Orthopaedic And Sports Medicine Center-Norman, P.C.

In response to
the additional letter from L***, Orthopaedic and Sports Medicine has made
numerous attempts to educate Mrs*** regarding this account and the matter
still remains that the complainant fails to understand that they are
responsible, by insurance regulations, to pay all
assigned patient
responsibility as determined by the adjudicated insurance claimOnce the
insurance company receives the billing from the clinic, the claim is
adjudicated based on the patient’s current insurance plan by the insurance
carrierAt that time, the insurance carrier assigns financial responsibility
based on what the insurance carrier will allow for the charges billed, the
amount that the insurance company will pay for this claim, and the amount that
is assigned to the patient for patient responsibilityOur clinic understood
per the conversation on 7/5/with the insurance company that we were to
collect “$35” on that date of serviceWe were not provided with any additional
instructions from the insurance carrierThis is not uncustomary since we are
not always privy to other billing that may or may not be pending with our
patients’ insurance carriers that could change patient responsibility
Unfortunately, as with all healthcare entities, high patient deductibles,
co-insurances and out of pocket maximums complicate this process for both
patients and healthcare providersOur clinic staff attempts to provide our
patients with the most accurate estimation possible based on the
information that we are provided from the insurance carrier, which is what our
staff attempted to do, in good faith, on this particular date. Furthermore, all of our patients
acknowledge, upon signing their patient documents, that they are financially
responsible for all balances.It is unreasonable
for Mrs*** to except our organization, or any healthcare entity, to provide
her with an accurate estimate prior to her insurance carrier adjudicating the
claimMrs*** was provided with the full cost of the boot, which was $325,
and was provided with the correct information that OSC was given by the
insurance carrierUnfortunately, the insurance plan benefit assigned all of
the remaining allowable to patient responsibility and, as required as condition
of insurance contracting, OSC had to pass this amount along to the patient for
paymentThe office did not make an error but was acting in its best judgement
and good faith with the information that wasprovided.In September,
Mrs*** contacted OSC repeatedly, speaking with three different managers,
who are qualified to answer these questions and assist herThey explained this
process to her numerous times, to which the only satisfactory answer for Mrs
*** was for us to “write off” the balance because “she wasn’t going to pay”
The staff explained our policy for balances that go unpaid, which is that these
accounts are turned over to a collection agencyThe staff offered Mrs*** a
payment arrangement in accordance with our financial policy, and Mrs***
refused to agree to any payment arrangement other than for the balance to be
written offThe managers explained to her, that for any additional
considerations, the account would have to be forwarded to the COOOver a two
day period, Mrs*** demanded from the staff that she was to speak with me
immediatelyThe staff explained to her that I was in meetings and would return
her call as soon as possible but it could take two business daysMrs***
did not find that acceptable and demanded for them to get me out of meetings and
to find me.She threatened to
come to our clinic and stand at that front desk until I spoke with herIt was
during this conversation that one of the staff members explained to her that I
manage multiple facilities and was actually at our surgery centerOur surgery
center was not involved in this issue; however, Mrs*** called the surgery
center and was extremely rude to my executive assistance, again demanding for
her to get me out of a meeting to speak with me right thenMy executive
assistant was not privy to any of the issues regarding this individual or
account but was very upset at the manner in which Mrs***spoke to her and
was even more concerned with Mrs***’ aggressive behaviors over the phone
The following business day, when I returned to OSC, I was presented with three
grievances from staff due to Mrs***’ behaviors as a result of her
aggression, continuous argumentative approach with no resolution and Mrs***
telling one of the phone operators to “get her *** out of her chair and go look
in the parking lot to see if the COO was there.” The staff deals with thousands of patients
each week and each described Mrs***’ behavior as one of the “worst patient
encounters” they’ve experiencedI had another staff member who, upon making
her complaint to the HR manager, was crying and described Mrs*** as “abusive”.It was
shortly passed 5pm on September 8, 2017, when I personally contacted Mrs***
via phoneDuring this call, I also had one of the managers present, while Mrs
*** was on speaker phone, to witness this callMrs*** was extremely
argumentative and, once again, was only willing to accept the solution for
writing off the billDue to Mrs***’ continual behaviors on the phone, I
