ProHealth Care, Inc.

I recently received a letter from Pro Health Care (Dr. Lauren Bremberger). She says I have been non-compliant regarding hypertension follow-ups and no longer wants to be my primary care physician. She had put me on blood pressure medication in 04/18 as my blood pressure was high whenever I visited her office, which is typical for me as I have tend to have very high readings when I see a physician. I told her this but she insisted I had high blood pressure. Shortly there after I had a procedure and my BP dropped to nothing. Dr. Bremberger than took me off the medication and asked me to monitor my blood pressure from home a couple of times a week and email her with the results, which I did. My pressure was within the normal range every time. I also monitored through a work clinic and it was not high at all. For some reason, notes must have not been made on my file and Pro Healthcare called me and told me I needed to followup on medications with my doctor a couple of months ago. I told them I wasn't on any medications, Apparently they never got my files corrected because the doctor is sending me a letter about hypertension. I don't plan on seeing Dr. Bremberger again, she is a nice enough person, but seems to jump quickly at things before knowing the patient. She put me on BP meds the first time in, instead of monitoring the situation. I also did not like the way she dismissed me as a patient, a certified letter is no way to do this! She should have called me. I will find another physician that hopefully cares to understand me a bit better.
I have a great GYN doctor Beth Angsten at Pro Healthcare. Otherwise I would choose to change to Aurora. Thanks for your time.
Debarah K. Jones

If Mr. *** would like us to provide to you a full and complete response, he would need to complete a medical authorization specifying that we can release information to you and to the Revdex.comWe also wanted to make sure that Mr. ***understood that if he does authorize ProHealth Care to disclose confidential information to the Revdex.com (or any other 3rd party), we cannot confirm or control how that 3rd party will maintain, access, communicate or otherwise use the records or information once it is released to them, including that the 3rd party may make the information public. In Mr. ***’s January 13th response, he states that he has now provided a signed authorization for the release of his son’s records to youI did not receive a copy of any authorizationHowever after receiving the January 13th response, I checked with our medical records departmentIt appears that Mr. *** did send a signed medical authorization, but he did not fill out the part asking him to identify who ProHealth Care is authorized to release information toI believe that our medical records department would have returned the authorization to Mr. *** because the form does not say who can receive the information and records. So at this time ProHealth Care is still unable to provide a complete responseWe would need a medical authorization allowing us to disclose records of information to you and to the Revdex.comI can resend another copy of this form to you if you need one. This authorization form can be downloaded at: http://www.prohealthcare.org/patient-guest-services-medical-records-request.aspx Then in the section titled "Disclosure of Health Information To:" Mr. *** should indicate that the information and records can be released to you and the Revdex.com (assuming that he wants us to disclose information to you)In addition, it would be helpful if Mr. *** could return the authorization, if he does wish to complete one, either to you (so that you can forward to me) or to me directly (via email, fax or whatever method is easier for him). Once again, we want to make sure that Mr. *** understands that if he authorizes us to release records and information pursuant to an authorization form, ProHealth Care cannot control how the records and information is used once releasedIf Mr. *** has questions about how the Revdex.com would use, disclose or communicate the records or information (including whether it would be become public record in some way) he would need to direct those questions to you or the Revdex.com. I would be happy to answer any questions Mr. *** had about that issueIn addition, I can advise you that we have reached out to Mr. *** directly and offered to discuss his concerns and questions with him directlyI am happy to answer any questions you may have as well. Your January 13th communication asked us to respond within daysI will be happy to provide another response by January 23rd, but without a completed medical authorization we will still be unable to fully respond to Mr. ***’s submission to you. Thank you for your time and review of this emailPlease feel free to contact me with any questions. *** *** *** ** *** ***V.PRisk Management &Risk Management OfficerProHealth Care, Inc.N17 W24100 Riverwood Drive, Suite 375Waukesha, WI 53188Direct: (262) 928-2124Cell: (262) 443-3443Fax: (262) 953-8733E-mail: [email protected]

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID ***, and have determined that this does not resolve my complaint. For your reference,
details of the offer I reviewed appear below.I have NOT received calls from anyone lately...I received calls years ago. I talked to several people about this manner. I was told by numerous people that would just keep telling me to call someone else, or we will look into this manner and give you a call back. I left several messages and did not recieve a response from anyone other then, I will pass this information along. OR We will investigate this manner and get back to you. OR I am sorry this is not really my department, I am not sure why they sent you to me.She did not receive proper care, in face the PA and the original doctor BOTH came to me and apologized to me for missing this the first time. Think about this from a medical point of view if given the proper care the first visit....HOW does a healthy girl go septic in less then hours, have her middle tonsils so swollen that the PA in the ER wanted to intubate her, as they were so enlarged that if she moved her head even the slightest bit....it closed off her airway!There are also records from Carroll University's medical center with Kaitlin being seen on the same day she came into the ER for the first time. They felt that her health was so bad that they were not able to attend to her medical needs and sent her to the ER...where your ER doctor released her without a proper examination...if he would have examined her properly, or taken the word of another medical professional who had referred her to you, she would not have gone septic, had to miss mid-terms....have her grades suffer as they did......THIS IS NOT THE CARE THAT AN ER ROOM SHOULD GIVE A PATIENT WHO WAS SENT THERE BY ANOTHER MEDICAL PERSON, YET ALONE ANYONE! The above reason is why WE are not accepting the businesses response!Thank you *** ***
[To assist us in bringing this matter to a close, we would like to know your view on the matter.]
Regards,
Laura Mokry

I am writing to you on behalf of ProHealth Care Inc., to respond to your letter of June 10, related to Ms
*** * ***I have reviewed your letter and information which you had provided related to Ms
***s June 9, complaint related to physical therapy services she received in
at the Muskego
Clinic and provided by ProHealth Care's Outpatient Therapy Services. You kindly agreed to allow us to respond to your letter by June 26, 2015. ANeed for Medical Authorization in Order to Provide Complete Response
Ms*** submission raises questions which in part relate to information in her medical or billing
recordsFor example, Ms*** raises questions including plans for treatment, information regarding her
billing and payment history, including what she was charged, how those charges relate to her insurance and the
services and care included in the charges. Accordingly in order to provide a full and complete response to Ms*** concerns, we would need to
be able to refer to and disclose portions of her billing records and medical records for the dates of the care at
issueWe would only need to refer to and disclose information limited to the questions raised and treatment
referenced in Ms*** submission. However medical records and medical information within those records are protected and confidential under
Federal and Wisconsin lawProHealth Care is very diligent in protecting the confidentiality of our patient's
health care informationThat means that without an authorization from Ms*** allowing us to disclose
information regarding the care at issue to you, we are not able to provide a full and complete response to your
June 10th letter. At this time, we have not received a signed authorization from Ms***In the event Ms*** is
willing to provide you with a signed medical authorization, I am enclosing a copy of the authorization form
which can be used for that purposeShe would simply need to complete it to indicate that the records could be
disclosed by us to you and the Revdex.com of Wisconsin(This same document is available on the intemet at
http://www.prohealthcare.org/patient-guest-services-medical-records-request.aspx...⇄ should
understand that ProHealth Care cannot confirm or control how records authorized to be released to a third
party are maintained, accessed or otherwise used by that third party. While we cannot at this time disclose protected health information we can at least provide you with some basic
information about ProHealth Care's billing process and the charges for clinic visits and for outpatient therapy servicesWe can also confirm for you that the Ms*** billing has been reviewed and confirmed to be
accurate and appropriate. BResponse to Ms*** Concerns
Patients who receive therapy services through ProHealth Care's Outpatient Therapy Services are advised prior
to the start of their therapy that therapy services are charged as hospital outpatient therapy services and that it
is the patient's responsibility to verify their hospital outpatient therapy benefits with their insurance providers
This information may be conveyed in multiple waysFor example, patients who are going to participate in
physical therapy receive a "welcome" letter Outpatient Therapy Services which reminds them that it is the
patient's responsibility to verify the amount and nature of coverage for their hospital outpatient therapy visits
with their own health insurer
In addition, patients receiving care through a ProHealth clinic, such as the Muskego Clinic, sign a "General
Consent and Agreement to Pay for Treatment" formThis form also communicates to the patient that it will be
up to them to confirm what health insurance coverage they have for the services they receive at or through the
ClinicThe Agreement also asks the patient to acknowledge that if there is a portion of the bills that are not
covered by their insurance carrier, that they would be responsible for payment of those services
In reading Ms*** submission, I note that she has concerns with information from her health insurer
(which she indicates is United Healthcare) and with the accuracy of information United Healthcare provided
related to how much she would be responsible for paying personallyProHealth Care was not part of those
discussions and any concerns that Ms*** has with her insurer would need to be addressed by that
company itself. CSummary
As noted above, we are unfortunately limited in our ability to respond to the specifics of Ms***'s
concerns without an authorization allowing us to disclose information to you and the Revdex.com of Wisconsin
What we can confirm at this time is: (1) Ms*** billing was reviewed and confirmed as accurate and
appropriate for the services she received, (2) hospital outpatient therapy services are provided by ProHealth
Care's Outpatient Therapy Services and not by the Clinic and are billed separately as hospital outpatient
therapy, (3) patients are advised that therapy services are billed as hospital outpatient therapy services and are
informed, in several different ways, that the individual would need to raise questions about the extent of
coverage or confirming coverage for hospital outpatient therapy benefits with their health insurer. I hope that this letter is of some assistance to you in reviewing this matterLet me reiterate once again that
without a medical authorization, we are not able to provide you with a full response at this timeIf and when
we receive a signed authorization, we would be happy to promptly provide you with more detail. Please let me know if you have any questions and I will be happy to respondThank you for your time and consideration of this letter and our position. Very Truly Yours,*** *** ***

[A default letter is provided here which indicates your acceptance of the business's response. If you wish, you may update it before sending it.]
Revdex.com:
I have reviewed the response made by the business in reference to complaint ID ***, and find that this resolution is satisfactory to me.
Regards,
*** ***

Upon review of the medical records for patient *** *** Guarantor ID: *** *** ***, I agree that an additional was not warranted. The charge has been removed and a refund will be forthcomingFor the second part of the review on the labs done on DOS 06/12/2015, our office
contacted United Health Care as a corrected claim had been sent to them. United Health Care does not recognize screening codes as preventative so a corrected claim was sent with the preventative code added. The claim was applied to the deductible each time for both labs done that day. United Health Care admits that they did not process the second claim as a corrected claim but as “already processed” so no changes were made. They have agreed to reprocess the claim which can take up to business days. This is not a guarantee of payment for the two labs done that day. There is a phone note in the patient’s chart specifically asking for one of the labs to be done as the patient was having symptoms and wanted to be sure everything was all right. Since this was a medical reason and not part of a preventative visit it may still be applied to the deductible. We will await the response from the insurance. The lab charges have been put back out to an insurance balance so the patient will not get a statement until the insurance has processedWe hope that satisfactorily answers the patient’s concernsSincerely, *** *** Coder Team Lead *** ***

Revdex.com:I have reviewed the response made by the business in reference to complaint ID *** and have determined that this does not resolve my complaint. For your reference, details of the offer I reviewed appear below.[To assist us in bringing this matter to a close, we would like to know your view on the matter.]
I have faxed the medical request to the hospitalMy son's name is *** *** dob ***The fact of the matter is we would not have done the theropy unless they told us it was compeltely covered by insurancewe asked them at the desk to review and both the front office and the supervisor said it was completely covered by insurace and we had no out of pocketNow it also states at their office to ask for an estimate right thereSince this complaint I was sent to collection and have paid the full amount in question but this really should be refunded to me as it was a complete bait and switch Regards,*** ***

I will need a medical authorization signed before I can properly respond to this complaint

If Mr. *** would like us to provide to you a full and complete response, he would need to complete a medical authorization specifying that we can release information to you and to the Revdex.comWe also wanted to make sure that Mr. ***understood that if he does authorize ProHealth Care to disclose confidential information to the Revdex.com (or any other 3rd party), we cannot confirm or control how that 3rd party will maintain, access, communicate or otherwise use the records or information once it is released to them, including that the 3rd party may make the information public. In Mr. ***’s January 13th response, he states that he has now provided a signed authorization for the release of his son’s records to youI did not receive a copy of any authorizationHowever after receiving the January 13th response, I checked with our medical records departmentIt appears that Mr. *** did send a signed medical authorization, but he did not fill out the part asking him to identify who ProHealth Care is authorized to release information toI believe that our medical records department would have returned the authorization to Mr. *** because the form does not say who can receive the information and records. So at this time ProHealth Care is still unable to provide a complete responseWe would need a medical authorization allowing us to disclose records of information to you and to the Revdex.comI can resend another copy of this form to you if you need one. This authorization form can be downloaded at: http://www.prohealthcare.org/patient-guest-services-medical-records-request.aspx Then in the section titled "Disclosure of Health Information To:" Mr. *** should indicate that the information and records can be released to you and the Revdex.com (assuming that he wants us to disclose information to you)In addition, it would be helpful if Mr. *** could return the authorization, if he does wish to complete one, either to you (so that you can forward to me) or to me directly (via email, fax or whatever method is easier for him). Once again, we want to make sure that Mr. *** understands that if he authorizes us to release records and information pursuant to an authorization form, ProHealth Care cannot control how the records and information is used once releasedIf Mr. *** has questions about how the Revdex.com would use, disclose or communicate the records or information (including whether it would be become public record in some way) he would need to direct those questions to you or the Revdex.com. I would be happy to answer any questions Mr. *** had about that issueIn addition, I can advise you that we have reached out to Mr. *** directly and offered to discuss his concerns and questions with him directlyI am happy to answer any questions you may have as well. Your January 13th communication asked us to respond within daysI will be happy to provide another response by January 23rd, but without a completed medical authorization we will still be unable to fully respond to Mr. ***’s submission to you. Thank you for your time and review of this emailPlease feel free to contact me with any questions. *** *** *** ** *** ***V.PRisk Management &Risk Management OfficerProHealth Care, Inc.N17 W24100 Riverwood Drive, Suite 375Waukesha, WI 53188Direct: (262) 928-2124Cell: (262) 443-3443Fax: (262) 953-8733E-mail: [email protected]

We are in receipt of the recent authorization that patient *** *** has submitted through the Revdex.comWe are in the process of checking with our Health Information Department to confirm that the authorization form that the patient provided you will allow us to provide you a more
detailed response to the patient’s complaintIn the case that we need additional information, we have also provided our authorization form in the recent email and letter we sent you this morning regarding Mr*** complaintI will keep you informed once we receive a response from our Health Information Management departmentWe appreciate your patience in this matter and hope to provide you a response soon Regards, *** ***Patient Relations SpecialistProHealth CareOffice: (262) 928-4784Fax: (262) 953-8733***

As of this date, we have do not have a signed medical authorization that would allow us to disclose specific information. We have provided as much of a response as we are able at this time. We can provide a more complete response if we receive the information noted in the attached
letter. I will forward the original to you today be US Mail as well.If you have any questions or need any further information, please do not hesitate to contact me. In addition if you receive a signed authorization you can forward that to my attention. Thanks*** ***I am writing to you on behalf of ProHealth Care Inc., to respond to your e-mail of November 25, You e-mail forwarded the electronic submission made by *** *** to the Revdex.com related to medical bills for care for his sonANeed for Additional Information/Medical Authorization for Complete Response According to his submission, Mr*** has questions about medical bills which he states relate to therapy care that his son received at ProHealth CareHowever Mr*** submission does not identify the name or date of birth of the patient, and he does not identify the dates of the care or charges he questionsIt would be difficult to provide specific answers to Mr***'s questions without more information.In addition Mr***'s submission raises questions which in part relate to information that would be in a patient's medical and billing recordsFor example Mr*** raises questions related to a plan of care and therapy, discussions about that care and the scope of bills he has received for that careMr*** also raises questions about what he was charged and what is covered under his insuranceIn order to provide a full and complete response to Mr***'s concerns, ProHealth Care would need to be able to refer to and disclose portions of billing records and medical records for the dates of the care at issueWe would also need confirmation of the name and date of birth of the patient, as well as identification of the dates of care at issueHowever at this time we are limited in what information we can provide to you in response to Mr***'s questionsUnder Wisconsin and Federal law, medical records and medical information within those records are protected and confidentialProHealth Care is very diligent in protecting the confidentiality of our patient's health care informationAs a result, without an authorization from Mr*** allowing us to disclose information regarding the care at issue to you, we are not able to provide a full and complete response to your November 25themail and Mr***'s submissionIf Mr*** wishes to authorize disclosure of this information to you, he would need to complete a medical authorization formOn December 29thwe forwarded a copy of ProHealth Care's medical authorization form to youAs of the date of this letter, we have not received a signed authorization from Mr***If Mr*** is willing to provide you with a signed medical authorization, he can use the enclosed authorization form (the same as what we previously sent) for that purposeMr*** would simply need to complete it to indicate that the records could be disclosed by us to you and the Revdex.com of Wisconsin(This same document is available on the intemet at http://www.prohealthcare.org/patientguest-services-medical-records-request.aspx)...⇄ should understand that if he does authorize ProHealth Care to release records or information to a third party like the Revdex.com, ProHealth Care cannot confirm or control how that third party will maintain, access, communicate or otherwise use the records or information once releasedBResponse to Mr***'s Submission While we cannot at this time disclose protected health information, we can at least provide you with some basic information about ProHealth Care's Outpatient Therapy Services billing practices that apply generally to ProHealth patientsPatients who receive therapy services through ProHealth Care's Outpatient Therapy Services are advised before receiving any therapy that such services are charged as hospital outpatient therapy servicesPatients are advised that it is their responsibility to verify their insurance coverages, including therapy benefits, with their insurance providersThis information is communicated to patients in multiple waysFor example, patients who are going to participate in therapy receive a "welcome" letter Outpatient Therapy Services at the start of the therapy programThis letter reminds patients that it is their responsibility to verify the amount and nature of coverage for their hospital outpatient therapy visits with their own health insurerIn addition patients receiving outpatient therapy services at a ProHealth clinic location will first sign a "General Consent and Agreement to Pay for Treatment" formThe form tells the patient that it is up to them to confirm what health insurance coverage they have for the therapy servicesThe Agreement also asks the patient to acknowledge that if there is a portion of the bills that are not covered by their insurance carrier, that they would be responsible for payment of those servicesProHealth staff does not make representations to patients about the nature or extent of their insurance coverageIf a patient raises questions about their coverage, ProHealth staff refers that patient back to their insurance companyGiven the variety of health care plan coverages, and the fact that staff would not have knowledge about the specifics of particular patient's coverage or billing history with their particular provider in a particular year, ProHealth staff can only suggest that the patient contact their insurer if they have questions about what might be coveredCSummary In conclusion I want to reiterate that we are unfortunately limited in our ability to provide you with a complete response to Mr***'s submission at this timeIn order to respond more fully we would need additional information from Mr*** (the name and date of birth of the patient and specific charges at issue)In addition, ProHealth Care is significantly limited in our ability to answer Mr***'s questions for you without an authorization allowing us to disclose protected health information at issue to you and the Revdex.com of WisconsinWhat we can confirm for you at this time is that ProHealth Care has established practices and materials to consistently communicate to our patients that ProHealth cannot advise or confirm the nature or scope of their individual health care coverageProHealth tells patients that it is a patient's responsibility to know the extent of their insurance coverage, and that the patient should raise any questions about coverage with their insurerOn behalf of ProHealth Care, I appreciate your time and consideration of this letterIf Mr*** does provide a signed medical authorization, we would be happy to promptly provide you with more detailI will enclose a copy of the authorization form with this letterPlease let me know if you have any questions and I will be happy to respondYou may reach me at (262) 928-2124, at [email protected] at the address noted belowThank you for your time and consideration of this letter and our position*** *** Vice President of Risk Management & Risk Management Officer ProHealth Care, Inc

