Premier Health

Re: Complaint ID # [redacted] *o Whom It May Concern:We have reviewed the complaint referenced above and reviewed all pertinent informationWe have found the following to be true to the resolution of this case:On 09/01/2015, the patient presented to our facility as statedThe patient presented a [redacted] Insurance card and eligibility was run through our practice management system, which showed an urgent care copay of $ Our facilities do NOT quote fees prior to the visit, as the physician is the one who makes the medical decisions and completes the encounter form that is used for billing purposesAt no time was the patient told they would only have to pay $We charge our self-pay patients $125,so ! believe that the patient must not have understood when advised that we only collect the copay up front for services renderedWe always tell our patients there may be additional balances owed based on the individuals policy.We billed the patient s insurance on 09/02/2015, The patient's insurance pended the claim as they had requested that the patient update coordination of benefits information so that they could process the claimOur billing office procedure is to let the office know when the insurance requests additional information from the patient so that the facility may contact the patient directlyDuring this time, statements are not sent until all avenues are exhausted in obtaining paymentOur records show that the office Manager of the [redacted] location, Veronica spoke with the patient on 12/07/The patient advised Veronica that she had updated all information with [redacted] and we could resubmit the claim for processing.We refiied the claim to [redacted] on 12/07/ [redacted] rejected the claim as a duplicate of an already processed lineWhen a claim is rejected as duplicate that means that they stand behind their original adjudication of the claim, which In this case the patient still needed to update the requested information with themWe then denied the claim in our practice management system so the patient would receive a billThe first statement went out on 12/16/for $(balance remaining after copay)A second statement went out on 01/13/for $150.00.On 1/29/2016, the patient contacted our billing office and was advised that [redacted] was requesting additional information before they would reprocess the claimOn 02/07/2016, we received the claim adjudication information from [redacted] , which reprocessed the claim and applied $126,to the patient deductible along with the $50,copay assessedThe patient has now received two statements for the remaining balance of $126.89, which has resulted in this complaint.We understand the patient's frustration as both the billing office and the facility have advised the patient to contact each other about the chargesAs stated above the facility staff has no way of knowing prior to the actual visit what the charges are to be other than the copayThe billing office only submits claims per the billing provider, I am not sure whom the patient spoke with on 03/20/as Premier Urgent does not employ, anyone named BriannaI assume the patient meant Veronica who is the office manager at the [redacted] facilityUpon further review of the patient's insurance card, the [redacted] explanation of benefits and review of benefits the reason the patient was assessed a deductible by [redacted] is that the patient is an employee of [redacted] and underthat policy they are required to use certain providers and facilities [redacted] provider relations state this is dearly documented in the summary of benefits that the policy subscriber receives and that the patient is to utilize [redacted] of [redacted] If the patient chooses to obtain urgent care services elsewhere, they are subject to deductible and co-insurance under the planIt is the responsibility of the patient to know and understand their benefits prior to receiving any medical careOur facility sees thousands of patients each year and while we do our best to keep up with all plans, there is no way for our staff to know what is covered under each individual's policy prior to being seen.We are willing to reduce the charges down to our self-pay fee of $The patient balance remaining would be $as the patient paid $at the time of service.Health insurance plans are very complex so we can understand how the patient would be confused over their benefitsWe hope this resolves the patient's complaint to their satisfactionSincerely, Paige [redacted] F [redacted] Billing Manager