explained to her that if she continued to raise her voice with me and would not
allow me the opportunity to explain the process to her, I would discontinue the
call and only speak with the patient directlyMrs*** proceeded to continue
to interrupt me, which is why I am certain that she did not hear the
information that was being presented to herAdditionally, at no time did we
demand payment in full by Monday but rather requested that she call back on
Monday and let OSC know if she would be interested in a payment plan or would
be paying the balance in fullMrs*** continued yelling at me, at which
time I had no other option but to explain to Mrs*** that as a result of her
continual behaviors with me and the staff, she will no longer be permitted to
contact OSC on behalf of this accountI then had no other option but to
discontinue the call.Mrs*** has
not only filed a complaint with the Revdex.com but she has also sent certified letters
to the clinic that were degrading, demanding and sought one solution, which was
to write off the balanceShe also typed a letter and asked another patient of
Dr***’ to deliver this to him in the middle of his clinic, during that
patient’s appointmentAgain, this letter was degrading, demanding and sought a
single solutionShe has also involved other staff in other health systems
regarding this matter attempting to put pressure on OSC to resolve the matter
solely to her satisfaction of writing off the balance.While I can
fully appreciate the position that the Revdex.com has with attempting to resolve this
matter, OSC has spent an onerous amount of time on this issuesThe behaviors
of Mrs*** are threatening, harassing and unusual for this type of
situationIt is the position of OSC, that any additional correspondence from
Mrs*** through other patients and/or to our clinic will be escalated to our
legal counselTo write off or “waive” the patient responsibility violates
contractual agreements with insurance carriers and regulations that OSC is
required to comply with by lawThe attempt of Mrs*** to utilize personal
contacts that she has in senior executive roles within the healthcare systems
to attempt to “pressure” OSC to “waive” this billing, is illegalOSC will not
violate these regulations or laws on behalf of Mrs***, her family, or any
patients for that matterAgain, we handled all of our patient accounts in the
same manner as we have this accountIf Mrs*** has any further questions
regarding the patient responsibility of the account, and feels that the claim
assignment of patient responsibility is incorrect, I would encourage her to
contact the insurance carrier for further clarification or to dispute the
adjudication of the claimThe patient explanation of benefits for this claim
establishes the amount that we are to collectOSC collected this amount for
this account in accordance to the insurance assignment of the financial
responsibility on this claim and in accordance with the contractual andregulatory
requirements for a healthcare entity that accepts billing to and payments from
insurance plans.If the Revdex.com
needs further clarification in order to close this matter, please do not
hesitate to contact me directly

Complaint: [redacted]
I am rejecting this response because:
  This is In response to [redacted]'s additional letter on behalf of Orthopaedic and Sports Medicine.I am bewildered as to why Ms. [redacted] feels as if she should "educate" me on MY insurance.  I have had insurance longer than she is old.  I never have had  any issues with other doctor's offices.  When I have a doctor's appointment, they tell me what I owe and I pay it in full....When I have a dentist appointment, they tell me what I owe and I pay it in full......When I visit the Eye doctor, they tell me what I owe and I pay it in full......When I visit the pharmacy, they tell me what I owe and I pay the bill in full.   I do not know why the Orthopaedic and Sports Medicine Office is any different.  We asked how much the boot was and were given a price and I paid it in full, that very day,  which is my custom.  It certainly does not make any common sense that I would pay $325 for the boot when I could have also driven 1 mile down the road and only paid $120.  I still believe that it was not in malice but the office simply made a mistake. We had a wonderful relationship with the office staff and physician.  I think they simply misquoted or the office misunderstood.However, this is quite a pricey mistake.  I did start by notifying the business office which originally stated that they had made an error. They were pleasant and apologetic.  After no response, I started back at the bottom of the chain of command. I spoke with the business office and then  asked for the business office supervisor who again was friendly but said there was nothing she could do and I would have to speak to [redacted] COO. So, I was transferred to various voicemails.  This occurred over the course of a week with no response from anyone, much less [redacted]. I tried calling back after several days and was told that she might be over at the surgery center and the office  gave me the number and suggested I  try calling over there.  Everyone was helpful and friendly. Not until [redacted] finally called me back on Friday evening at 5, did I ever speak with her.  