redacted] owed. The co-insurance amount Mr. [redacted] owed is $57.60, which is dictated by the terms of his plan. According to the provisions of his plan, surgical charges will pay at 80% and Mr. [redacted] is responsible for 20%. We billed Mr. [redacted] four times for the amount his insurance determined was his responsibility, and we called him twice to resolve this balance. Our office policy is that if the patient does not respond to our effort to collect on the balance, then the account will be sent to a collection agency. Mr. [redacted]'s complaint is unfounded because we are obligated by the terms of our contract with his insurance company just as he is obligated to the terms of his policy. We tried to reach the patient multiple times, and Mr. [redacted] had ample opportunity to contact Dr. [redacted]'s office if he disagreed with our billing. Please be advised that Dr. [redacted] rendered Mr. [redacted] services; and therefore, he needs to be paid the coinsurance of $57.60 according to the contract with the patient's insurance. Dr [redacted]'s followed the rules set forth by the contract with Mr. [redacted]'s insurance plan. We did not violate this contract or any other provisions that warrants Mr. [redacted]'s complaint. Please withdraw this complaint. Your attention in this matter is greatly appreciated. My contact phone number is [redacted], should you need any additional information. Thank you, [redacted] Business Manager