Oregon Clinic Ear Nose & Throat

As a clinic dedicated to providing Specialty Medicine with Commitment, Care andCompassion, we are saddened when anyone leaves our clinic any less than satisfied. Weproactively reach out to patients to resolve any concerns that arise.We received this same complaint on The Oregon Clinic website the...

evening of October20, 2016. I sent a response to Ms. [redacted] on October 21 asking her to please give me acall at my direct extension. Ms. [redacted] called me on Monday, October 24.When I spoke with Ms. [redacted], I explained to her our process of obtainingreferrals. Though our conversation, I learned that Ms. [redacted] was under the impressionthat if a primary care physician submits a referral then everything is approved and goodto go. She did not understand that the insurance has to approve the referral in order forthe visit to be paid by insurance. This misunderstanding was further complicated as sheworks (in some manner) with insurance billing but only plans that do not requirereferrals. She did not understand how her new insurance works regarding approval ofreferrals.The appointment Ms. [redacted] is referring to was scheduled for her new born-daughter,twelve days old at the time of scheduling. When scheduling the appointment, our staffexplained we would bill insurance if there was a referral in place with her insurance butif we did not receive the referral, she would need to sign a waiver and pay out of pocketas we are not able to get retro referral authorizations. Our staff did ask Ms. [redacted] tomake certain her daughter's primary care physician submitted the referral. At the timeof scheduling, Ms. [redacted] said she was aware but did not want to wait to schedule untilwe received the referral. She wanted her baby seen right away. The mother called uson 10/12 and we worked her baby in on 10/17. (We often urgently work in new bornbabies instead of waiting approximately three weeks out for the next availableappointment.)
Ms. [redacted] was not informed the referral was not approved prior to her arrival because, at the time ofscheduling, she had agreed to pay the $200 fee if no referral was received. Again, at the time of scheduling, Ms.. [redacted] chose not to wait until the referral was received and she was aware of our $200 fee. At the time of check in,she could have opted not to pay and reschedule once the referral was received. She decided to move forward wit h the visit as she wanted her daughter seen that day; she signed the waiver and paid the $200 for the appointment. Also at the time of check in, Ms. [redacted] was given our clinic's Financial Policy and was asked to read and sign the policy. Our policy specifically addresses Referrals and Pre-authorizations . Ms. [redacted] signed the Financial Policy and it is scanned in her daughter's chart.Additionally, when Ms. [redacted] was in the clinic there was no indication she was at all unhappy or did not understand what was occurring.  Typically, the staff give me a heads up if they think a patient(parent) may be upset. I received no such 'heads up' from our staff.  I also mentioned this to Ms. [redacted] during our conversation and she did agree she gave no indication to the staff or physician that she was upset.Before ending the conversation with Ms. [redacted] I asked her if there was anything I could do to make this situation better for her as we want everyone to be satisfied with our services. She said she wished we had explained that the insurance had to approve the visit instead of just getting a referral from the primary care physician. Also, she did not feel she should have had to pay because she did not understand. I told her that was good feedback and I would remind the staff of the importance of fully informing our patients of our processes regarding insurance referrals. The mother did not request any discount/refund or have any additional questions at that time. I reminded Ms. [redacted] she had mydirect extension if she had any further questions . At the end of our conversation, I thought it ended well and Ms. [redacted] understood all that had occurred.As I told Ms. [redacted] I would, I followed through and reminded the staff of the importance of fully explaining how we must have an authorized referral from the insurance for the appointment to be covered.I appreciate your request for a response to this complaint.Sincerely,Bradley V[redacted]Clinic Manager

Complaint: [redacted]I am rejecting this response because: the business' response contradicts itself. He wrote that I didn't ask for a refund while mentioning that I stated I should not have had to pay for the consultation. They did not do their "due diligence" in this case. How reasonable would it be for me to just leave and drive 3 hrs home because of the lack of follow through on their part? My primary care physician did send. A referral as they asked me to do. I did all I was told and now I am blamed for now knowing how my insurance works?Sincerely,[redacted]