Physicians' Alliance, Ltd, Oyster Point Health Center

August 8, Dear [redacted] ,I am in receipt of the response from [redacted] rejecting the explanation regarding his balance from date of service 4/3/Per my original response dated 7/28/ [redacted] sent us an explanation of benefits dated 5/27/denying his 4/3/service with remark code [redacted] = patient ineligible for this serviceThis resulted in patient being responsible for the remaining balance of $66.87.I am not sure what additional information I can supply as his primary and secondary payer processed this service and we are contractually obligated to collect on the balance, I supplied the proof on my original response with the explanations of benefits received from both insurances.Please let me know if there is any additional information needed to resolve this matter.Sincerely, Kathy S Billing Director

- Billing adjustment to match what my insurance co-pay of $for an office visit - Not to keep coming up with more payments due for past office visits after they tell my Wife or I that nothing is due - To collect co-pays at the time of office visit instead of saying "we'll bill your insurances" - To make sure my secondary insurance company receives a copy of the EOB from my primary insurance so that they know what to pay - Not to send bills to collections prior to both insurances making their payments

[To assist us in bringing this matter to a close, you must give us a reason why you are rejecting the responseIf no reason is received your complaint will be closed Administratively Resolved]
Complaint: ***
I am rejecting this response because:I spoke with a ***-*** representative on the phone today after reviewing your response to my claimIn reference to my 4/3/office visit you stated that "His secondary insurance ***-*** denied as patient ineligible for this service"This is a statement*** sent a request for EOB from my primary insurance and they never received a response from your officeThey never said that I was ineligible for this serviceThis seems to be the norm and where most of the billing gets screwed upYou never forward my EOBs from my primary insurance to my secondary insurance
Regards,
*** ***

July 28, Dear ***,I am in receipt of the complaint filed by *** *** *** on 7/17/14.In regards to the visit on 4/3/his primary insurance *** *** applied $114,to his deductible, His secondary insurance ***-*** denied as patient ineligible for this
service, they applied a contractual adjustment which was taken resulting in a patient responsible balance of $(See attached EOB's from both insurance companies)He had a $credit from invoice which was transferred and applied to invoice 112, (See attached billing ledger), The remaining balance owed for his services is $which is still due*** *** is requesting as his desired settlement to receive a billing adjustment, but due to our contracts with these payers we are not obligated to adjust a patient responsible balance.In regards to the visit on 8/6/his primary insurance *** *** applied $85,to his deductibleHis secondary insurance ***-*** denied as patient ineligible for this service, they applied a contractual adjustment which was taken resulting in a patient responsible balance of $51,(See attached EOB's from both insurance companies)He was sent to collections based on three patient statements were sent dated 12/10/2013, 1/15/2014, and 2/20/with no patient response3/14/received a call from patient regarding collections and that he never received the above statements, we verified his address and all was confirmedHe must have contacted his insurance ***-*** as we received payment on 4/21/His account was removed from collections minus his copay and collection fee of $Patient paid the collection agency for the full amount so his account resulted in a creditWhich was then transferred to current balances, as you can see on the attached billing ledger it shows what invoices the credits were applied toOne of the balances was for his daughter Katelyn from 8/31/date of service (See attached billing ledger).Please let me know if this does not address all of the issues presented by *** ***,Sincerely,
Kathy S
Billing Director

- Billing adjustment to match what my insurance co-pay of $for an office visit
- Not to keep coming up with more payments due for past office visits after they tell my Wife or I that nothing is due
- To collect co-pays at the time of office visit instead of saying "we'll bill your insurances"
- To make sure my secondary insurance company receives a copy of the EOB from my primary insurance so that they know what to pay
- Not to send bills to collections prior to both insurances making their payments

August 8, Dear ***,I am in receipt of the response from *** *** rejecting the explanation regarding his balance from date of service 4/3/Per my original response dated 7/28/*** sent us an explanation of benefits dated 5/27/denying his 4/3/service with remark code *** = patient ineligible for this serviceThis resulted in patient being responsible for the remaining balance of $66.87.I am not sure what additional information I can supply as his primary and secondary payer processed this service and we are contractually obligated to collect on the balance, I supplied the proof on my original response with the explanations of benefits received from both insurances.Please let me know if there is any additional information needed to resolve this matter.Sincerely,
Kathy S
Billing Director