Midland Family Medical Services

Complaint: ***I am rejecting this response because:
*** *** ***,
CEO was not in the building when we were seen.
She is both the CEO & wife of the Physician Assistant, *** *** ***. Her perspective is based upon the
other employees' perceptions & them trying to put a positive spin upon this
entire situation. So, the whole sentence
"this is truly not how it happened" is a falsehood stated to save the
company’s reputation. She cannot make
that statement without first hand witnessing the situation. It was always their intention to “extort”
money from us. She should be upset &
worry about their reputation. Their office
is knowingly practicing fraud and knowingly "extorting monies" from
their patients, due to their "office manager" forcing patients to pay
for services, when their benefits sheets clearly state they do not have to
pay. Just because I am the first to
report it, does not mean that it is not true.
The practice needs to become educated and update their policies. I should not have had to "wait for a
refund check". They should have
read the benefits sheet correctly & allowed me to leave without collecting
any money, per the insurance carrier contractFirst, extortion is
when you demand payment when no payment is due.
Therefore, they did extort the $copay from us, as it was never due
to them. *** admitted that it is
their practice to withhold prescriptions for copays. Again, just because I am the first to
publicly declare that they are performing this policy, does not mean that the
policy is proper or legal. Yes, ***
mailed a refund check for $several weeks after the services were
rendered. However, she never apologized
to us & she did not sign the refund letterYes, the
"office manager" ran the “Real Time Insurance Verification Form"
& showed it to me. She circled the
"Out of Network" vsthe "In Network" section on the
page. We had met the Out of Pocket
maximum for the In Network amount due to my husband's knee surgeries. The amount remaining was
"zero". I did become IRATE
after the "office manager" became snippy at me, after I told her she
was reading the paper WRONG. The
"out of pocket maximum" means that the patient has already paid out
the maximum amount of monies for all services. That means the patient no longer has a
copay due, as the insurance is now paying 100% of the allowable
amount. That means the $copay no
longer applies. Obviously, the
"office manager" is not capable of this "higher
reasoning". The out of pocket
maximum is part of the Insurance Contracts & it is not against the whole
section with "contracts with all insurance companies that state that it is
the Doctor’s contractual obligation to collect copays and deductibles from the
patient at the time services are rendered"USE SOME COMMON SENSE
PEOPLE! If the copay is not due, then
you do not collect it. SIMPLE! The "office manager" never
"apologized". She simply
stated over & over that "her job is to collect copays". So, I am still stating I would like a written
& signed apology from the practiceSecond, *** (not
Brain), called the office the next day to speak specifically to
***. She did NOT call
us. I was in the room when *** &
*** were speaking on the phone. ***
remained calm during the entire conversation.
He did eventually hang up on ***.
This is due to *** just plain not listening to what we were
stating. Again, it is extortion to
demand payment when no payment is dueThird, I
stand firm that the practice is not being run in accordance to standard
practices. Just because they have been
in business for over years and have never had such accusations made against
our company, does not mean that they have been performing everything legally. Most insurance carriers are requiring that
the PA credential separately from the Supervising Physician. The simple reason is money. If the claim is filed under the PA, then the
insurance carrier only pays 85% of the allowable amount vspaying 100% of the
allowable amount, for when the physician performs the same service. I must point out that she is uneducated &
out of date when she stated "Per the law, a PA is not allowed to file an
insurance claim under their own name, all claims are filed under the Doctor
that supervises them and this is not fraud". So, by declaring that she never files any
claims to the insurance carriers under the PA is very disturbing to me &
clearly should be used in court against her, should it come to that. It would be interesting to see how much money
they owe back to Medicare for claims filed these past years in this mannerForth, just
because we liked *** *** ***, does not mean that the company he works for
is following correct protocols & policies.
It also does not mean that we are not supposed to fight for our rights
as citizens of this great nationI again
state, the practice is knowingly practicing fraud & extorting payments from
their patients, based upon the response from *** *** ***
Best regards,*** ***

Midland Family Medical Services, LLC. [redacted]...