Re: Complaint ID # [redacted] *o Whom It May Concern:We have reviewed the complaint referenced above and reviewed all pertinent informationWe have found the following to be true to the resolution of this case:On 09/01/2015, the patient presented to our facility as statedThe patient presented a [redacted] Insurance card and eligibility was run through our practice management system, which showed an urgent care copay of $ Our facilities do NOT quote fees prior to the visit, as the physician is the one who makes the medical decisions and completes the encounter form that is used for billing purposesAt no time was the patient told they would only have to pay $We charge our self-pay patients $125,so ! believe that the patient must not have understood when advised that we only collect the copay up front for services renderedWe always tell our patients there may be additional balances owed based on the individuals policy.We billed the patient s insurance on 09/02/2015, The patient's insurance pended the claim as they had requested that the patient update coordination of benefits information so that they could process the claimOur billing office procedure is to let the office know when the insurance requests additional information from the patient so that the facility may contact the patient directlyDuring this time, statements are not sent until all avenues are exhausted in obtaining paymentOur records show that the office Manager of the [redacted] location, Veronica spoke with the patient on 12/07/The patient advised Veronica that she had updated all information with [redacted] and we could resubmit the claim for processing.We refiied the claim to [redacted] on 12/07/ [redacted] rejected the claim as a duplicate of an already processed lineWhen a claim is rejected as duplicate that means that they stand behind their original adjudication of the claim, which In this case the patient still needed to update the requested information with themWe then denied the claim in our practice management system so the patient would receive a billThe first statement went out on 12/16/for $(balance remaining after copay)A second statement went out on 01/13/for $150.00.On 1/29/2016, the patient contacted our billing office and was advised that [redacted] was requesting additional information before they would reprocess the claimOn 02/07/2016, we received the claim adjudication information from [redacted] , which reprocessed the claim and applied $126,to the patient deductible along with the $50,copay assessedThe patient has now received two statements for the remaining balance of $126.89, which has resulted in this complaint.We understand the patient's frustration as both the billing office and the facility have advised the patient to contact each other about the chargesAs stated above the facility staff has no way of knowing prior to the actual visit what the charges are to be other than the copayThe billing office only submits claims per the billing provider, I am not sure whom the patient spoke with on 03/20/as Premier Urgent does not employ, anyone named BriannaI assume the patient meant Veronica who is the office manager at the [redacted] facility.Upon further review of the patient's insurance card, the [redacted] explanation of benefits and review of benefits the reason the patient was assessed a deductible by [redacted] is that the patient is an employee of [redacted] and underthat policy they are required to use certain providers and facilities [redacted] provider relations state this is dearly documented in the summary of benefits that the policy subscriber receives and that the patient is to utilize [redacted] of [redacted] If the patient chooses to obtain urgent care services elsewhere, they are subject to deductible and co-insurance under the planIt is the responsibility of the patient to know and understand their benefits prior to receiving any medical careOur facility sees thousands of patients each year and while we do our best to keep up with all plans, there is no way for our staff to know what is covered under each individual's policy prior to being seen.We are willing to reduce the charges down to our self-pay fee of $The patient balance remaining would be $as the patient paid $at the time of service.Health insurance plans are very complex so we can understand how the patient would be confused over their benefitsWe hope this resolves the patient's complaint to their satisfaction.Sincerely,Paige [redacted] F*Billing Manager

Re: Complaint ID # [redacted]o Whom It May Concern:We have reviewed the complaint referenced above and reviewed all pertinent information. We have found the following to be true to the resolution of this case:On 09/01/2015, the patient presented to our facility as stated. The...

patient presented a [redacted] Insurance card and eligibility was run through our practice management system, which showed an urgent care copay of $ 50.00. Our facilities do NOT quote fees prior to the visit, as the physician is the one who makes the medical decisions and completes the encounter form that is used for billing purposes. At no time was the patient told they would only have to pay $50.00. We charge our self-pay patients $125,00 so ! believe that the patient must not have understood when advised that we only collect the copay up front for services rendered. We always tell our patients there may be additional balances owed based on the individuals policy.We billed the patient s insurance on 09/02/2015, The patient's insurance pended the claim as they had requested that the patient update coordination of benefits information so that they could process the claim. Our billing office procedure is to let the office know when the insurance requests additional information from the patient so that the facility may contact the patient directly. During this time, statements are not sent until all avenues are exhausted in obtaining payment. Our records show that the office Manager of the [redacted] location, Veronica spoke with the patient on 12/07/2015. The patient advised Veronica that she had updated all information with [redacted] and we could resubmit the claim for processing.We refiied the claim to [redacted] on 12/07/2015. [redacted] rejected the claim as a duplicate of an already processed line. When a claim is rejected as duplicate that means that they stand behind their original adjudication of the claim, which In this case the patient still needed to update the requested information with them. We then denied the claim in our practice management system so the patient would receive a bill. The first statement went out on 12/16/2015 for $150.00 (balance remaining after copay). A second statement went out on 01/13/2016 for $150.00.On 1/29/2016, the patient contacted our billing office and was advised that [redacted] was requesting additional information before they would reprocess the claim. On 02/07/2016, we received the claim adjudication information from [redacted], which reprocessed the claim and applied $126,89 to the patient deductible along with the $50,00 copay assessed. The patient has now received two statements for the remaining balance of $126.89, which has resulted in this complaint.We understand the patient's frustration as both the billing office and the facility have advised the patient to contact each other about the charges. As stated above the facility staff has no way of knowing prior to the actual visit what the charges are to be other than the copay. The billing office only submits claims per the billing provider, I am not sure whom the patient spoke with on 03/20/2016 as Premier Urgent does not employ, anyone named Brianna. I assume the patient meant Veronica who is the office manager at the [redacted] facility.
Upon further review of the patient's insurance card, the [redacted] explanation of benefits and review of benefits the reason the patient was assessed a deductible by [redacted] is that the patient is an employee of [redacted] and underthat policy they are required to use certain providers and facilities. [redacted] provider relations state this is dearly documented in the summary of benefits that the policy subscriber receives and that the patient is to utilize [redacted] of [redacted]. If the patient chooses to obtain urgent care services elsewhere, they are subject to deductible and co-insurance under the plan. It is the responsibility of the patient to know and understand their benefits prior to receiving any medical care. Our facility sees thousands of patients each year and while we do our best to keep up with all plans, there is no way for our staff to know what is covered under each individual's policy prior to being seen.We are willing to reduce the charges down to our self-pay fee of $125.00. The patient balance remaining would be $75.00 as the patient paid $50.00 at the time of service.Health insurance plans are very complex so we can understand how the patient would be confused over their benefits. We hope this resolves the patient's complaint to their satisfaction.
Sincerely,
Paige ** F[redacted]
Billing Manager

