Orthopedic Associates of Lancaster, LTD

Thank you for writing to OAL regarding [redacted] ***I apologize for the slight delay from when I received your original letter on May 26th, as I wanted to properly research the patients account before responding to you.For the injury and patient in question, we treated the patient twice; on January 16th, and February 3rd, At that time, the patient presented his personal insurance and we subsequently billed it to his insurance carrier on his behalf without questionWe also reviewed and had the patient sign our Patient Financial Responsibility form, which states:“Patients shall be financially responsible for medical services related to automobile/workers' compIt is the responsibility of the patient to notify OAL of the date of the injury, claim #, insurance company address, phone number and contact person."Through the patients first two encounters, there was no workers compensation claim information (i.eworkers compensation insurer, claim number, etc.) was presented to OALOn 3/25/the patient's wife, who also submitted this complaint, called us and expressed that there was a claim and that she would be faxing the information to OALThe account was marked for reprocessing pending the submission and verification of an open workers compensation claimHowever, we never received the claim information from [redacted] ***.OAL is more than willing to rebill [redacted] ***'s workers' compensation claim provided we have all of the information and his claim is open with his employerOnce we receive payment from the workers compensation carrier, all monies will be refunded to both [redacted] and his personal insurance.Thanks,Michael J

Thank you for writing to OAL regarding *** ***I apologize for the slight delay from when I received your original letter on May 26th, as I wanted to properly research the patients account before responding to youFor the injury and patient in question, we treated the patient twice; on
January 16th, and February 3rd, At that time, the patient presented his personal insurance and we subsequently billed it to his insurance carrier on his behalf without questionWe also reviewed and had the patient sign our Patient Financial Responsibility form, which states:“Patients shall be financially responsible for medical services related to automobile/workers' compIt is the responsibility of the patient to notify OAL of the date of the injury, claim #, insurance company address, phone number and contact person."
Through the patients first two encounters, there was no workers compensation claim information (i.eworkers compensation insurer, claim number, etc.) was presented to OALOn 3/25/the patient's wife, who also submitted this complaint, called us and expressed that there was a claim and that she would be faxing the information to OALThe account was marked for reprocessing pending the submission and verification of an open workers compensation claimHowever, we never received the claim information from *** ***OAL is more than willing to rebill *** ***'s workers' compensation claim provided we have all of the information and his claim is open with his employerOnce we receive payment from the workers compensation carrier, all monies will be refunded to both *** *** and his personal insurance.Thanks,Michael J

Thank you for writing to OAL regarding [redacted]. I apologize for the slight delay from when I received your original letter on May 26th, as I wanted to properly research the patients account before responding to you.For the injury and patient in question, we treated the patient twice; on January...

16th, 2015 and February 3rd, 2015. At that time, the patient presented his personal insurance and we subsequently billed it to his insurance carrier on his behalf without question. We also reviewed and had the patient sign our Patient Financial Responsibility form, which states:“Patients shall be financially responsible for medical services related to automobile/workers' comp. It is the responsibility of the patient to notify OAL of the date of the injury, claim #, insurance company address, phone number and contact person."Through the patients first two encounters, there was no workers compensation claim information (i.e. workers compensation insurer, claim number, etc.) was presented to OAL. On 3/25/15 the patient's wife, who also submitted this complaint, called us and expressed that there was a claim and that she would be faxing the information to OAL. The account was marked for reprocessing pending the submission and verification of an open workers compensation claim. However, we never received the claim information from [redacted].OAL is more than willing to rebill [redacted]'s workers' compensation claim provided we have all of the information and his claim is open with his employer. Once we receive payment from the workers compensation carrier, all monies will be refunded to both [redacted] and his personal insurance.Thanks,Michael J

Review: I was billed for an amount due, paid half and was issued a refund and then sent to collections less than a month later.Desired Settlement: I would like these charges nullified due to the time involved in resolving the issue.