This is the only time I ever spoke with her. I would think any supervisor, or especially the COO, would want to know if there was a problem in the office so it could be corrected. What a surprise when I was threatened and interrupted and berated on our first encounter.  I was shocked by her manner.  I did write her a letter and sent it to her since she wouldn't listen to anything I had to say.  Why am I being treated this way for their mistake?? I did send it certified mail but will never know if it actually reached her.  Any manager, worth their salt, would certainly listen to both sides.  I have no idea about what her office told her about my situation.  Maybe they are afraid of her.  If she treats a patient this way, I can only imagine how she treats her staff.  However, the encounters [redacted] spoke of in her previous reply, simply did not occur with me.  Perhaps she is confusing me with someone else or is simply not truthful.  I never use foul language that she attributed to me, so her description simply did not occur with me. Perhaps she was frustrated because I did have to call so many times only to reach voicemails that were never returned.  Perhaps if she had taken a moment to call me, without waiting a week, I could have saved my time in trying to reach her.  I feel a week for a return call is excessive.  Yes, it is frustrating on the patients part to repeatedly be sent to voicemail. Yes, she is correct that I did send a letter to the doctor.  After her behavior, I felt that if I just mailed a letter to the doctor, most likely, it would never reach him. I felt as if it would be intercepted and destroyed.  I wanted the doctor to know that his care was amazing but also wanted him to know how the business office, and especially his COO was treating his patients.  Yes, I did have a friend that had an appointment with this doctor.  At the end of her appointment, as she and the doctor were leaving the room, she simply handed the letter to him for his later review.  Perhaps this infuriated Ms. [redacted].  Again, if she had been reasonable and had an ounce of sympathy and had attempted to discuss and resolve this issue rather than just yelling at me,  I would never have had to go to extra lengths. At least the doctor, as a physician owner,  understands from my  perspective what occurred, and then he can do with this issue as he wishes. I never asked [redacted] to "write it off"! I had paid all of my bills to this office in full to this point.  A mistake was made and I needed it corrected. We all make mistakes but how you handle those mistakes is very telling about the office and the person. Because [redacted] feels this is all my fault and has threatened me with collections even before the first bill arrived, blocked my number from even calling the office, and has fabricated so many issues about me, it makes me wonder about this office.  According to the June 2017 Norman Transcript, this office was fined over a million dollars for allegations of submitting false claims to Medicare, Medicaid, the VA, and Tri-care.   I do understand that this is a different issue but obviously this office has had past mistakes.Also, several years ago, perhaps before Ms. [redacted] worked for this business, another family member used this office.  A device was ordered and the cost was $150. It was paid in full that day because we were told our insurance didn't cover that device.  Not until the end of that year, I was notified by my insurance that the device was covered and had been paid in full earlier in the year to the Orthopaedic and Sports Medicine Office.    I called the office concerning this issue since the device had been double paid.  They examined their records and saw this was the case.  I requested a refund check be mailed to me and they agreed.  Two weeks went by and no check. I called again, they said they would mail it to me.....no check after another couple of weeks.  I called a third time and again requested the  check. They assured me they had mailed it, or perhaps not  but they would mail it.    After another two weeks and no check, I called them and told them I would be by in person tomorrow to receive the check. Of course when I arrived, no one knew anything about it.  They had to make many phone calls and after a great length of time, found someone who could refund my money!  So, yes Ms. [redacted], this office does make mistakes!!!How a mistake is handled is very telling about a company.  I think anyone that reads the previous reply from Ms. [redacted] can see for themselves how this situation was handled.  No one wants to pay over $200 when they don't have to.  Ms. [redacted] has handled this very poorly. I simply wanted a, "We are so very sorry!"  "What can we do to make this right?" [redacted] was not present the day we were in the office and the boot became an issue but there were four of us that witnessed the interaction.  The doctors in this office are fabulous but the billing office is riddled with errors. What COO replies as Ms. [redacted] has to a patient?There are many other amazing Orthopaedic physicians in the Oklahoma City area and another wonderful Orthopaedic group in Norman.  However, I will never again use this office!! 
Sincerely,
L [redacted]