Re: Complaint ID # [redacted]o Whom It May Concern:We have reviewed the complaint referenced above and reviewed all pertinent information. We have found the following to be true to the resolution of this case:On 09/01/2015, the patient presented to our facility as stated. The patient presented a...

[redacted] Insurance card and eligibility was run through our practice management system, which showed an urgent care copay of $ 50.00. Our facilities do NOT quote fees prior to the visit, as the physician is the one who makes the medical decisions and completes the encounter form that is used for billing purposes. At no time was the patient told they would only have to pay $50.00. We charge our self-pay patients $125,00 so ! believe that the patient must not have understood when advised that we only collect the copay up front for services rendered. We always tell our patients there may be additional balances owed based on the individuals policy.We billed the patient s insurance on 09/02/2015, The patient's insurance pended the claim as they had requested that the patient update coordination of benefits information so that they could process the claim. Our billing office procedure is to let the office know when the insurance requests additional information from the patient so that the facility may contact the patient directly. During this time, statements are not sent until all avenues are exhausted in obtaining payment. Our records show that the office Manager of the [redacted] location, Veronica spoke with the patient on 12/07/2015. The patient advised Veronica that she had updated all information with [redacted] and we could resubmit the claim for processing.We refiied the claim to [redacted] on 12/07/2015. [redacted] rejected the claim as a duplicate of an already processed line. When a claim is rejected as duplicate that means that they stand behind their original adjudication of the claim, which In this case the patient still needed to update the requested information with them. We then denied the claim in our practice management system so the patient would receive a bill. The first statement went out on 12/16/2015 for $150.00 (balance remaining after copay). A second statement went out on 01/13/2016 for $150.00.On 1/29/2016, the patient contacted our billing office and was advised that [redacted] was requesting additional information before they would reprocess the claim. On 02/07/2016, we received the claim adjudication information from [redacted], which reprocessed the claim and applied $126,89 to the patient deductible along with the $50,00 copay assessed. The patient has now received two statements for the remaining balance of $126.89, which has resulted in this complaint.We understand the patient's frustration as both the billing office and the facility have advised the patient to contact each other about the charges. As stated above the facility staff has no way of knowing prior to the actual visit what the charges are to be other than the copay. The billing office only submits claims per the billing provider, I am not sure whom the patient spoke with on 03/20/2016 as Premier Urgent does not employ, anyone named Brianna. I assume the patient meant Veronica who is the office manager at the [redacted] facility.Upon further review of the patient's insurance card, the [redacted] explanation of benefits and review of benefits the reason the patient was assessed a deductible by [redacted] is that the patient is an employee of [redacted] and underthat policy they are required to use certain providers and facilities. [redacted] provider relations state this is dearly documented in the summary of benefits that the policy subscriber receives and that the patient is to utilize [redacted] of [redacted]. If the patient chooses to obtain urgent care services elsewhere, they are subject to deductible and co-insurance under the plan. It is the responsibility of the patient to know and understand their benefits prior to receiving any medical care. Our facility sees thousands of patients each year and while we do our best to keep up with all plans, there is no way for our staff to know what is covered under each individual's policy prior to being seen.We are willing to reduce the charges down to our self-pay fee of $125.00. The patient balance remaining would be $75.00 as the patient paid $50.00 at the time of service.Health insurance plans are very complex so we can understand how the patient would be confused over their benefits. We hope this resolves the patient's complaint to their satisfaction.Sincerely,Paige ** F[redacted]Billing Manager

