Peak Potential Therapy, LLC

There are a few components need to be clarified:The parent signed the Policy Agreement on 1/19/17, accepting and understanding that they are responsible for payments for services not covered by any other third party [insurance]Yes, we have the capability to bill insurance, but there is never a guarantee that insurance will cover servicesThe testing service was provided 1/19/The family was not able to provide payment at time of service, as their card would not go throughOn good faith the family said they would call back to pay for service, and the family did make payment in full $ Their daughter tested with her score being within limitsShe did not qualify for servicesThere is no ICD-10/diagnosis code for "no speech-language disorder," in order to warrant medical necessity for the insurance to payTherefore we did not submit the claim, immediatelyIt was submitted 5/26/17, the day after the family’s request when they said push it through despite no medical necessity We were in contact with the family to resolve the issue on 3/12/17, 5/25/17, 5/26/17, and 8/17/Yes, a 10% credit ($41.50) was provided to the client 3/15/17, for the paperwork's drawn out time frame (months) and inconvenience to the familyIn addition to the monetary credit, the family received a gift certificate for a free re-evaluation to help mafor the slow reporting follow-up In regards to their insurance, the claim was initially submitted 5/26/(the day after speaking with the client), with the amount $in box # ***, but was not in box # [redacted] (clerical oversight)We received EOB notice from insurance via USPS on 7/5/17, and then a follow up letter via USPS on 8/4/stating the missing diagnosis code and totalWe did contact their insurance on 8/14/to resolve the issue, and a Senior Specialist at the insurance told us to research and contact billing department to find a “Possible Diagnosis Code.” After researching and figuring out how to ethically bill for a client who does not qualify for services, we resubmitted the claim on 9/8/ In conclusion, the family received the speech-language evaluation service in a timely manner for which they paidThey are not satisfied with the delayed time frame of the follpaperwork, for which they accepted compensationNow, they want a full refund, which was never addressed to the owner prior to this Revdex.com complaint being submitted If copies of the Policy Agreement, Written Communication to Family, Claim Forms, EOB, Insurance Follow up Letter, Processed Credit to Family, or other supporting documentation is needed, please let me know

Dear Ms***, We hope this message finds you doing well and thank you for taking the time to communicate your dissatisfaction with our clinic. Please accept our sincerest apology for any trouble and inconvenience we may have causedWe would like to acknowledge that your complaint was
received and want to assure you that we’re more than happy to work with you on a resolution. We certainly try to please all of our patients and are sorry that there has been a breakdown in our relationshipThat said, I’m very disheartened by your message since my team and I have done everything from trying to help you understand your balance to offering to work with your insurance representative to help resolution to your concernsAs much as we can appreciate you reaching out to inquire about your account, the fact remains that your account still shows an outstanding balanceAs mentioned in prior communications, our records indicate that your account balance with Peak Potential Therapy is still past due in the amount of $You’ve been provided with every itemized invoice since you started services with us, which precisely outlines each transactionI would like to extend to you another opportunity to review your detailed account summary with you and/or your insurance company, at your convenienceWe have every desire to address your needs and provide the best solution available to resolve your issue as soon as possible. Further, we would like to work with you to understand how and why you believe that an $1,refund is owed. Please provide us with a detailed explanation outlining specifically how and why a refund is owed, which should itemize each transaction and add up to the total refund. Upon review of this information, I’d be happy to work with you to see if we can come to terms and final resolutionWe regret losing you as a patient and want to make your transition to a new provider as easy as possiblePlease contact our office so we can provide you with an authorization to release of medical records formOnce you find another clinic, please send us the signed authorization designating where you would like a copy of your records sent and we will obligeWe look forward to resolving this matter amicably soon

There are a few components need to be clarified:The parent signed the Policy Agreement on 1/19/17, accepting and understanding that they are responsible for payments for services not covered by any other third party [insurance]Yes, we have the capability to bill insurance, but there is never a
guarantee that insurance will cover servicesThe testing service was provided 1/19/The family was not able to provide payment at time of service, as their card would not go throughOn good faith the family said they would call back to pay for service, and the family did make payment in full $ Their daughter tested with her score being within limitsShe did not qualify for servicesThere is no ICD-10/diagnosis code for "no speech-language disorder," in order to warrant medical necessity for the insurance to payTherefore we did not submit the claim, immediatelyIt was submitted 5/26/17, the day after the family’s request when they said push it through despite no medical necessity We were in contact with the family to resolve the issue on 3/12/17, 5/25/17, 5/26/17, and 8/17/Yes, a 10% credit ($41.50) was provided to the client 3/15/17, for the paperwork's drawn out time frame (months) and inconvenience to the familyIn addition to the monetary credit, the family received a gift certificate for a free re-evaluation to help mafor the slow reporting follow-up. In regards to their insurance, the claim was initially submitted 5/26/(the day after speaking with the client), with the amount $in box # ***, but was not in box #** (clerical oversight)We received EOB notice from insurance via USPS on 7/5/17, and then a follow up letter via USPS on 8/4/stating the missing diagnosis code and totalWe did contact their insurance on 8/14/to resolve the issue, and a Senior Specialist at the insurance told us to research and contact billing department to find a “Possible Diagnosis Code.” After researching and figuring out how to ethically bill for a client who does not qualify for services, we resubmitted the claim on 9/8/ In conclusion, the family received the speech-language evaluation service in a timely manner for which they paidThey are not satisfied with the delayed time frame of the follpaperwork, for which they accepted compensationNow, they want a full refund, which was never addressed to the owner prior to this Revdex.com complaint being submitted. If copies of the Policy Agreement, Written Communication to Family, Claim Forms, EOB, Insurance Follow up Letter, Processed Credit to Family, or other supporting documentation is needed, please let me know.

