Initial Business Response /* (1000, 6, 2015/12/10) */
This is in response to the complaint filled against our office by [redacted]- compliant number XXXXXXXX.
[redacted] is a patient of ours and was seen for an appointment on October 6, 2015. After billing her services to her medical...
insurance based on her medical diagnosis is was determined that the patient has some out of pocket costs as directed by her medical insurance. Those minimal fees were transferred to the patients account on October 26, 2015. And a statement was sent to the patient reflecting the patient portion of her services as directed by her medical insurance.
She contacted our office on November 2nd confused by her bill and spoke with the Practice Manager at length regarding how her services were billed. She was misunderstanding the difference between routine vision care and medical care. Her services were billed to her medical insurance as it is a medical based exam due to a medical condition and can not be billed to her routine vision discount plan. She seemed to understand the difference at that time and said she was also going to confirm with her insurance.
The following day November 3, 2015 we received a call at 5:30pm from her routine vision discount plan asking why we had not billed the services to them. The diagnosis and procedures were clarified with her vision discount plan and they agreed that those services were not covered under their plan and assured our staff that they would explain it to the patient. At 5:45pm the same day we received a second call from a second representative of her vision discount plan asking why we had not billed the services to them. It was again explained and determined that we billed services properly to her major medical insurance company. They representative again agreed with our billing and said she would explain it to the patient.
The patient again called our office on November 4th, this time asking to speak directly to the doctor regarding the bill. Our staff did explain to the patient again how and why her services were billed and let her know we would pass the message on to the doctor, but did inform her that the Doctor does not normally return calls for billing issues. However [redacted] did in fact return her call and left a detailed message on her machine at the home number again explaining the billing.
On November 5th the patient again called our office demanding to speak with the doctor regarding her bill. She was informed that the Doctor left a message for her on her home number on November 4th and that the Doctor would not be calling her again to discuss it.
At 3:15pm on November 5th we received another call from a representative with her vision discount plan asking why we had not billed services to them. It was again explained to them and agreed that we billed her services properly to her major medical insurance. Her vision discount plans was instructed to put notes on the patients account that our office was not to be called again regarding billing for this date of service.
On Friday November 6th our Practice Manager again contacted the patient to review her billing with her and to let her know that the Doctor was not the person who could discuss her billing questions with her. The patient was reminded that the charges are her legal responsibility, nothing was billed incorrectly, and she signed our payment policy stating she would take care of any and all charges as directed by her insurance company. She was also informed that the Doctor would not be calling her again regarding this billing issue.
The Doctor has received both notes from the patient requesting a call to discuss her bill, but the patient has been informed on multiple occasions the Doctor is not the person to discuss her billing with. Her services have been reviewed in detail with her on numerous occasions by our staff and her vision discount plan and there is nothing more to discuss. The Doctor has already left a message for the patient and will not be contacting her again regarding this issue.
Initial Consumer Rebuttal /* (3000, 8, 2015/12/13) */
(The consumer indicated he/she DID NOT accept the response from the business.)
To correct [redacted] response...a routine eye exam was scheduled on October 6, 2015...expenses were to be directed to [redacted] eye insurance. [redacted] will cover a routine vision exam no matter what the diagnosis.
WELLVISION(r) EXAM
Eligibility: YOU ARE ELIGIBLE.
Frequency:Every year beginning in March.
Copay:$20.00
Coverage: Covered after copay.
Description: Only [redacted] offers a WellVision Exam, focused on your eyes and overall wellness. Your VSP doctor can see if you have vision problems and signs of other health conditions too.
To correct [redacted] response to phone conversations with [redacted] insurance on November 3, 2015...they never agreed that the services were not covered under their plan...they agreed to relay ParkRidge Vision's response to me. My routine eye exams have been covered by [redacted] insurance since December 2012 when I was first diagnosed with Keratoconus.
A phone call from [redacted] was received on November 4, 2015 by an answering machine. Unfortunately only a partial message was left due to technology. A return call was made requesting to speak to [redacted], NOT DEMANDING, as stated by [redacted].
Both notes were sent to [redacted] marked personal and not to be opened by her staff. Once again I am requesting a phone call from [redacted] at a time that is convenient for both us.