[A default letter is provided here which indicates your acceptance of the business's response.? If you wish, you may update it before sending it.]
Revdex.com:
I have reviewed the response made by the business in reference to complaint ID ***, and find that this resolution is satisfactory to me.?
Regards,
*** ***

Upon review of the medical records for patient *** *** Guarantor ID: *** *** ***, I agree that an additional was not warranted.? The charge has been removed and a refund will be forthcomingFor the second part of the review on the labs done on DOS 06/12/2015, our office
contacted United Health Care as a corrected claim had been sent to them.? United Health Care does not recognize screening codes as preventative so a corrected claim was sent with the preventative code added.? The claim was applied to the deductible each time for both labs done that day.? United Health Care admits that they did not process the second claim as a corrected claim but as “already processed” so no changes were made.? They have agreed to reprocess the claim which can take up to business days.? This is not a guarantee of payment for the two labs done that day.? There is a phone note in the patient’s chart specifically asking for one of the labs to be done as the patient was having symptoms and wanted to be sure everything was all right.? Since this was a medical reason and not part of a preventative visit it may still be applied to the deductible.? We will await the response from the insurance.? The lab charges have been put back out to an insurance balance so the patient will not get a statement until the insurance has processedWe hope that satisfactorily answers the patient’s concernsSincerely, *** *** Coder Team Lead *** ***

Please reach out to the Emergency Department manager at 262-928-so we can discuss further

I will need a medical authorization signed before I can properly respond to this complaint.

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.[To assist us in bringing this matter to a close, we would like to know your view on the matter.]
I have faxed the medical request to the hospital. My son's name is [redacted] dob [redacted]. The fact of the matter is we would not have done the theropy unless they told us it was compeltely covered by insurance. we asked them at the desk to review and both the front office and the supervisor said it was completely covered by insurace and we had no out of pocket. Now it also states at their office to ask for an estimate right there. Since this complaint I was sent to collection and have paid the full amount in question but this really should be refunded to me as it was a complete bait and switch.  Regards,[redacted]

This letter is to confirm that we have received an Inquiry from you regarding a consumer complaint filed by [redacted] concerning Pro Health Care - Medical Associates. Your letter was directed to an individual that no longer is working at Prohealth Care so unfortunately your letter was not...

delivered to me until today.I have reviewed the phone calls and notes concerning this matter and will acknowledge that Ms. [redacted] did contact our office and asked to be listed as the responsible parent for her son's account. That chance was made per her request. Her request to be listed as the responsible parent does affect all services provided to her son. As previously explained to Ms. [redacted], her son has or e account and that one account will have one parent listed as the responsible parent.I have been able to determine that all statements. even those in her ex-husbands name have always been sent to the Bayberry Dr. which Ms. [redacted] listed as her home address. I have also been able to determine that Ms. [redacted] has made payment towards other services prior to the name change leaving me to believe that she had access to the statements sent to t he Bayberry Dr. address. These statements Included the amount in dispute.We are aware that it can be difficult for patients to understand their medical bills, We work with our patients and allow them the opportunity to make consistent interest free monthly payments which will resolve their medical bills in a reasonable timeframe. We believe that open communication is important between both parties. By reaching a mutual understanding we reduce the possibility of disappointment or misunderstanding for everyone.I would like to offer the following solution to Ms, [redacted] to help resolve this matter, If Ms. [redacted] is willing to make payment in full for the balance that is owed, then I would be happy to have this amount removed from her credit report once her payment has been received.Thank you for your inquiry, if you have any questions, please let me know.Sincerely,[redacted]

