Positive Steps Therapy

RE: [redacted] Dear Sir or Madam,This is in response to a claim, filed against our company on 6/17/The client is reporting that she was unaware of her insurance responsibility and the information that she was provided by our company was misleadingShe further reported that our company is uncaring, in regards to this complaint, we have the following informationPositive Steps Therapy has a very formal process for insurance verification, in which we notify the family openly and immediately on their first day of service that we will verify their insurance benefits as a courtesy, however it is the family’s responsibility to be aware of their benefitsWe often receive incorrect information from insurance plans or find human error can be an issue in understanding these plansWe work with insurance companies on a daily basis and often find the company’s employees to be unable to answer specific coverage questions in regards to covered services and copaymentsTherefore, we specify that we will do our best to find the information that we can to assist familiesWe sometimes do not know how the claim will process until we receive notification from the insurance companyThere are also times when insurance companies will change their policies in the middle of a patient’s service and recoup funds from us and then make it the responsibility of the family, in which we have no control of eitherTheir insurance policy is a policy and a company they have chosen.When families receive services and we determine that our information might have been erroneous, we will contact the family to make them aware of the situation, so that they can make an informed decision on whether or not they will.continue with their careFurthermore, their insurance company will send them an explanation of benefits to let them know how the claim is being processed.The review of documentation regarding this patient’s information finds that our staff did immediately notify the family of this situationOn their first date of service, the front office staff has documented that they notified the client’s husband that our office was not in network with their secondary insurance and that if their primary insurance information changed they would be responsible for paymentWhen the claims processed and returned to our billing department a discussion occurred with the client’s husband which he agreed to a payment of $towards his balanceFollowing that discussion, the client spoke with the facility director in the McCandless officeThe client stated that, she could not afford the copayment and that she would be discontinuing servicesThe facility director provided the client with our primary billing person’s contact information and phone number and told the client that our companywould work with her to establish payment options to suit her needsThe client did not follow up with the billing contactTwo weeks later, our physical therapist, called the family to provide any further information or ideas to assist their daughter and offered an opportunity for family to contact her with any questions or concerns for their child’s needsThe family did not return her callThe family was sent bills on 11/11/and 12/14/and did not contact our billing , department with any information or frustration regarding their insurance verification or concerns to pay the patient responsibilityThe family was sent through our pre-collections process on 2/10/and still failed to follow up with our company regarding any concerns to the services they received.It is difficult to hear that our company is uncaring and misleading when we work so very hard to provide children with exceptional careWe do not have specific control over insurance plans that are chosen by our consumers and do our very best to notify families and explain to them the processWhere we can understand a family’s frustration when dealing with these issues, we work very hard to provide services and assistance so families do not find themselves overwhelmed with costs.Please feel free to contact me further should you have questions regarding our rebuttal to this complaintBest regards, [redacted] , [redacted] ***

RE: *** Dear Sir or Madam,This is in response to a claim, filed against our company on 6/17/The client is reporting that she was unaware of her insurance responsibility and the information that she was provided by our company was misleadingShe further reported that our
company is uncaring, in regards to this complaint, we have the following informationPositive Steps Therapy has a very formal process for insurance verification, in which we notify the family openly and immediately on their first day of service that we will verify their insurance benefits as a courtesy, however it is the family’s responsibility to be aware of their benefitsWe often receive incorrect information from insurance plans or find human error can be an issue in understanding these plansWe work with insurance companies on a daily basis and often find the company’s employees to be unable to answer specific coverage questions in regards to covered services and copaymentsTherefore, we specify that we will do our best to find the information that we can to assist familiesWe sometimes do not know how the claim will process until we receive notification from the insurance companyThere are also times when insurance companies will change their policies in the middle of a patient’s service and recoup funds from us and then make it the responsibility of the family, in which we have no control of eitherTheir insurance policy is a policy and a company they have chosen.When families receive services and we determine that our information might have been erroneous, we will contact the family to make them aware of the situation, so that they can make an informed decision on whether or not they will.continue with their careFurthermore, their insurance company will send them an explanation of benefits to let them know how the claim is being processed.The review of documentation regarding this patient’s information finds that our staff did immediately notify the family of this situationOn their first date of service, the front office staff has documented that they notified the client’s husband that our office was not in network with their secondary insurance and that if their primary insurance information changed they would be responsible for paymentWhen the claims processed and returned to our billing department a discussion occurred with the client’s husband which he agreed to a payment of $towards his balanceFollowing that discussion, the client spoke with the facility director in the McCandless officeThe client stated that, she could not afford the copayment and that she would be discontinuing servicesThe facility director provided the client with our primary billing person’s contact information and phone number and told the client that our companywould work with her to establish payment options to suit her needsThe client did not follow up with the billing contactTwo weeks later, our physical therapist, called the family to provide any further information or ideas to assist their daughter and offered an opportunity for family to contact her with any questions or concerns for their child’s needsThe family did not return her callThe family was sent bills on 11/11/and 12/14/and did not contact our billing , department with any information or frustration regarding their insurance verification or concerns to pay the patient responsibilityThe family was sent through our pre-collections process on 2/10/and still failed to follow up with our company regarding any concerns to the services they received.It is difficult to hear that our company is uncaring and misleading when we work so very hard to provide children with exceptional careWe do not have specific control over insurance plans that are chosen by our consumers and do our very best to notify families and explain to them the processWhere we can understand a family’s frustration when dealing with these issues, we work very hard to provide services and assistance so families do not find themselves overwhelmed with costs.Please feel free to contact me further should you have questions regarding our rebuttal to this complaint Best regards,
*** ** ***, *** *** ***