Business

Response:

The Revdex.com 1337 North Front Street Harrisburg, PA 17102

Dear Revdex.com Representative:

The patient in question accrued a $50 balance with our practice for two unpaid copayments, We follow a well-defined collections process in reference to outstanding balances.

Upon receipt of processing from the insurance, outlining any patient financial responsibility, the patient value is moved in our system from an "insurance due" to "patient due" status. Our patient statements are system-gene rated each Friday and capture any new balances for that week.

If payment in full is not received or if a signed payment plan has not been setup, another statement is sent a month later. If another month goes by and payment in full has not been received nor has a signed payment plan been defined, a final statement is sent from our practice. After three statements have been sent out on a monthly basis, a patient's account will fall into our pre-collections workflow. When an account falls into precollections, a letter is printed and mailed to the patient explaining their current status with our practice, the risk of being forwarded to a collections agency and what needs to be done in order to avoid that fate. Coupled with this letter is a phone-call from one of our collectors. Their intent is to reach the patient; discuss the status of their account, answer any and ail questions the patient may have, and talk about accepted methods of payment. The result of the phone call is noted and if the patient was unable to be reached, their account is then deferred in our workflow for 10 days, The 10 days is to allow for the pre-collections letter to be delivered and give the patient 3-7 days to respond to our Business Office. Following the 10 day deferral and no contact or communication from the patient, a final call will be made with the same intent as the first. If the final call is made with no resolution on the account, it is then marked as "ready for collections" and sent in a file each Thursday.

The patient in question was sent a statement (bill) on 4/18/2013 for unpaid copays from a 3/14/2013 visit. No payment was received and no contact was made. Another statement was sent on 5/16/2013. No payment was received and no contact was made by the patient. A final statement was sent on 6/20/2013. A pre-collections letter was sent out 6/26/2013 accompanied by a phone call from one of our staff. Our collector left avoicemail asking for the patient to call back regarding their account and deferred it for 10 days. No payment or communication was received from the patient in the 10 day deferral period, A final call was made to the patient on 7/8/2013 with no response. That account was assigned "ready for collections" (a workflow status triggering it to be swept, by our system, into the collections file generated each week) that same day. A $25 payment was made by the patient on 7/10/2013 on our online payment portal. By making the payment online, circumventing any communication to explain circumstance and not satisfying a full payment or defined payment arrangement, the payment was system-posted to their account and the remaining balance was forwarded to our collections agency the next day, 7/12/2013.

The patient called into our Business Office on S/15/2013 upset that they had been sent to collections, I spoke with the patient, explained why we have our collections process and what they could have done to prevent being sent (spoken to a representative and set up a payment arrangement or spoken to a rep and described the nature of their payment and intention to pay in the future). I further described that although a $25 payment was made, there is no way for our practice to know or anticipate when the rest of the balance will be received. This is what necessitates the communication aspect of our process and why we call the patient at least twice before moving forward.

We do place a high importance on customer goodwill and after hearing the patient's complaint, I offered to reconcile the situation for both parties. 1 offered for the balance to be pulled back from the collections agency and ensure the patient's credit was not marked in anyway, if the patient agreed to pay the remaining $25 within a day, The patient did not agree to my offer, explaining that they no longer felt the balance was owed due to the amount of time and effort spent talking with me and previously with the Credit Agency. I would not write the balance off, explaining that considerable time, effort and resources were spent trying to collect the owed balance.

The patient mentioned a refund in their complaint. No actions or notes support this anywhere in our system and no record of which can be located on our credit/debit card service.

Our right to pursue owed balances is outlined on our General Financial Policy signed by each patient. Furthermore, our practice offers a unique Online Billing Office where not only can a representative be reached at the patient's convenience, but our collections process is outlined in detail.

If there are any further questions or concerns, please do not hesitate to contact me.

Regards,

Consumer

Response:

[To assist us in bringing this matter to a close, you must give us a reason why you are rejecting the response. If no reason is received your complaint will be closed Administratively Resolved]

Review: [redacted]

I am rejecting this response because: