Pleasant Valley Eyecare, Inc.

AUG-19-09:31R FROM:DRC*** 2166429829 TO:P 2 DrGC*** Optometrist (216) 642-OFFICE • FAX (216) 642-Broadview Road • Parma, Ohio 44134 Friday August 18, 2017 Re: Complaint ID *** Dear Revdex.com, In
regards to the complaint filled by *** ***, When *** and *** scheduled their appointments for eye examinations they were scheduled under the understanding that they still carried Vision Service Plan for their vision plan and Medical Mutual as their major medicalIt was not until they arrived for their scheduled appointment that they informed our office that they no longer had Vision Service Plan and that their Medical Mutual plan had changedIt is the patients responsibility to provide us with the correct insurance information. We did verify with Medical Mutual that they did have coverage for this benefitWith this understanding ** *** *** *** agreed to stay for their appointment and have their eye examinations. Our office did receive the explanation of benefits from Medical Mutual with a denial of their claims stating that they arc part of a select network that our office did not participate with even though we are in network with Medical MutualWe did send ** *** *** *** a bill for their exams with reduced charges since their insurance company denied the claims and we offer a "prompt pay" discount to our patients without insurance. Our office never received payment or any letter from ** *** so we did send a second "Past Due" notice to them for paymentHad we received any correspondence from ** ***, we would have surely contacted hint to explain and clear up this matter. Upon receipt of your complaint our office did contact Medical Mutual again in regards to their claim denialsMedical mutual stated that ** *** did file an appeal for the claims and was issued a letter of denial on 06/21/explaining their select network and that it is their responsibility to make sure the providers that they choose to go to are in their select network handbookAll Medical Mutual providers arc not a part of all networks and they are responsible for the charges that occurredOur response to this situation is that we will write off the remaining balance for *** of the reduced charge of $and she will owe us $As for ***, the reduced charge of $will remainOur explanation for, this is that if we were in their select network ***'s exam would have been covered*** has a pre existing medical diagnosis of *** *** *** ** *** *** which we are required to submit to the patients medical insurance companyHis charges are subject to his deductible which had not been met no matter what facility he would have had services rendered at. We will also forward a copy of this response to ** ***If our office can be of any further assistance to this matter, please do not hesitate to contact us. Sincerely,DrGC***, OD

Company responded via phone:The company will not be adjusting Edward's balance to zero.   They feel they have been more than  fair. They have reduced the charges for his wife to zero. They have also reduced Edwards charge from $176  to $103.00.Their explanation for this charge is that Edward has a pre existing medical diagnosis of D31.32 Benign neoplasm of left choroid which they are required to submit to the patients medical insurance company.  His charges are subject to his deductible which had not been met. No matter what facility he would have had services rendered at the balance would have been owed.Company stated the total  charges for the consumer would have been $280.  After the adjustments that have been made to both accounts, they now owe $103.  The company stated they did not receive a letter from the consumer and when the appointment was scheduled, it was in their  appointment scheduling that the insurance was with Vision Service Plan which is what they had previously.  Company was not aware of new insurance till the day of the appointment. The company has been in touch with Medical Mutual regarding the complaint and the claims.  Medical Mutual stated their is no guarantee of payment, the claims were correct and no adjustments would be made through medical mutual as well.  Medical Mutual stated as well that the patient is responsible for the balance.

I still reject this as a resolution.  As stated before I gained my knowledge from the front desk  as they told me I was covered after I asked.  If they would have stated they did not know or that I needed to check with my insurance I would have.  I will not be paying this bill.  That aside this has now become a HIPAA violation issue as the Dr office is now disclosing my medical information to the Revdex.com without my consent. (statement from the DR office in the last message) *Their explanation for this charge is that [redacted] has a pre existing medical diagnosis of [redacted].  Revdex.com documentation can/will become public information, I have not given the DR office any permission to disclose my medical information to the Revdex.com. Now that I have been misinformed by your front desk and you have released my medical information without to the Revdex.com without consent there is only one choice to resolve this matter.  I will ask one more time through the Revdex.com to resolve this bill to $0 dollars before I take this matter further.
Regards,
[redacted]