Professional Building Contractor Licensing Review Board

I will answer to each of MsGinger ***’s numbered assertions below: Our correspondence with your office indicated that Ms***’s son is years old The most recent address that Ms ***’s son has given Beloit Health System is his parents’ address If he has moved to another residence he has not shared that address with our organization The information Beloit Health System received concerning a need for Mr [redacted] to contact Progressive Insurance came directly from that auto carrier itself Beloit Health System has no other details concerning interaction between the patient and Progressiveother than what Progressive shared with our billing office after we billed them for the Emergency Room claim Mr [redacted] did, indeed, provide auto insurance as well as group health insurance for his February Emergency Room claim Based on industry standard coordination of benefits requirements, his group health insurance was payor of last resort because Progressive had responded that they would pay his claims related to the accident Beloit Health System billed Progressive and followed up with them on several occasions to check the status of the claim Each time we were told that payment would be forthcoming after they had a response from the patient to some inquiries they sent to him We have no reason to believe that Progressive gave our staff information, but we also have no way of validating the accuracy of what they told us When the patient obtained payment from Progressive in August 2016, he brought it to Beloit Health System and we applied it to his balance Unfortunately, his Progressive plan only paid a portion of his claim Because he had group health insurance secondary to Progressive for these services, we submitted a secondary claim to United Healthcare the next day However, United Healthcare denied it due to the age of the claim We encouraged the patient to file an appeal with his group health plan for reconsideration of his claim Mr***’s father expressed concern about the charges on his son’s February Emergency Room claim in August We contacted the manager of the Emergency Department who reviewed the patient’s entire medical record to make sure that he received all the services and diagnostic tests that we billed to his insurance plan She verified that the patient did, indeed, receive each and every one of these services and that was communicated back to the patient’s father at that time Ms***’s daughter has had different issues than her brother, and the issues are different for various dates of service In some cases her group health insurance refused to pay at all because she did not respond to their requests for additional informationBeloit Health System has copies of correspondence from UMR to the patient, and we also have copies of letters we sent to her urging her to respond to her insurance company In other instances her group health insurance made payment, but she had coinsurance and deductibles that were not paid The patient also has other dates of service on which she was covered by a Forwardhealth/MercyCare plan as a secondary payor to her group health plan, but Beloit Health System is out of network for MercyCare so she is not entitled to a benefit for services rendered by our organization Ms***’s daughter has kept Beloit Health System updated on her current address, so all communication between her and Beloit Health System is sent directly to her home There are obviously a large number of different types of services and bills associated with Ms***’s children’s issues, and we understand that she may or may not be fully aware of all the details of each other than what is shared with her by her children We encourage each of these patients to contact our staff directly to obtain additional information about any of their outstanding debts Because these individuals are adults I shall refrain from sharing their names with you as I did in my initial correspondence, and we are restricted from sharing Protected Healthcare Information with their mother as well The best way for these two individuals to work out any billing related questions or problems for these older accounts as well as current and future visits is to work directly with our staff in a timely manner Please feel free to contact my office if you have any additional questions or concerns Thank you for your kind consideration of this matter Deborah JB [redacted] , FHFMABeloit Health System, Inc[redacted]