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID [redacted], and have determined that this does not resolve my complaint.  For your reference, details of the offer I reviewed appear below.I appreciate the time Positive Steps took to respond to my complaint.  As stated earlier though, prior to my husband taking my daughter for therapy, I called Positive Steps and had a phone conversation with them regarding my insurance.  I was told that the company did accept both insurances and our family would not have to pay anything for the services.  I am disabled with severe arthritis and have had two hip surgeries with hip replacements several years ago. I am only 53 years old, but cannot work due to arthritis and severe lymphedema following the surgery.  My husband is a teacher in a Catholic School, and I have two children with autism and health issues.  We struggle to make ends meet, and had we thought we would have to pay any amount we would not have used this company.  Because I am disabled my husband had to bring my daughter for treatment.  Since I am the one who deals with the health care and insurance matters he assumed everything was OK based on my phone conversation with Positive Steps, and just signed what was given him.  It is true the company did notify us that our insurance would not cover some of the cost but this was only after about 8 sessions at which time we owed $160.00.  I know that doesn't sound like much, but to us it is a week of groceries or payment of a gas bill.  When the company asked us about making payment arrangements I did call (this was in December) and told them to please wait as I was still working things out with our insurance company.  Then the letters started coming from collection agencies.  I may have missed the follow up call from the therapist as I was in the hospital several times and perhaps the message was erased or my mom who was staying here at the time may have failed to pass along the message.  She is 91 years old and forgets a lot.  I appreciate the call to follow up on my daughter, but still I feel the company could at least reduce the amount we owe given the fact that we were told over the phone, prior to ever stepping foot in the office, that we were fully covered.  At that time there was NO mention that the insurance company may not pay.  It is true that I should have asked more questions and grilled my insurance company before that first appointment.  I have learned the hard way and will not make this mistake again. But I also maintain that if Positive Steps had told me over the phone that day that they would not know if we were covered until treatment was well on the way, we would have figured something else out.  We would never have made that first appointment.  So while I assume most of the blame, I still feel that Positive Steps should assume some too as they were misleading on the phone. If Positive Steps is truly the caring company they claim to be, perhaps they could work with us by reducing the amount we owe.  If they did we would greatly appreciate it, and work very hard to settle this matter.  Thank you.
[redacted]

RE: [redacted] Dear Sir or Madam,This is in response to a claim, filed against our company on 6/17/2015. The client is reporting that she was unaware of her insurance responsibility and the information that she was provided by our company was misleading. She further reported that our company is...

uncaring, in regards to this complaint, we have the following information. Positive Steps Therapy has a very formal process for insurance verification, in which we notify the family openly and immediately on their first day of service that we will verify their insurance benefits as a courtesy, however it is the family’s responsibility to be aware of their benefits. We often receive incorrect information from insurance plans or find human error can be an issue in understanding these plans. We work with insurance companies on a daily basis and often find the company’s employees to be unable to answer specific coverage questions in regards to covered services and copayments. Therefore, we specify that we will do our best to find the information that we can to assist families. We sometimes do not know how the claim will process until we receive notification from the insurance company. There are also times when insurance companies will change their policies in the middle of a patient’s service and recoup funds from us and then make it the responsibility of the family, in which we have no control of either. Their insurance policy is a policy and a company they have chosen.When families receive services and we determine that our information might have been erroneous, we will contact the family to make them aware of the situation, so that they can make an informed decision on whether or not they will.continue with their care. Furthermore, their insurance company will send them an explanation of benefits to let them know how the claim is being processed.The review of documentation regarding this patient’s information finds that our staff did immediately notify the family of this situation. On their first date of service, the front office staff has documented that they notified the client’s husband that our office was not in network with their secondary insurance and that if their primary insurance information changed they would be responsible for payment. When the claims processed and returned to our billing department a discussion occurred with the client’s husband which he agreed to a payment of $50.00 towards his balance. Following that discussion, the client spoke with the facility director in the McCandless office. The client stated that, she could not afford the copayment and that she would be discontinuing services. The facility director provided  the client with our primary billing person’s contact information and phone number and told the client that our companywould work with her to establish payment options to suit her needs. The client did not follow up with the billing contact. Two weeks later, our physical therapist, called the family to provide any further information or ideas to assist their daughter and offered an opportunity for family to contact her with any questions or concerns for their child’s needs. The family did not return her call. The family was sent bills on 11/11/2014 and 12/14/2014 and did not contact our billing , department with any information or frustration regarding their insurance verification or concerns to pay the patient responsibility. The family was sent through our pre-collections process on 2/10/2015 and still failed to follow up with our company regarding any concerns to the services they received.It is difficult to hear that our company is uncaring and misleading when we work so very hard to provide children with exceptional care. We do not have specific control over insurance plans that are chosen by our consumers and do our very best to notify families and explain to them the process. Where we can understand a family’s frustration when dealing with these issues, we work very hard to provide services and assistance so families do not find themselves overwhelmed with costs.Please feel free to contact me further should you have questions regarding our rebuttal to this complaint. Best regards,[redacted], [redacted]

