North Country Emergency Medical Consultants

To Whom It May Concern:This Information is in response to [redacted] complaint # [redacted] to the Revdex.com for herdate of service of 11/06/She was seen In the Emergency Department at Samaritan Medical Centerin Wwatertown, New York by Dr [redacted] of North Country Emergency Medical Consultants.We received Tricare insurance information via secure, electronic transmission, from the hospital(Samaritan Medical Center) on 11/15/and we billed TricareOn 11/21/2016, we received aTricare rejection stating there was an error with the ID#We checked the Tricare web that day andfound the patient wasn't eligible for Tricare and we billed the patient for updated health insuranceinformationOn 12/20/2016, the hospital provided an update electronically and we refiled the claim onthat dayThe patient mailed a copy of Tricare/US Family Health Plan card on 12/22/(This cardhad an effective date of 12/1/which is after the date of service) We were still awaiting an updatedresponse from Tricare after we sent a bill on 12/20/We received that updated on 01/05/asTricare rejected the claim again stating an error with the ID#This was transferred to the patient again.We received another copy of the card from the patient on 01/12/(a Tricare/US Family Health Plancard as well as "Tricare Prime Benefits- Summary of Costs and Benefits") • There was no newinformation and this claim was left in self-payOn 01/23/we received another electronic updatefrom the hospital (SMC) and once again Tricare rejected the account on 02/08/for the samereason, error with the I DWe received a patient update on 02/09/2017, a copy of the patient'sinsurance card and we billed out US Family Health Plan; however, on 03/09/2017, we received an EONfrom US Family Health stating member not on file; claim was transferred back to self-payOn07/28/2017, eligibility was checked and the mailing address was confirmedThis was resubmitted to USFamily Health Plan and we are currently waiting for the insurance company to respond.If you are in need of further Information, please contact my office at:DrMa [redacted] , PresidentNorth Country Emergency Medical ConsultantsWashington StreetWatertown, NY [redacted] Sincerely, Ma [redacted] MD

I have reviewed the response made by the business in reference to complaint ID ***, and have determined that this does not resolve my complaint. For your reference, details of the offer I reviewed appear below. On date of service US Family Health Care card was provided, after the date of service US Family Changed card numbers from having a U in front of numbers to having straight numbersSee image for the old card which would have been provided at date of service, see document which had been provided with the updated card informationYou will also notice that several times I attempted to contact them, I bypassed the hospital and went straight to the North Country Emergency Medical Services Home office, which is why the hospital on the report is not reporting the same number of communications attempts that I amYes the final statement on the response(On 07/28/2017, eligibility was checked and the mailing address was confirmedThis was resubmitted to US Family Health Plan and we are currently waiting for the insurance company to respond.) addresses the financial portion of the issue with this bill, however it does not address the communications issue between North Country Emergency Medical Consultants and myself/my wife/the complainantsIf further communication was required or intervention between customer and insurance company was required, why did the North Country Emergency Medical Consultants not reach out for further contact, they had both the communications path(mail, email, phone) of myself and the insurance companyWhy, if they said they tried processing the bill, did my insurance company not send any Explanation of Benefits(EOB) stating they tried to improperly process the account, and why did the company attach the second bill, which still has yet to be properly processed, to the first bill and attempt a demand of funds with threat of collections within daysThe only communication that was ever received from North Country Emergency Medical Consultants was the bills with no explanation and no noticeable information regarding its failure. Regards, *** ***

This response is in regards to *** and *** *** complaint to the Revdex.com.DOS: 4/20/17We billed US Family Health Plan and received a denial dated 7/7/stating member not on file(Attachment 1)The patient received a statement dated 7/21/stating "patient cannot be identifiedas our insured" before going to collections on 9/28/This has been rebilled to US Family Health Plan .DOS: 11/6/16, 6/25/17, and 7/30/17These claims are pending with North Country Emergency Physicians and have been rebilled to US FamilyHealth Plan.Attached (Attachment 2) is what we received from the patient on 12/20/16, 1/11/17, and 2/3/17.All balances due on an account are billed together on one statement but separated by the DOS, billedamount, and denial reasonSee Attachment 3, the statement dated 7/21/as an example.It is policy to send out statements to patientsThis ensures we have a record of communication.All claims have been rebilled to the insurance companyWe will appeal any denialsThe patient will notbe held responsible for any balances outside of co-pays, deductibles or balances US Family Healthdeems patient responsibility.We are sorry that the patient/family feels we have failed to help themWe are making all attempts toobtain payment for their claim.Thank you,North Country Emergency Medical Consultants, PC

To Whom It May Concern:This Information is in response to [redacted] complaint #[redacted] to the Revdex.com for herdate of service of 11/06/2016. She was seen In the Emergency Department at Samaritan Medical Centerin Wwatertown, New York by Dr. [redacted] of North Country Emergency...

Medical Consultants.We received Tricare insurance information via secure, electronic transmission, from the hospital(Samaritan Medical Center) on 11/15/2016 and we billed Tricare. On 11/21/2016, we received aTricare rejection stating there was an error with the ID#. We checked the Tricare web that day andfound the patient wasn't eligible for Tricare and we billed the patient for updated health insuranceinformation. On 12/20/2016, the hospital provided an update electronically and we refiled the claim onthat day. The patient mailed a copy of Tricare/US Family Health Plan card on 12/22/2016. (This cardhad an effective date of 12/1/16 which is after the date of service) We were still awaiting an updatedresponse from Tricare after we sent a bill on 12/20/2016. We received that updated on 01/05/2017 asTricare rejected the claim again stating an error with the ID#. This was transferred to the patient again.We received another copy of the card from the patient on 01/12/2017 (a Tricare/US Family Health Plancard as well as "Tricare Prime Benefits- Summary of Costs and Benefits") • There was no newinformation and this claim was left in self-pay. On 01/23/2017 we received another electronic updatefrom the hospital (SMC) and once again Tricare rejected the account on 02/08/2017 for the samereason, error with the I D. We received a patient update on 02/09/2017, a copy of the patient'sinsurance card and we billed out US Family Health Plan; however, on 03/09/2017, we received an EONfrom US Family Health stating member not on file; claim was transferred back to self-pay. On07/28/2017, eligibility was checked and the mailing address was confirmed. This was resubmitted to USFamily Health Plan and we are currently waiting for the insurance company to respond.If you are in need of further Information, please contact my office at:Dr. Maja [redacted], PresidentNorth Country Emergency Medical Consultants830 Washington StreetWatertown, NY 13601[redacted]Sincerely, Maja [redacted] MD