Primary Health Group at Bremo

Review: I fell down around the corner from my apartment. I broke my wrist badly enough that I had to have immediate surgery a few days later. I reported this to [redacted] explaining to him I will need a referral not only did he give a hard time to receive a referral he put the wrong name of doctor on the referral. I thought we were all set but six months later I am receiving large bills stating that there was not a referral when I heard this I immediately used all of my resources calling the hospital to the doctor who performed the surgery. The complaint is not with the doctor or the insurance etc. it was apparent that it was the fault of [redacted]. I talked to the receptionist again she had a nasty tone with me. She put me on hold to see if they could go back to the date of service and it was told to me that they could not go back to that date of service. This will mean I will owe 19,000.00 for something that could be corrected but the Doctor won"t fix it. SO what do I do next I have followed all the rules especially being very polite. I was brought up that way and I will always be a lady. This is a rather simple procedure to fix. This to me is most embarassing! What should I do next?Desired Settlement: I hope that we all can come to a common ground. I would like this bill paid correctly without messing up my credit.

Business

Response:

Dear [redacted],

I am writing to you in response to your letter dated 1/8/2014, regarding [redacted].

[redacted] contacted our office on 6/13/13 stating that she had broken her wrist and went to the Emergency Room. Her physician, [redacted], instructed his nurse to obtain a referral for the patient to [redacted] with [redacted]. The name of the orthopedist [redacted] was provided to [redacted] by [redacted]. A referral was faxed to [redacted] office on 6/14/13. The patient was seen by [redacted] within the same group which is outside of [redacted] control. A separate referral was not obtained as both physicians share the same tax identification number which is customarily sufficient. However, on 1/19/14, [redacted] nurse called [redacted], and an addendum to the original referral was issued to reflect [redacted] name to alleviate issues that may have occurred according to [redacted]. The original referral number was not changed per [redacted] guidelines. [redacted] nurse also called [redacted] office at [redacted] and informed them of the update so that they could refile the claim if necessary for reimbursement. This information was provided to the patient by both the nurse and the practice manager.

When the patient contacted our practice on 1/7/2014, she stated that she needed a referral obtained because she went to the [redacted] in June 2013. Since the patient is no longer a patient of Primary Health Group Bremo, the patient was informed that we could not go back to June of 2013 to obtain a retroactive referral that we had not been made aware of previously. After obtaining more information from the patient on 1/9/2014, it became clear that the patient had communicated incorrect information on 1/7/2014. The patient had, in fact, been seen at the [redacted] in March and May 2013 and referrals were obtained by [redacted] nurse and faxed to the clinic. According to the [redacted], reimbursement was received for both visits. [redacted] is waiting for reimbursement from the patient's secordary insurance carrier, [redacted], for [redacted] office visit on 3/25/13. This was verified and also communicated to the patient by the practice manager on 1/9/14, as well.

[redacted] stated that she appreciated the extra effort and resolution that she was provided on 1/9/14.

Respectfully,

Practice Manager