Final Business Response /* (4000, 15, 2015/12/22) */
Our office stands by our position on the matter. There are no additional steps to be taken in this case.
Our office has billed properly and legally for the services provided. As previously stated, [redacted] received a comprehensive eye health exam, not a routine eye exam. Therefore we can not bill anything to [redacted]. A routine exam may have been covered under [redacted], but that is not the service that was provided and therefore can not and will not be billed to [redacted]
Our office has spent a considerable amount of time trying to educate this patient on her insurance benefits to no avail. The doctor has already contacted her and left a detailed message. At this point services were rendered and the patient owes her portion of the fees for those services. If she chooses not to pay those fees she will be sent to collections. The patient signed the forms in our office stating she understood the billing processes and agreed to our payment policy.
We are sorry to loose her as a patient and hope that she is able to find another office that is able to help her. We are happy to send her records to her next doctor to better help her care in the future.
Final Consumer Response /* (4200, 17, 2015/12/26) */
(The consumer indicated he/she DID NOT accept the response from the business.)
I was hoping to resolve this issue but unfortunately [redacted] is unwilling to communicate with me.
[redacted] also is not being honest regarding [redacted] stance. [redacted] has been very sympathetic to me and states they cannot tell a doctor's office how to bill but they do not understand why ParkRidge Vision will not submit a routine eye exam which is covered for Keratoconus patients.
Per [redacted] this insurance claim can be reversed and filed with [redacted]. Insurance fraud would not be committed.
A considerable amount of time has not taken place trying to educate me due to the fact that [redacted] screamed over the phone that [redacted] and myself should have no more contact with the office and hung up on me.
A check for $20.00 has been sent to the office. This is my responsibility for the routine eye exam that was requested and the Determination of Refractive that would have been covered by [redacted].
ParkRidge Vision is not sorry to lose me as a patient or the several others that I have referred to this office. If this were true, [redacted] would not have screamed at me over the phone on November 6th.
Yes I have found another office that specializes in Keratoconus. They also will bill routine eye exams for patients with Keratoconus to [redacted].
Initial Business Response /* (1000, 6, 2015/12/10) */
This is in response to the complaint filled against our office by [redacted]- compliant number XXXXXXXX.
[redacted] is a patient of ours and was seen for an appointment on October 6, 2015. After billing her services to her medical...
insurance based on her medical diagnosis is was determined that the patient has some out of pocket costs as directed by her medical insurance. Those minimal fees were transferred to the patients account on October 26, 2015. And a statement was sent to the patient reflecting the patient portion of her services as directed by her medical insurance.
She contacted our office on November 2nd confused by her bill and spoke with the Practice Manager at length regarding how her services were billed. She was misunderstanding the difference between routine vision care and medical care. Her services were billed to her medical insurance as it is a medical based exam due to a medical condition and can not be billed to her routine vision discount plan. She seemed to understand the difference at that time and said she was also going to confirm with her insurance.
The following day November 3, 2015 we received a call at 5:30pm from her routine vision discount plan asking why we had not billed the services to them. The diagnosis and procedures were clarified with her vision discount plan and they agreed that those services were not covered under their plan and assured our staff that they would explain it to the patient. At 5:45pm the same day we received a second call from a second representative of her vision discount plan asking why we had not billed the services to them. It was again explained and determined that we billed services properly to her major medical insurance company. They representative again agreed with our billing and said she would explain it to the patient.
The patient again called our office on November 4th, this time asking to speak directly to the doctor regarding the bill. Our staff did explain to the patient again how and why her services were billed and let her know we would pass the message on to the doctor, but did inform her that the Doctor does not normally return calls for billing issues. However [redacted] did in fact return her call and left a detailed message on her machine at the home number again explaining the billing.
On November 5th the patient again called our office demanding to speak with the doctor regarding her bill. She was informed that the Doctor left a message for her on her home number on November 4th and that the Doctor would not be calling her again to discuss it.
At 3:15pm on November 5th we received another call from a representative with her vision discount plan asking why we had not billed services to them. It was again explained to them and agreed that we billed her services properly to her major medical insurance. Her vision discount plans was instructed to put notes on the patients account that our office was not to be called again regarding billing for this date of service.
