Phelps County Regional Medical

Initial Business Response / [redacted] (1000, 8, 2015/12/29) */ To Whom it may concern: This [redacted] had a mammogram and bone density test on 6-3-Both tests were coded according to medical coding guidelinesWe had to take a contractual adjustment on July 24th per our contract with the insurance company and the balance was applied to the patient deductible/co-payThe insurance paid the mammogram in full on July 30thThe patient called in, was upset that their wellness part of their policy did not pay the bone density in fullThe patient indicated that the insurance said we needed to change the coding, which we couldn't do according to coding guidelinesWe contacted the physician's office to see if there was anything else that they knew that would be able to use that codeThey indicated there wasn't anything else in the chart that would help usOn 9-28-we talked to the insurance company and explained that we couldn't change the coding to what they want as the patients family doesn't have a history of osteopeniaThe insurance person said they understood so they would contact the patientThis is months old and has worked its way through the billing cycleI will ask the collection agency to put this account on hold for another days to see if the patient is able to get the insurance company to pay for this test under the wellness part of their contract Sincerely, [redacted] Director Patient Financial Services Initial Consumer Rebuttal / [redacted] (3000, 10, 2015/12/29) */ (The consumer indicated he/she DID NOT accept the response from the business.) When my doctor told me to get a bone density as part of my preventive care post menopausal, I called the insurance company and asked if it was coveredI was told it was covered 100% as long as it was coded preventativeOn the day of the test I told the people in PCRMC I only wanted the test if it was coded correctly.They kept me there 1/hours and assured me it was coded correctly so I allowed them to do the testThe insurance company will not pay because it was coded incorrectlyPCRMC will not code it correctlyI have tried very hard to work this out and neither will budgeCan you please help me? Final Business Response / [redacted] (1000, 13, 2016/01/08) */ I am in receipt of your letter dated 12-31-I have again reviewed the entire chartShe was scheduled at 7:am and was taken back at 7:Both tests were complete by 8:47amI called the patient this morning and discussed this at length with herI am sorry that her insurance wouldn't cover the bone density test under her wellness part of her coverage, but there is nothing that we can doThe insurance company should have told her what if any restrictions there were to the test being covered, which per the patient they did notShe is appealing through the state insurance commission as her insurance denied her appealI told her we would put her bill on hold until the end of FebruaryShe will call me and we will work out a settlement or a payment plan for her I can understand why she would be unhappy about the situationI feel that insurance companies need to do a better job in explaining to consumers about whether something is covered or not covered and under what section of their plan Sincerely, [redacted] Director Patient Financial Services

Initial Business Response /* (1000, 8, 2015/12/29) */
To Whom it may concern:
This [redacted] had a mammogram and bone density test on 6-3-15. Both tests were coded according to medical coding guidelines. We had to take a contractual adjustment on July 24th per our contract with the insurance...

company and the balance was applied to the patient deductible/co-pay. The insurance paid the mammogram in full on July 30th. The patient called in, was upset that their wellness part of their policy did not pay the bone density in full. The patient indicated that the insurance said we needed to change the coding, which we couldn't do according to coding guidelines. We contacted the physician's office to see if there was anything else that they knew that would be able to use that code. They indicated there wasn't anything else in the chart that would help us. On 9-28-15 we talked to the insurance company and explained that we couldn't change the coding to what they want as the patients family doesn't have a history of osteopenia. The insurance person said they understood so they would contact the patient. This is 6 months old and has worked its way through the billing cycle. I will ask the collection agency to put this account on hold for another 30 days to see if the patient is able to get the insurance company to pay for this test under the wellness part of their contract.
Sincerely,
[redacted]
Director Patient Financial Services
Initial Consumer Rebuttal /* (3000, 10, 2015/12/29) */
(The consumer indicated he/she DID NOT accept the response from the business.)
When my doctor told me to get a bone density as part of my preventive care post menopausal, I called the insurance company and asked if it was covered. I was told it was covered 100% as long as it was coded preventative. On the day of the test I told the people in PCRMC I only wanted the test if it was coded correctly.They kept me there 2 1/2 hours and assured me it was coded correctly so I allowed them to do the test. The insurance company will not pay because it was coded incorrectly. PCRMC will not code it correctly. I have tried very hard to work this out and neither will budge. Can you please help me?
Final Business Response /* (1000, 13, 2016/01/08) */
I am in receipt of your letter dated 12-31-15. I have again reviewed the entire chart. She was scheduled at 7:30 am and was taken back at 7:35. Both tests were complete by 8:47am. I called the patient this morning and discussed this at length with her. I am sorry that her insurance wouldn't cover the bone density test under her wellness part of her coverage, but there is nothing that we can do. The insurance company should have told her what if any restrictions there were to the test being covered, which per the patient they did not. She is appealing through the state insurance commission as her insurance denied her appeal. I told her we would put her bill on hold until the end of February. She will call me and we will work out a settlement or a payment plan for her.
I can understand why she would be unhappy about the situation. I feel that insurance companies need to do a better job in explaining to consumers about whether something is covered or not covered and under what section of their plan.
Sincerely,
[redacted]
Director Patient Financial Services

the above person was treated in our Emergency Room on 6-11-16.  Total charges was $1,579.00 as self-pay discount of 30% was applied leaving a balance due from the patient of $1,105.30.One of our staff returned a phone call to the customer and explained to them that they could pay us in full in...

6 months or they could sign up for an interest free bank loan and the payments on this loan would be $46.00 per month.  Our staff sent out an itemized bill per the customer's request and information about the interest free loan.  Our phone logs do show messages received on 9-27-16 and 10-3-16.  My staff did not enter anything in the notes about what was done, so because lack of documentation I can not dispute the claim that the calls were not returned.I feel that the confusion was that the customer didn't realize that she had to provide information and agree to the interest free loan program.  Due to the facts I have asked the collection agency to return the account to the hospital.  We will allow the customer to continue making the $46.00 monthly payments to the hospital until the account is paid in full.

Initial Business Response /* (1000, 8, 2016/02/24) */
This person was treated in the Emergency Room in May of 2015. No indication of any concern about the care was received. He/she was instructed to follow up with another Physician for any follow-up care. I don't have any way of knowing he/she...

did. The insurance paid on 6/15/15. The remaining balance was his/her deductible and/or co-pay. A letter was sent out informing him/her of insurance paying and the balance that was due and asked to contact us for payment arrangements. No one ever contacted us. In August a payment of $24.29 was received. September we received $25.00, October received another $25.00 and no payment was received in November. In December he/she called and wanted a settlement for the remaining balance. We do not do settlements on older balances and he/she was notified of this. He/she then stated that he/she would pay what he/she could find afford. He/she paid $5.00 in December, $5.00 on January 4, 2016. We sent a notice that the account would be sent to collections. He/she paid $5.00 on1/15/16, $15.00 on 1/25/16 and $5.00 on 2/5/16. If he/she continued to pay $25.00 per month it would take 17 more months to pay the balance in full. I am willing to extend payments out to 12 more months which would mean monthly payments of $34.59. He/she needs to contact us to accept this payment offer or the balance is due in full.

See attached.

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID [redacted], and find that this resolution is satisfactory to me.   However a payment of $56 was made to the credit company on the first of the month to keep my account in good standings with them.  I will need that payment to register on my balance due to the hospital.
Sincerely,
[redacted]