Northwest Obstetrics & Gynecology Associates Inc

This is in response to Ms. [redacted]’s complaint. 
When Ms [redacted] scheduled her initial appointment she was
asked if her insurance was through  the
healthcare exchange (we are not providers for Aetna plans thru the healthcare
exchange).  Her insurance was through her
mother and...

was an individual policy—not thru the exchange.  Individual policies vary as to what options
the insured chooses to obtain.   Ms.
[redacted] asked if we were on her insurance plan and she was told that we are on
her plan.  At no time was Ms. [redacted] ever
told that her visit would be paid in full. 
She would have been told that she was covered by her insurance.  This means that at the time of her visit she
did have insurance. Being covered and having the insurance pay in full are two separate
issues.  Being covered means that the patient
does have insurance and the charges may be allowed per the contacted rate and
are subject to the deductible and coinsurance. 
It does not mean the charges will be paid in full.    
When Ms [redacted] presented to the office there were numerous
forms for her to complete;  these forms
were also made available on line prior to her office visit; which state frequently
that it is ultimately the patient’s responsibility to know what their insurance
coverage is and that they are responsible for all charges incurred.  Ms. [redacted] signed all these forms.  It wasn’t until after her visit and it was
determined that she had a viable pregnancy that her benefits were checked.    On
October 5, 2015 she was sent a letter which explained her estimated financial
responsibility for her pregnancy.  Her
responsibility was estimated to be $1000.00 after taking into consideration her
deductible , coinsurance and out of pocket responsibility.  This amount was to be spread out over the
course of 5 months.  She was asked to
make a $200.00 payment at her next appointment and to call the office with any
questions. 
On October 8, 2015 we received notification from the insurance
company that they were not paying the charges for her September 4, 2015 visit
due to the diagnosis(es) were not covered by her plan.   The patient would have received a copy of this notification from her insurance company also.  If she disagreed with her insurance companies determination she could have appealed this her insurance company.  She was sent 3 statements with no
response from her.  A final notice letter
was sent on February 1, 2016 asking her to contact the office to make payment
arrangements.  Again no response.  On February 25, 2016 @ 2pm a call was placed
to the patient giving her the opportunity to make payment or set up a payment
plan to avoid the account being turned over to our collection agency.  At that time she stated she would not pay the
bill.
Ms. [redacted] was given numerous attempts to contact the office
to discuss her outstanding balance but this was not done  in fact no contact was made to the office at
all other than her sending us a release of her medical records in November of
2015. 
We do sympathize with Ms. [redacted]’s predicament,  but she was given ample opportunities to work
with the office but made no attempt.   We do the best we can but ultimately it is the
patient’s responsibility to know what their insurance covers and what their
responsibility will be in regards to their insurance.  I am attaching all forms that Ms. [redacted] signed prior to her appointment.  Also attached is a copy of the EOB from her insurance company.