Review: On 9/1/15 I was seen at Dr.Premier Urgent Care of [redacted] located at [redacted] (###-###-####). I was seen to see if I had strep. When being checked in, I was never told one time that my visit was going to be $200. I was just told that it was going to be $50 (my copay). I was seen for five minutes by a lady in a tank top and flip flops who looked in my ears and mouth. She never did any additional testing. All it took was 5 minutes. She wrote 3 prescriptions for nasal spray, cough syrup, and an antibiotic. Four months later, in January I received my first bill from Premier Health, LLC (###-###-####) located at [redacted] Pittsburgh, [redacted]. I called them about my bill and was told all they needed was to process my bill through insurance and they would cover it. I gave them my insurance information which was processed (they paid $23.11). I received my next bill and called on 3/16 which I spoke to a lady and explained at no point was it told to me how much this visit would be until I got billed. She said that I needed to call the office I was seen at, they would have to be the ones to take care of the bill but she could set me up on a payment plan. When I said something about the Revdex.com, she hung up on me. I called the office I was seen at on 3/16 asking the office manager to call me. I finally spoke to the office manager name Brianna on 3/20. She told me that they don't know how much they bill for, that their billing facility handles it, all they know is the copay and I'd have to call them. I told her that I did and they said the office would handle it and she said that was incorrect. I asked if they were affiliated with the Revdex.com and she told me she has no clue. I told her she how can they charge people for services when they have no clue the amount that they're charging? She again said she didn't know. My next move is to again call the billing department to get this bill resolved.Desired Settlement: I want my bill adjusted to $0, the urgent care office to be held liable for misadvertising as well as the billing company.

Business

Response:

Re: Complaint ID # [redacted]o Whom It May Concern:We have reviewed the complaint referenced above and reviewed all pertinent information. We have found the following to be true to the resolution of this case:On 09/01/2015, the patient presented to our facility as stated. The patient presented a [redacted] Insurance card and eligibility was run through our practice management system, which showed an urgent care copay of $ 50.00. Our facilities do NOT quote fees prior to the visit, as the physician is the one who makes the medical decisions and completes the encounter form that is used for billing purposes. At no time was the patient told they would only have to pay $50.00. We charge our self-pay patients $125,00 so ! believe that the patient must not have understood when advised that we only collect the copay up front for services rendered. We always tell our patients there may be additional balances owed based on the individuals policy.We billed the patient s insurance on 09/02/2015, The patient's insurance pended the claim as they had requested that the patient update coordination of benefits information so that they could process the claim. Our billing office procedure is to let the office know when the insurance requests additional information from the patient so that the facility may contact the patient directly. During this time, statements are not sent until all avenues are exhausted in obtaining payment. Our records show that the office Manager of the [redacted] location, Veronica spoke with the patient on 12/07/2015. The patient advised Veronica that she had updated all information with [redacted] and we could resubmit the claim for processing.We refiied the claim to [redacted] on 12/07/2015. [redacted] rejected the claim as a duplicate of an already processed line. When a claim is rejected as duplicate that means that they stand behind their original adjudication of the claim, which In this case the patient still needed to update the requested information with them. We then denied the claim in our practice management system so the patient would receive a bill. The first statement went out on 12/16/2015 for $150.00 (balance remaining after copay). A second statement went out on 01/13/2016 for $150.00.On 1/29/2016, the patient contacted our billing office and was advised that [redacted] was requesting additional information before they would reprocess the claim. On 02/07/2016, we received the claim adjudication information from [redacted], which reprocessed the claim and applied $126,89 to the patient deductible along with the $50,00 copay assessed. The patient has now received two statements for the remaining balance of $126.89, which has resulted in this complaint.We understand the patient's frustration as both the billing office and the facility have advised the patient to contact each other about the charges. As stated above the facility staff has no way of knowing prior to the actual visit what the charges are to be other than the copay. The billing office only submits claims per the billing provider, I am not sure whom the patient spoke with on 03/20/2016 as Premier Urgent does not employ, anyone named Brianna. I assume the patient meant Veronica who is the office manager at the [redacted] facility.Upon further review of the patient's insurance card, the [redacted] explanation of benefits and review of benefits the reason the patient was assessed a deductible by [redacted] is that the patient is an employee of [redacted] and underthat policy they are required to use certain providers and facilities. [redacted] provider relations state this is dearly documented in the summary of benefits that the policy subscriber receives and that the patient is to utilize [redacted] of [redacted]. If the patient chooses to obtain urgent care services elsewhere, they are subject to deductible and co-insurance under the plan. It is the responsibility of the patient to know and understand their benefits prior to receiving any medical care. Our facility sees thousands of patients each year and while we do our best to keep up with all plans, there is no way for our staff to know what is covered under each individual's policy prior to being seen.We are willing to reduce the charges down to our self-pay fee of $125.00. The patient balance remaining would be $75.00 as the patient paid $50.00 at the time of service.Health insurance plans are very complex so we can understand how the patient would be confused over their benefits. We hope this resolves the patient's complaint to their satisfaction.Sincerely,Paige ** F[redacted]Billing Manager