I am rejecting this response because: the company has been notified by me and TriCare/Healthnet that they are not allowed to balance bill for the difference not covered under their contractThey company owes me $600+ in a refund and refuses to recalculate the billing since they are trying to collect more than their contracted allowanceI have paid the balance twice, paid more than the copay, and insurance has also paid the provider

Dear Ms***, We hope this message finds you doing well and thank you for taking the time to communicate your dissatisfaction with our clinic.? Please accept our sincerest apology for any trouble and inconvenience we may have causedWe would like to acknowledge that your complaint was
received and want to assure you that we’re more than happy to work with you on a resolution.? We certainly try to please all of our patients and are sorry that there has been a breakdown in our relationshipThat said, I’m very disheartened by your message since my team and I have done everything from trying to help you understand your balance to offering to work with your insurance representative to help resolution to your concernsAs much as we can appreciate you reaching out to inquire about your account, the fact remains that your account still shows an outstanding balanceAs mentioned in prior communications, our records indicate that your account balance with Peak Potential Therapy is still past due in the amount of $You’ve been provided with every itemized invoice since you started services with us, which precisely outlines each transactionI would like to extend to you another opportunity to review your detailed account summary with you and/or your insurance company, at your convenienceWe have every desire to address your needs and provide the best solution available to resolve your issue as soon as possible.? Further, we would like to work with you to understand how and why you believe that an $1,refund is owed.? Please provide us with a detailed explanation outlining specifically how and why a refund is owed, which should itemize each transaction and add up to the total refund.? Upon review of this information, I’d be happy to work with you to see if we can come to terms and final resolutionWe regret losing you as a patient and want to make your transition to a new provider as easy as possiblePlease contact our office so we can provide you with an authorization to release of medical records formOnce you find another clinic, please send us the signed authorization designating where you would like a copy of your records sent and we will obligeWe look forward to resolving this matter amicably soon

I am rejecting this response because: the company has been notified by me and TriCare/Healthnet that they are not allowed to balance bill for the difference not covered under their contract. They company owes me $600+ in a refund and refuses to recalculate the billing since they are trying to collect more than their contracted allowance. I have paid the balance twice, paid more than the copay, and insurance has also paid the provider.

There are a few components need to be clarified:The parent signed the Policy Agreement on 1/19/17, accepting and understanding that they are responsible for payments for services not covered by any other third party [insurance]. Yes, we have the capability to bill insurance, but there is never a...

guarantee that insurance will cover services. The testing service was provided 1/19/17. The family was not able to provide payment at time of service, as their card would not go through. On good faith the family said they would call back to pay for service, and the family did make payment in full $415.00.  Their daughter tested with her score being within normal limits. She did not qualify for services. There is no ICD-10/diagnosis code for "no speech-language disorder," in order to warrant medical necessity for the insurance to pay. Therefore we did not submit the claim, immediately. It was submitted 5/26/17, the day after the family’s request when they said push it through despite no medical necessity.   We were in contact with the family to resolve the issue on 3/12/17, 5/25/17, 5/26/17, and 8/17/17. Yes, a 10% credit ($41.50) was provided to the client 3/15/17, for the paperwork's drawn out time frame (2 months) and inconvenience to the family. In addition to the monetary credit, the family received a gift certificate for a free re-evaluation to help make-up for the slow reporting follow-up.  In regards to their insurance, the claim was initially submitted 5/26/17 (the day after speaking with the client),  with the amount $373.50 in box # [redacted], but was not in box #** (clerical oversight). We received EOB notice from insurance via USPS on 7/5/17, and then a follow up letter via USPS on 8/4/17 stating the missing diagnosis code and total. We did contact their insurance on 8/14/17 to resolve the issue, and a Senior Specialist at the insurance told us to research and contact billing department to find a “Possible Diagnosis Code.”  After researching and figuring out how to ethically bill for a client who does not qualify for services, we resubmitted the claim on 9/8/17.    In conclusion, the family received the speech-language evaluation service in a timely manner for which they paid. They are not satisfied with the delayed time frame of the follow-up paperwork, for which they accepted compensation. Now, they want a full refund, which was never addressed to the owner prior to this Revdex.com complaint being submitted.  If copies of the Policy Agreement, Written Communication to Family, Claim Forms, EOB, Insurance Follow up Letter, Processed Credit to Family, or other supporting documentation is needed, please let me know.