Northern Virginia Doctors Of Optometry

To whom it may concern,Pt was seen for services on 11/01/These services included a [redacted] , this service for a new patient is $with no insuranceHer [redacted] covers this service with a $ co-payShe also received [redacted] which is a separate service that we schedule for addition time when scheduling the appointmentBased on her prescription our fee for this without insurance is $Per patients [redacted] benefit and after verifying with [redacted] patient has $towards contact lens services and materials (purchasing contacts)If patient choices to do so a MAXIMUM of$of the $can be used towards the $contact lens evaluation and the patient would NOT lose the remaining $190,00, which in the beginning we believed she would lose that additional Swhich is why we only provided her with a 15% discount making her charge for the contact lens evaluation $She also opted to [redacted] that is normally $but discounted to a $self pay fee is the doctor does not find a medical diagnosis code, or if the Doctor finds a medical diagnosis, which he did in this case it can be sent to the medical insurance and the patient pays the specialist co pay on their medical insurance, Which in this case was $35.00.At the time of check out she was charged:$for exam$for contact lens evaluationTotal Charges $120.50She was mistakenly NOT charged the $specialist co pay for the [redacted] The person at the font desk thought she had been charged the $no insurance fee for the imagine so refunded $which is the difference between the no insurance fee and her specialistco pay for her medical insuranceThat day after the $refind she was only charged when she should have been charged:$for exam$for contact lens evaluation$specialistco pay for [redacted] $Total Charges for that dayAfter filing the [redacted] to her medical insurance we received notification that the medical insurance would cover the imaging with NO co pay and since we did not charge her for it there was no need for an addition refind associated with the [redacted] .I reached out to the patient via telephone and email on 12/05/On the voicemail I left I informed the patient that I would be more than happy to speak with the patient to explain all charges and how we were going to file claims to both the vision and medical insuranceIn my last communication with her I offered her a $60,refund based on my new understanding of her [redacted] benefit of $In the email I stated that we do not store full credit card numbers on file but she does have a credit on her account in the amount of $and I would just need her to call in with her card number to have it refunded to herI also stated that I verified with [redacted] on 12/05/that the other Doctor's office she visited on 12/04/to purchase materials was in fact able to use her benefits on 12/04/as we did call and release the benefitsAfter verifying with [redacted] that I could in fact submit documents with some identifying information (because only non identifying information would ever be posted to the public) to support our claim I have attached in the fax and in the hard copy of our response sent via the postal service the paper trail of emails in order to show that we are happy to assist her in any way possible and that I have tried to offer her an explanation of benefits, copies of her credit card receipts to show what she was charged and refunded, her [redacted] authorization highlighting the $co pay for exam and the explanation for the contact lens services and materials breaking down the 15% discount we originally gave and the explanation of being able to use $of the $towards the contact lens services instead of the 15% discount and that the patient is responsible for any charges for contact lens services above $which in this case would have been $and her EOB (explanation of benefits) from her medical insurance showing that we billed a medical procedure ( [redacted] ) to the medical insurance for $and they paid infill with no co pay due from the patient, At the conclusion of this case I would be happy to issue a check to the patient and mail it to her home in the amount of Sinstead of her having to callinto give us her card number again as I understand she may not be comfortable giving us her card information again.Thank you for your review in this matter, Janice R [redacted] Office Manager, [redacted] Location Northern Virginia Doctors of Optometry [redacted]

To whom it may concern,Pt was seen for services on 11/01/2017. These services included a [redacted], this service for a new patient is $210.00 with no insurance. Her [redacted] covers this service with a $10.00...

co-pay. She also received [redacted] which is a separate service that we schedule for addition time when scheduling the appointment. Based on her prescription our fee for this without insurance is $130.00. Per patients [redacted] benefit and after verifying with [redacted] patient has $250.00 towards contact lens services and materials (purchasing contacts). If patient choices to do so a MAXIMUM of$60.00 of the $250.00 can be used towards the $130.00 contact lens evaluation and the patient would NOT lose the remaining $190,00, which in the beginning we believed she would lose that additional S190 which is why we only provided her with a 15% discount making her charge for the contact lens evaluation $110.50. She also opted to [redacted] that is normally $135.00 but discounted to a $39.00 self pay fee is the doctor does not find a medical diagnosis code, or if the Doctor finds a medical diagnosis, which he did in this case it can be sent to the medical insurance and the patient pays the specialist co pay on their medical insurance, Which in this case was $35.00.At the time of check out she was charged:$10.00 for exam$110.50 for contact lens evaluationTotal Charges $120.50She was mistakenly NOT charged the $35.00 specialist co pay for the [redacted]. The person at the font desk thought she had been charged the $39.00 no insurance fee for the imagine so refunded $4.00 which is the difference between the no insurance fee and her specialistco pay for her medical insurance. That day after the $4.00 refind she was only charged 16.50 when she should have been charged:$10.00 for exam$110.50 for contact lens evaluation$35.00 specialistco pay for [redacted]$155.50 Total Charges for that dayAfter filing the [redacted] to her medical insurance we received notification that the medical insurance would cover the imaging with NO co pay and since we did not charge her for it there was no need for an addition refind associated with the [redacted].I reached out to the patient via telephone and email on 12/05/2017. On the voicemail I left I informed the patient that I would be more than happy to speak with the patient to explain all charges and how we were going to file claims to both the vision and medical insurance. In my last communication with her I offered her a $60,00 refund based on my new understanding of her [redacted] benefit of $250.00. In the email I stated that we do not store full credit card numbers on file but she does have a credit on her account in the amount of $60.00 and I would just need her to call in with her card number to have it refunded to her. I also stated that I verified with [redacted] on 12/05/2017 that the other Doctor's office she visited on 12/04/2017 to purchase materials was in fact able to use her benefits on 12/04/2017 as we did call and release the benefits. After verifying with [redacted] that I could in fact submit documents with some identifying information (because only non identifying information would ever be posted to the public) to support our claim I have attached in the fax and in the hard copy of our response sent via the postal service the paper trail of emails in order to show that we are happy to assist her in any way possible and that I have tried to offer her an explanation of benefits, copies of her credit card receipts to show what she was charged and refunded, her [redacted] authorization highlighting the $10 co pay for exam and the explanation for the contact lens services and materials breaking down the 15% discount we originally gave and the explanation of being able to use $60 of the $250.00 towards the contact lens services instead of the 15% discount and that the patient is responsible for any charges for contact lens services above $60.00 which in this case would have been $70.00 and her EOB (explanation of benefits) from her medical insurance showing that we billed a medical procedure ([redacted]) to the medical insurance for $135.00 and they paid infill with no co pay due from the patient, At the conclusion of this case I would be happy to issue a check to the patient and mail it to her home in the amount of S60 instead of her having to callinto give us her card number again as I understand she may not be comfortable giving us her card information again.Thank you for your review in this matter, Janice R[redacted] Office Manager, [redacted] Location Northern Virginia Doctors of Optometry [redacted]