Phelps County Regional Medical Reviews (6)
Jan 01, 2020
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) */
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...
Initial Business Response /* (1000, 8, 2016/02/24) */