Newport-Mesa Audiology, Balance And Ear Institute, Inc.

Review: My 1 yr old twins qualified for speech therapy and our physician gave us RX for a hearing test. We were referred to Newport Mesa Audiology. They called me to say they spoke with our insurance and they are in network and the hearing test is a covered service. The negotiated rate $650/child. With our benefits we owe 20% (inurance 80%) after we hit our deductible. They told us we had to pay $1300 prior to the hearing test and we would be reimbursed after they receive payment from our insurance. After multiple conversations with them regarding the cost of the test they assured us the only reason they were asking for the entire cost ($1300) in advance is because we have a high deductible. We had the exam in Feb 2015 and our insurance has denied the claim in Oct 2015. We have been in contact with them to try and get our 80% back. ($1040), but they are refusing to reimburse us. It has been almost 8 months. They told us they will review the denial and appeal it. Today the office manager told my husband that they will honor the $650 price quote, but not the 80%/20% that they told us before we had the test done. We would have never gone to Newport Mesa Audiology $1300 for hearing tests for 1 year old twins with speech delay to rule out a hearing disorder as the cause for delayed speech. They did a bait and switch on us. They gave us an exact quote for their service, told us they were in-network, told us the hearing test they do is a covered service, told us the reason we had to pay in full up front is because of our deductible, told us they would re-imburse us and now almost 8 months later, nothing has been resolved. We are out $1300.Desired Settlement: I want Newport Mesa Audiology to honor the price they quoted us. We have met/exceeded our deductible and should only be charged 20% ($260) of the negotiated rate. Even if they are successful with their appeal, we will only owe 20% of the $1300. We want our money back. Please feel free to contact me with any questions.

Business

Response:

Re: Complaint ID: [redacted]. [redacted]Dear Ms. [redacted]:This letter is in response to the above-mentioned complaint, Please be advised that we take these matters very seriously. In the case of Mrs. [redacted]'s twins, as of the date of this letter, we have not received any notification from the patient's insurance carrier, with respect to any denial or any communication thereof. In the case that the claims were denied for medical necessity, in our normal course of business, we would formulate an appeal and send it to the appropriate department of the insurance carrier.As a matter of protocol, we verify benefits for each and every patient that we see at our Institute. We advise the patient via phone prior to their appointment of their benefits and if there will be an out of pocket (OOP) cost, if any. In this case, we advise Mrs. [redacted] that because they had such a high deductible, the OOP cost of the appointment per child would be $650.00, which is the cost of the appointment. The patient paid the OOP cost at the time of the appointment. The benefits quoted the patient prior to the appointment were that their insurance company would pay 80% and they would be responsible for a 20% co-insurance, once the deductible has been met. However, as it is with all verification of benefits, the insurance carrier's all state that when we verify benefits, "A quote of benefits and/or authorization does not guarantee payment or verify eligibility. Payment of benefits are subject to all terms, conditions, limitations, and exclusions of the member's contract at time of service",Once we receive the Explanation of Benefits from the patient's insurance carrier, we will formulate an appeal and send it to the patient's carrier. They will respond and then we will make the appropriate financial reimbursement, if any; based on what their decision is. There is no “bait and switch". Pursuant to our protocol, we advise our patients of the situation prior to providing services.If you have any questions, please contact our Director of Operations, Mr. [redacted]. Thank you for yourMedical DirectorHTM;hsNewport-Mcsa Audiology Balance and Ear Institute l” a g c | 2