“A refraction is being done when the tech puts the phoropter device in front of your face and, while changing dials, ask if is better that etc that process has two uses It is necessary to produce a prescription for glasses But it is also used during medical eye exams to determine whether the patient’s vision changes are related to the need for a new glasses prescription or are being caused by a medical issue They are part of any good eye exam In her case the refraction was done for medical reasons but also produced a new prescription for a change in her glasses As far as knowing about her insurance because she had given us her insurance card it is not any medical practice’s responsibility to explain the patient’s insurance benefits to them The patient receives a sizeable document form their insurance carrier explaining all the terms and condition of that plan and it is the patient’s responsibility to understand those benefits We will be happy to answer questions about any specific terms in that plan that the patient may not understand but it is not our responsibility, nor would it even be feasible, to explain every benefit in every insurance plan that we encounter in our practice Ms [redacted] ’s issue should be with her insurance plan and why they did not reimburse us for the medically necessary refraction done while doing a medically responsible exam of her eyes in our office.”
We received the above complaint filed by [redacted] As an ophthalmology practice, we see patients with a huge number of different insurance plans We try to be knowledgeable on the plans that the majority of our patients have but can’t be fully cognizant of every detail of every plan and all the variations due to elective choice made by employers in terms of which actual terms they elect to cover in their planWhen [redacted] called our office and spoke to [redacted] , we explained that we participate in her health insurance but do not participate in her vision plan network, We went on to explain that if she pays our bill she can then submit the paperwork that we will provide to her to her Vision Plan insurance and get partially or fully reimbursed She stated that she will not pay us anything and that she was going to file a report with the Revdex.com I feel that this is an attempt by her only to embarrass our practice as she would be out little or no money if she just paid us and got reimbursed The claim that was filed to her insurance carrier was filed using the correct codes for the services provided
Revdex.com: I have reviewed the response submitted by the business and have determined that the response does not satisfy or resolve my issues and/or concerns in reference to complaint # [redacted] Please add your rejection comments below It was never my intent to embarrass the practice I explained to them it was my intent to file with the Revdex.com because the additional charge was excessive and never explained to me during my visit I confirmed that they were on my insurance plan, I obtained a referral, I paid my co-payment directly to them I questioned why I received an additional bill, when my deductible and co-payments have been met I still do not know what a refraction is I believe it is a prescription for glasses that I did not fill Their optical shop never returned my phone call as I had thought of filling the prescription I feel that this is an unfair and unjust way to take additional monies from patients I realize you have many plans but because you have all of my insurance information, you should be able to tell me, as your patient, what would and would not be covered I certainly completed enough paperwork that this could be done on your end to ensure that we are on the same page and to provide the best customer service I ask that you kindly waive the fee and I will know to ask in the future Regards, [redacted]
“A refraction is being done when the tech puts the phoropter device in front of your face and, while changing dials, ask if is better that etc that process has two uses It is necessary to produce a prescription for glasses But it is also used during medical eye exams to determine whether the patient’s vision changes are related to the need for a new glasses prescription or are being caused by a medical issue They are part of any good eye exam In her case the refraction was done for medical reasons but also produced a new prescription for a change in her glasses As far as knowing about her insurance because she had given us her insurance card it is not any medical practice’s responsibility to explain the patient’s insurance benefits to them The patient receives a sizeable document form their insurance carrier explaining all the terms and condition of that plan and it is the patient’s responsibility to understand those benefits We will be happy to answer questions about any specific terms in that plan that the patient may not understand but it is not our responsibility, nor would it even be feasible, to explain every benefit in every insurance plan that we encounter in our practice Ms [redacted] ’s issue should be with her insurance plan and why they did not reimburse us for the medically necessary refraction done while doing a medically responsible exam of her eyes in our office.”
We received the above complaint filed by [redacted] As an ophthalmology practice, we see patients with a huge number of different insurance plans We try to be knowledgeable on the plans that the majority of our patients have but can’t be fully cognizant of every detail of every plan and all the variations due to elective choice made by employers in terms of which actual terms they elect to cover in their planWhen [redacted] called our office and spoke to [redacted] , we explained that we participate in her health insurance but do not participate in her vision plan network, We went on to explain that if she pays our bill she can then submit the paperwork that we will provide to her to her Vision Plan insurance and get partially or fully reimbursed She stated that she will not pay us anything and that she was going to file a report with the Revdex.com I feel that this is an attempt by her only to embarrass our practice as she would be out little or no money if she just paid us and got reimbursed The claim that was filed to her insurance carrier was filed using the correct codes for the services provided
Revdex.com: I have reviewed the response submitted by the business and have determined that the response does not satisfy or resolve my issues and/or concerns in reference to complaint # [redacted] Please add your rejection comments below It was never my intent to embarrass the practice I explained to them it was my intent to file with the Revdex.com because the additional charge was excessive and never explained to me during my visit I confirmed that they were on my insurance plan, I obtained a referral, I paid my co-payment directly to them I questioned why I received an additional bill, when my deductible and co-payments have been met I still do not know what a refraction is I believe it is a prescription for glasses that I did not fill Their optical shop never returned my phone call as I had thought of filling the prescription I feel that this is an unfair and unjust way to take additional monies from patients I realize you have many plans but because you have all of my insurance information, you should be able to tell me, as your patient, what would and would not be covered I certainly completed enough paperwork that this could be done on your end to ensure that we are on the same page and to provide the best customer service I ask that you kindly waive the fee and I will know to ask in the future Regards, [redacted]