Review: My 14 year old daughter was receiving physical therapy from this company. Prior to starting services we had asked if EVERYTHING was covered with our insurance, and we were told yes. We were told that we would incur NO COST. We did have to sign a paper however that stated we would pay out of pocket if the insurance failed to cover it. We signed only because we were told that we WERE in fact covered, and that we would not bear any expense. We assumed we were safe. After about 8 sessions we were billed for $160.00. It seems these charges were the copayments of $20.00 each that the insurance did not cover. When we asked why we weren't told that we would be charged this amount each visit, Positive Steps said that sometimes they don't know if a client will be fully covered until after they bill the insurance company. Yet, they never told us this information. Had I known I would have taken my daughter elsewhere. When I discussed this with the company we were told we had to pay it and that they in fact had my signature stating I would pay. I spoke with my health insurance company and there was not anything more they could do. Being that Positive Steps Therapy mislead us into thinking we had no cost to bear for our daughter's treatment, I think they should eat the cost as it was their mistake. They have turned my account into a collection agency. This company is uncaring and misleading in the way they do buiness.Desired Settlement: I would like to be relieved of the charges as I feel we were mislead, and had I known we would never had started treatment there.

Business

Response:

RE: [redacted] Dear Sir or Madam,This is in response to a claim, filed against our company on 6/17/2015. The client is reporting that she was unaware of her insurance responsibility and the information that she was provided by our company was misleading. She further reported that our company is uncaring, in regards to this complaint, we have the following information. Positive Steps Therapy has a very formal process for insurance verification, in which we notify the family openly and immediately on their first day of service that we will verify their insurance benefits as a courtesy, however it is the family’s responsibility to be aware of their benefits. We often receive incorrect information from insurance plans or find human error can be an issue in understanding these plans. We work with insurance companies on a daily basis and often find the company’s employees to be unable to answer specific coverage questions in regards to covered services and copayments. Therefore, we specify that we will do our best to find the information that we can to assist families. We sometimes do not know how the claim will process until we receive notification from the insurance company. There are also times when insurance companies will change their policies in the middle of a patient’s service and recoup funds from us and then make it the responsibility of the family, in which we have no control of either. Their insurance policy is a policy and a company they have chosen.When families receive services and we determine that our information might have been erroneous, we will contact the family to make them aware of the situation, so that they can make an informed decision on whether or not they will.continue with their care. Furthermore, their insurance company will send them an explanation of benefits to let them know how the claim is being processed.The review of documentation regarding this patient’s information finds that our staff did immediately notify the family of this situation. On their first date of service, the front office staff has documented that they notified the client’s husband that our office was not in network with their secondary insurance and that if their primary insurance information changed they would be responsible for payment. When the claims processed and returned to our billing department a discussion occurred with the client’s husband which he agreed to a payment of $50.00 towards his balance. Following that discussion, the client spoke with the facility director in the McCandless office. The client stated that, she could not afford the copayment and that she would be discontinuing services. The facility director provided the client with our primary billing person’s contact information and phone number and told the client that our companywould work with her to establish payment options to suit her needs. The client did not follow up with the billing contact. Two weeks later, our physical therapist, called the family to provide any further information or ideas to assist their daughter and offered an opportunity for family to contact her with any questions or concerns for their child’s needs. The family did not return her call. The family was sent bills on 11/11/2014 and 12/14/2014 and did not contact our billing , department with any information or frustration regarding their insurance verification or concerns to pay the patient responsibility. The family was sent through our pre-collections process on 2/10/2015 and still failed to follow up with our company regarding any concerns to the services they received.It is difficult to hear that our company is uncaring and misleading when we work so very hard to provide children with exceptional care. We do not have specific control over insurance plans that are chosen by our consumers and do our very best to notify families and explain to them the process. Where we can understand a family’s frustration when dealing with these issues, we work very hard to provide services and assistance so families do not find themselves overwhelmed with costs.Please feel free to contact me further should you have questions regarding our rebuttal to this complaint. Best regards,[redacted], [redacted]