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 have NOT received calls from anyone lately...I received calls years ago.  I talked to several people about this manner.  I was told by numerous people that would just keep telling me to call someone else, or we will look into this manner and give you a call back.  I left several messages and did not recieve a response from anyone other then, I will pass this information along.  OR We will investigate this manner and get back to you.  OR I am sorry this is not really my department, I am not sure why they sent you to me.She did not receive proper care, in face the PA and the original doctor BOTH came to me and apologized to me for missing this the first time.  Think about this from a medical point of view .... if given the proper care the first visit....HOW does a healthy girl  go septic in less then 48 hours, have her middle tonsils so swollen that the PA in the ER wanted to intubate her, as they were so enlarged that if she moved her head even the slightest bit....it closed off her airway!There are also records from Carroll University's medical center with Kaitlin being seen on the same day she came into the ER for the first time.  They felt that her health was so bad that they were not able to attend to her medical needs and sent her to the ER...where your ER doctor released her without a proper examination...if he would have examined her properly, or taken the word of another medical professional who had referred her to you, she would not have gone septic, had to miss mid-terms....have her grades suffer as they did......THIS IS NOT THE CARE THAT AN ER ROOM SHOULD GIVE A PATIENT WHO WAS SENT THERE BY ANOTHER MEDICAL PERSON, YET ALONE ANYONE!  The above reason is why WE are not accepting the businesses response!Thank you [redacted]
  
[To assist us in bringing this matter to a close, we would like to know your view on the matter.]
Regards,
Laura Mokry

We are in receipt of the recent authorization that patient [redacted] has submitted through the Revdex.com. We are in the process of checking with our Health Information Department to confirm that the authorization form that the patient provided you will allow us to provide you a more...

detailed response to the patient’s complaint. In the case that we need additional information, we have also provided our authorization form in the recent email and letter we sent you this morning regarding Mr. [redacted] complaint. I will keep you informed once we receive a response from our Health Information Management department. We appreciate your patience in this matter and hope to provide you a response soon.   Regards, [redacted]Patient Relations SpecialistProHealth CareOffice: (262) 928-4784Fax: (262) 953-8733[redacted]

As of this date, we have do not have a signed medical authorization that would allow us to disclose specific information.  We have provided as much of a response as we are able at this time.  We can provide a more complete response if we receive the information noted in the attached...

