Physicians' Medical Services Bureau, Inc.

I would like to thank the Revdex.com for their help in this matter.   As of today, all the claims have been finally sent my my insurance company and have been processed with the insurance paying their portion of the bill.  I would also like to thank the one worker who looked into what was truly holding up the processing of my bills.  I have never been treated so rudely by the president of a company or had to use the Revdex.com to resolve a conflict.  I am just waiting on a revised bill from said company.

First of all, my company (PMSB, Inc.) is a business to business medical claims processing company which has provided services, without a single formal complaint, for over 30 years.  I've owned the company for that entire period.  We have NO individual clients or customers; all of my...

services are provided to medical practices. Any (special) requests from patients are typically routed through the medical provider to me, not from individuals to me.  Any communications I have with individuals directly, as opposed to the provider requesting on behalf of the individual, is "above and beyond the call of duty".  I have, however, spoken directly to Ms. [redacted] on several occasions.  She suggests that I have not submitted claims, originated from services provided to Ms. [redacted] by [redacted], to the insurance company for adjudication.  This statement is false, and Ms. [redacted] knows that it's false.  I have electronically filed her claims, using the information supplied to me by the practice, on several different occasions.  The transmission of her claims was done so while implementing all applicable HIPAA regulatory mandates.  I receive, from the insurance company, an HL7 record showing electronic receipt of those claims.  I am required to submit claims, for our providers, one time.  If the insurance company does not pay, the amount of the (unpaid) claim becomes (legally) the patients responsibility.  We received, on more than one occasion, notification, FROM THIS PATIENTS INSURANCE COMPANY, that the policy Ms [redacted] provided as her insurance was not in force at the time the services were provided.  After the first time I received that notification (from the insurance company), I (appropriately) invoiced Ms [redacted].  The patient invoice is clear...it shows the date of service, the amount owed, and the reason the balance is due.  Ms. [redacted] called me, after receiving this invoice, and stated that there was an insurance error, said that the claim should have been paid, and asked me to resubmit claims.  I did so, more than once.  Each time, the insurance company rejected the claim with the same information: "Policy not in effect at the time of service".  At this point, it becomes the responsibility of the patient to contact the insurance company, and pay the invoice to the doctor.  The patient can then settle the issue and, if resolved, the patient can receive reimbursement for the amount paid to the practice. I have no legal, or any other, responsibility to this patient.  All statements I have made in this response can be backed up with computer records if necessary.