Missoula Bone and Joint

Review: On July 9th 2014 Dr. [redacted] performed a Right Knee tota* replacement. On 8/21/2014 I went in for my first follow up. This required a x-ray. While the office cal* was concidered a follow up and was covered with my surgery the x-ray was not. same day same office, same Dr. but Missoula Bone and Joint chooses to bil* seprately so they can charge an addiotiona* fee to Medicare ( [redacted] ) and co-pay to me. My insurance company has advised me to take this action.Desired Settlement: quit billing for a procedure that should be covered under my follow up from surgery

Business

Response:

[redacted]

Resolution Moderator

Revdex.com

RE: Case ID [redacted] ([redacted])

Dear Mr. [redacted],

I am writing in response to the complaint filed against Missoula Bone & Joint received on January 6, 2015 by Mr. [redacted]. It appears Mr. [redacted] is appealing the x-ray charge of $85.00 performed on August 21, 2014. I have reviewed Mr. [redacted]’s account information as wel* as the correspondence between himself and a representative from our billing department.

Missoula Bone & Joint follows Medicare’s definition of the globa* surgica* package. The globa* surgica* package bundles together specific services along with certain postoperative services such as incisiona* care. However, diagnostic tests, such as x-rays are not included in the surgica* package and are billed separately.

[redacted] Medicare has processed the x-ray charges from August 21, 2014 and from the Explanation of Benefits received from his carrier, Mr. [redacted] owes $15. Mr. [redacted] spoke with a representative from our billing department on December 12, 2014 inquiring about the x-ray charge. At that time we explained that office visits are included for 90 days following surgery but that we do charge for any x-rays obtained. Mr. [redacted] relayed to our office that [redacted] Medicare notified him that they would reprocess this claim so he would not owe $15. To this date we have not received additiona* reimbursement from [redacted] Medicare for this date of service. It was also noted by our staff that Mr. [redacted] seemed satisfied with our process and explanation.

At this time Mr. [redacted]’s current patient balance is $15. We apologize to Mr. [redacted] for any misunderstanding or confusion with our billing practices. I hope you find this explanation acceptable but please contact me directly should you have additiona* questions.

Sincerely,

Operations Manager

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 wil* be closed Administratively Resolved]

When this office visit and x-ray were done, this was not in any way connected with Missoula Bone and Joint. And I was assured when Dr. [redacted] joinded Missoula Bone and Joint that no billing practices would change. But this one was added at a later time 12/04/2014 Not when I went to see Dr. [redacted] 8/21/2014. I will contact Dr. [redacted] directly.

Revdex.com,

I have reviewed the response made by the business in reference to complaint ID [redacted] and have determined that this does not resolve my complaint. For your reference, details of the offer I reviewed appear below.

[To assist us in bringing this matter to a close, we would like to know your view on the matter.]

Regards,

Business

Response:

Dr. [redacted] joined Missoula Bone & Joint in August 2014. Missoula Bone & Joint does follow the same billing practices as Dr. [redacted] and standards nationally. I did confirm with Dr. [redacted] assistant that Mr. [redacted] would’ve been charged for an x-ray if treated and one was obtained at his previous practice. Our office submitted a claim electronically to [redacted] Medicare on 9/29/14 for date of service 8/21/14 for CPT code [redacted] (x-ray). When no response was received from insurance we resubmitted a paper claim on 11/25/14. [redacted] Medicare processed this claim on 12/4/14 indicating Mr. [redacted]’s balance was a contractual co-pay of $15. After insurance processed the claim we mailed Mr. [redacted] a statement indicating his balance due. Please let me know if I can help explain further.

Consumer

Response:

[A default letter is provided here which indicates your acceptance of the business' response. If you wish, you may update it before sending it.]

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.

Regards,