letter.  I will forward the original to you today be US Mail as well.If you have any questions or need any further information, please do not hesitate to contact me.  In addition if you receive a signed authorization you can forward that to my attention. Thanks[redacted]I am writing to you on behalf of ProHealth Care Inc., to respond to your e-mail of November 25, 2015. You e-mail forwarded the electronic submission made by [redacted] to the Revdex.com related to medical bills for care for his son. A. Need for Additional Information/Medical Authorization for Complete Response According to his submission, Mr. [redacted] has questions about medical bills which he states relate to therapy care that his son received at ProHealth Care. However Mr. [redacted] submission does not identify the name or date of birth of the patient, and he does not identify the dates of the care or charges he questions. It would be difficult to provide specific answers to Mr. [redacted]'s questions without more information.In addition Mr. [redacted]'s submission raises questions which in part relate to information that would be in a patient's medical and billing records. For example Mr. [redacted] raises questions related to a plan of care and therapy, discussions about that care and the scope of bills he has received for that care. Mr. [redacted] also raises questions about what he was charged and what is covered under his insurance. In order to provide a full and complete response to Mr. [redacted]'s concerns, ProHealth Care would need to be able to refer to and disclose portions of billing records and medical records for the dates of the care at issue. We would also need confirmation of the name and date of birth of the patient, as well as identification of the dates of care at issue. However at this time we are limited in what information we can provide to you in response to Mr. [redacted]'s questions. Under Wisconsin and Federal law, medical records and medical information within those records are protected and confidential. ProHealth Care is very diligent in protecting the confidentiality of our patient's health care information. As a result, without an authorization from Mr. [redacted] allowing us to disclose information regarding the care at issue to you, we are not able to provide a full and complete response to your November 25themail and Mr. [redacted]'s submission. If Mr. [redacted] wishes to authorize disclosure of this information to you, he would need to complete a medical authorization form. On December 29thwe forwarded a copy of ProHealth Care's medical authorization form to you. As of the date of this letter, we have not received a signed authorization from Mr. [redacted]. If Mr. [redacted] is willing to provide you with a signed medical authorization, he can use the enclosed authorization form (the same as what we previously sent) for that purpose. Mr. [redacted] would simply need to complete it to indicate that the records could be disclosed by us to you and the Revdex.com of Wisconsin. (This same document is available on the intemet at http://www.prohealthcare.org/patientguest-services-medical-records-request.aspx)...⇄ Mr. [redacted] should understand that if he does authorize ProHealth Care to release records or information to a third party like the Revdex.com, ProHealth Care cannot confirm or control how that third party will maintain, access, communicate or otherwise use the records or information once released. B. Response to Mr. [redacted]'s Submission While we cannot at this time disclose protected health information, we can at least provide you with some basic information about ProHealth Care's Outpatient Therapy Services billing practices that apply generally to ProHealth patients. Patients who receive therapy services through ProHealth Care's Outpatient Therapy Services are advised before receiving any therapy that such services are charged as hospital outpatient therapy services. Patients are advised that it is their responsibility to verify their insurance coverages, including therapy benefits, with their insurance providers. This information is communicated to patients in multiple ways. For example, patients who are going to participate in therapy receive a "welcome" letter Outpatient Therapy Services at the start of the therapy program. This letter reminds patients that it is their responsibility to verify the amount and nature of coverage for their hospital outpatient therapy visits with their own health insurer. In addition patients receiving outpatient therapy services at a ProHealth clinic location will first sign a "General Consent and Agreement to Pay for Treatment" form. The form tells the patient that it is up to them to confirm what health insurance coverage they have for the therapy services. The Agreement also asks the patient to acknowledge that if there is a portion of the bills that are not covered by their insurance carrier, that they would be responsible for payment of those services. ProHealth staff does not make representations to patients about the nature or extent of their insurance coverage. If a patient raises questions about their coverage, ProHealth staff refers that patient back to their insurance company. Given the variety of health care plan coverages, and the fact that staff would not have knowledge about the specifics of particular patient's coverage or billing history with their particular provider in a particular year, ProHealth staff can only suggest that the patient contact their insurer if they have questions about what might be covered. C. Summary In conclusion I want to reiterate that we are unfortunately limited in our ability to provide you with a complete response to Mr. [redacted]'s submission at this time. In order to respond more fully we would need additional information from Mr. [redacted] (the name and date of birth of the patient and specific charges at issue). In addition, ProHealth Care is significantly limited in our ability to answer Mr. [redacted]'s questions for you without an authorization allowing us to disclose protected health information at issue to you and the Revdex.com of Wisconsin. What we can confirm for you at this time is that ProHealth Care has established practices and materials to consistently communicate to our patients that ProHealth cannot advise or confirm the nature or scope of their individual health care coverage. ProHealth tells patients that it is a patient's responsibility to know the extent of their insurance coverage, and that the patient should raise any questions about coverage with their insurer. On behalf of ProHealth Care, I appreciate your time and consideration of this letter. If Mr. [redacted] does provide a signed medical authorization, we would be happy to promptly provide you with more detail. I will enclose a copy of the authorization form with this letter. Please let me know if you have any questions and I will be happy to respond. You may reach me at (262) 928-2124, at [email protected] at the address noted below. Thank you for your time and consideration of this letter and our position. [redacted] Vice President of Risk Management & Risk Management Officer ProHealth Care, Inc.