[redacted]              [redacted]                                                         [redacted]     To:      Ann Atkinson             Revdex.com Date:    11/24/14 RE:      Complaint Filed By [redacted] ID:       [redacted]     To Whom It May Concern:   I am writing this letter in response to a Complaint that was filed against our office on 11/16/14 @ 8:44 pm.  This was an extremely lengthy complaint and I would like to address each issue that was stated against our company.             I would first like to say that I am sorry that [redacted] had a negative experience with our office and I am also sorry that she felt like she was treated unfairly, as our mission is to make each person’s experience here a positive one, so that they will return to our office in the future.              First of all, according to the complaint, [redacted] stated that she was upset that she did not get to see [redacted]y when she came to our office.  When [redacted] called to schedule the appointment I am the person that [redacted] spoke with, and at no time did [redacted] state to me that she and her husband ONLY WANTED TO SEE [redacted].  Our office policy is such that [redacted]C sees all new patients and then will review the case with [redacted] and [redacted] will then determine if he will accept the new patient or if the patient will continue to be seen by his PA, [redacted].  In fact, when I stated to [redacted] that [redacted] had filed a complaint with the Revdex.com, and in her complaint she stated that she was upset that she ONLY saw the PA and not [redacted].  [redacted] stated “that is odd because when I went into the room to see the [redacted] said to me ‘Oh, you are [redacted], we are so glad to meet you, everyone has told us such good things about you.’”             I would also like to state that when I called [redacted] on 10/23/2014 and spoke with him about the collection of his copay, he stated, “Oh well we don’t have any problems with [redacted] we just loved him and want to keep seeing him and we loved the nurses in the back, they were so sweet, our only complaint was the lady at the front, and her making us pay our copay.”              Secondly, according to [redacted] “at time of check out she was told that they each had to pay a $30.00 copay.”  This is truly not how it happened.  When [redacted] approached the front desk to check out she TOLD our office manager, “All she was going to pay was $30.00 and NO MORE.”  Our office policy states that ALL copays, deductibles, and non-covered charges are due at the time of service, and on the same day as the visit.  [redacted] and [redacted] each signed the Office Policy stating this information; therefore, they were fully aware that all copays, deductibles and non-covered services are due at the time of service.  When we printed off the “Real Time Insurance Verification Form,” which is what we work off of, it did state that [redacted]r would have a $30.00 copay on the date of his visit.  Our Office Manager showed this to [redacted], to verify that [redacted] did state that [redacted] did owe a $30.00 copay for the visit. [redacted] then became irate and began to argue with our office manager and said that “NO he does not have a copay because he had 2 knee surgeries this year and we have met the deductible and I am only paying you $30.00 today.”  Again our office manager showed [redacted] the “Real Time Insurance Verification Form” stating that, per [redacted] Insurance, “This is an estimate of what you’ll owe after any health account payment $30.00.”  Our office manager stated that we collect copays based on the verification that the insurance has on their website.              We have contracts with all insurance companies that state that it is the Doctor’s contractual obligation to collect copays and deductibles from the patient at the time services are rendered. [redacted] verification of [redacted] insurance coverage at the time of the visit, stated that [redacted] did in fact need to remit his $30.00 copay for the office visit.  [redacted] then began yelling at our office manager stating that she did not know what she was doing, and that she must be looking at the wrong information.  She also stated she was not going to pay anything but $30.00 for her copay.              [redacted] then became belligerent with our office manager, asking other employees and patients in the lobby, saying “Do you see how she is treating me?”  Another front office staff informed [redacted] that the office manager was only trying to do her job by collecting the copay that the insurance company stated that [redacted] did owe for the office visit.  [redacted] then began to question the intelligence of the office manager, and insulted her by saying “Well How long have you been doing this, because I have been doing medical coding for many years.” [redacted] then began to insinuate that our office manager had no idea what she was doing, in front of all staff members, and patients sitting in the lobby.   Our office manager told [redacted] “she was just trying to do her job and that was to collect the copay for both [redacted] and [redacted], because that is what she is required to do.”             When [redacted] refused to pay the copay for [redacted], our office manager asked [redacted] for the written prescriptions back until the payment was made.  This made [redacted] very angry. This also is our office policy, to keep prescriptions until payment has been made.  At that time, [redacted] was standing in the front office, speaking to another professional, listening to [redacted] argue and yell at the office manager.  [redacted] then approached the window, and told [redacted] that it is legally required of our office to collect copayments and deductibles from patients at the time of service or else we are in violation of our contract with the Insurance Company and we are within our right to withhold prescriptions until payments are made.             Our office manager then told [redacted] REPEATEDLY that if our office was in the wrong we would be happy to reimburse her the $30.00 copay.  [redacted] then stated “that if they did have a $30.00 credit then she wanted it credited back to her credit card that day.”  Our office manager stated “that we are Legally Not Allowed to keep credit card numbers on file, but that she would have a check sent to her for the $30.00.”  [redacted] also told our office manager that she demanded an apology from her.  Our office manager apologized again as she had been apologizing to [redacted], and then stated, “I apologize right now, I am just trying to do my job so that I don’t get in trouble, and I am sorry.” At that time, [redacted] did pay the $30.00.              I would like to say that our office does not “EXTORT MONIES” from anyone.  I find this accusation very offensive as well, due to the fact that we were only doing what is required of us by our contractual obligation with the Carter’s insurance company. We do not and have not EVER withheld any refund from any patient when they have a credit. We have reimbursed [redacted] Carter for the $30.00 credit that he has with our office in the form of a company check, and he now has a zero balance.                 I would also like to say that I called [redacted] on 10/23/2014 and explained to him that our office manager was doing her job, and that is to collect copays, deductibles and monies for non-covered services.  I also told him that I would GLADLY reimburse him his $30.00 after the insurance processed his claim.  [redacted] stated that we were trying to “EXTORT MONEY” from him and I stated that we are not in the business of EXTORTING MONEY from anyone and never from our patients.  We were merely collecting his $30.00 copay that his insurance company stated that he owed us on 10/22/14.   I also explained to [redacted] that if he had a problem with what [redacted] had stated that he owed, then he should contact [redacted] himself to resolve this matter.  [redacted] then stated “We really love [redacted] and wish to continue to keep seeing him and the nurses in the back were sweet, we are just upset about the front office staff and what happened yesterday.”  I apologized again to [redacted] and again stated that when the Insurance EOB comes back to us and if he has a credit I would GLADLY write him a check and mail it to him.  He continued to accuse us of extortion, for making him pay a copay.  I again stated when we received the Insurance EOB; we would send him a check.  He then hung the phone up on me.             As for the allegation that our office is defrauding an insurance company or anyone else for that matter, is beyond my comprehension, and is disheartening to me.  We run this practice with Integrity and Honesty and we strictly abide by the laws set out by the Texas Medical Board for Physicians and for Physician Assistant’s.  We have been in business for over 10 years and have never had such accusations made against our company.  The billing of an office visit for any PA is always filed under the Supervising Physician and not the PA.   Per the law, a PA is not allowed to file an insurance claim under their own name, all claims are filed under the Doctor that supervises them and this is not fraud.                I am sorry that this family feels that they were treated unfairly by us collecting their copay. Having patients fulfill their financial obligation for their office visits is not extortion.  We explained to them numerous times that they would receive a refund if they did end up with a credit.  It was never our intention to “Extort” money from them.  I would like to state I am upset that [redacted] is accusing our office of fraud of any kind, and trying to tarnish our reputation.  This concludes my response to the accusations made by [redacted] against our office.  If you have any questions, please feel free to call our office, and you may ask for me directly.    Thank you,   [redacted] Midland Family Medical Services