On Friday November 6th our Practice Manager again contacted the patient to review her billing with her and to let her know that the Doctor was not the person who could discuss her billing questions with her. The patient was reminded that the charges are her legal responsibility, nothing was billed incorrectly, and she signed our payment policy stating she would take care of any and all charges as directed by her insurance company. She was also informed that the Doctor would not be calling her again regarding this billing issue.
The Doctor has received both notes from the patient requesting a call to discuss her bill, but the patient has been informed on multiple occasions the Doctor is not the person to discuss her billing with. Her services have been reviewed in detail with her on numerous occasions by our staff and her vision discount plan and there is nothing more to discuss. The Doctor has already left a message for the patient and will not be contacting her again regarding this issue.
Initial Consumer Rebuttal /* (3000, 8, 2015/12/13) */
(The consumer indicated he/she DID NOT accept the response from the business.)
To correct [redacted] response...a routine eye exam was scheduled on October 6, 2015...expenses were to be directed to [redacted] eye insurance. [redacted] will cover a routine vision exam no matter what the diagnosis.
WELLVISION(r) EXAM
Eligibility: YOU ARE ELIGIBLE.
Frequency:Every year beginning in March.
Copay:$20.00
Coverage: Covered after copay.
Description: Only [redacted] offers a WellVision Exam, focused on your eyes and overall wellness. Your VSP doctor can see if you have vision problems and signs of other health conditions too.
To correct [redacted] response to phone conversations with [redacted] insurance on November 3, 2015...they never agreed that the services were not covered under their plan...they agreed to relay ParkRidge Vision's response to me. My routine eye exams have been covered by [redacted] insurance since December 2012 when I was first diagnosed with Keratoconus.
A phone call from [redacted] was received on November 4, 2015 by an answering machine. Unfortunately only a partial message was left due to technology. A return call was made requesting to speak to [redacted], NOT DEMANDING, as stated by [redacted].
Both notes were sent to [redacted] marked personal and not to be opened by her staff. Once again I am requesting a phone call from [redacted] at a time that is convenient for both us.
Final Business Response /* (4000, 15, 2015/12/22) */
Our office stands by our position on the matter. There are no additional steps to be taken in this case.
Our office has billed properly and legally for the services provided. As previously stated, [redacted] received a comprehensive eye health exam, not a routine eye exam. Therefore we can not bill anything to [redacted]. A routine exam may have been covered under [redacted], but that is not the service that was provided and therefore can not and will not be billed to [redacted]
Our office has spent a considerable amount of time trying to educate this patient on her insurance benefits to no avail. The doctor has already contacted her and left a detailed message. At this point services were rendered and the patient owes her portion of the fees for those services. If she chooses not to pay those fees she will be sent to collections. The patient signed the forms in our office stating she understood the billing processes and agreed to our payment policy.
We are sorry to loose her as a patient and hope that she is able to find another office that is able to help her. We are happy to send her records to her next doctor to better help her care in the future.
Final Consumer Response /* (4200, 17, 2015/12/26) */
(The consumer indicated he/she DID NOT accept the response from the business.)
I was hoping to resolve this issue but unfortunately [redacted] is unwilling to communicate with me.
[redacted] also is not being honest regarding [redacted] stance. [redacted] has been very sympathetic to me and states they cannot tell a doctor's office how to bill but they do not understand why ParkRidge Vision will not submit a routine eye exam which is covered for Keratoconus patients.
Per [redacted] this insurance claim can be reversed and filed with [redacted]. Insurance fraud would not be committed.
A considerable amount of time has not taken place trying to educate me due to the fact that [redacted] screamed over the phone that [redacted] and myself should have no more contact with the office and hung up on me.
A check for $20.00 has been sent to the office. This is my responsibility for the routine eye exam that was requested and the Determination of Refractive that would have been covered by [redacted].
ParkRidge Vision is not sorry to lose me as a patient or the several others that I have referred to this office. If this were true, [redacted] would not have screamed at me over the phone on November 6th.
Yes I have found another office that specializes in Keratoconus. They also will bill routine eye exams for patients with Keratoconus to [redacted].