Restore Sleep Health Services

Initial Business Response /* (1000, 9, 2016/01/08) */
[redacted]Document Attached[redacted]
This patient signed both a financial policy document and a consent for service which clearly states Insurance is a contract between you and your insurance company. It is in your best interest to know your insurance...

benefits and that you are financially responsible for any unpaid balances on your account. I have attached these documents. The physician who referred this patient to our Sleep Center is a neurologist and board certified in sleep medicine. She ordered the test. Based on the order we called and scheduled the patient for the sleep study. We do not set the price of test. Every medical test/procedure has a code assigned to it. The insurance company dictates what they will allow/pay for that code. This test was covered by the patients insurance but the patient has a high deductible plan. The deductible needs to met first before the insurance company will pay.
Initial Consumer Rebuttal /* (3000, 11, 2016/01/11) */
(The consumer indicated he/she DID NOT accept the response from the business.)
Restore Sleep Health Services did not address any of the concerns in the complaint. A written response showing each of the items of concern is attached.
Final Consumer Response /* (2000, 18, 2016/01/28) */
(The consumer indicated he/she ACCEPTED the response from the business.)
I appreciate that they responded with a complete response. The $308 that I paid was to the Clinic. Although I believe that there should be a proactive process to give the patient a cost estimate, it appears that it is possible to receive an estimate and that I could have requested an estimate prior to the services.
Final Business Response /* (1000, 15, 2016/01/28) */
Contact Name and Title: Greg [redacted]
Contact Phone: [redacted]
Contact Email: [email protected]
Complaint 1: "The expenses associate with sleep study were not disclosed prior to study" We provide an estimate of cost based on average allowed amounts upon request from consumer per Minnesota statute 62J.81 We did not receive request from Ms. [redacted].

Complaint 2: "Insurance covered barely half" of the bill.
Response: This is incorrect. Insurance covered (or allowed) $1,893.45, which is 70% of our charge. She is confusing "covered" with "paid". She has a high deductible plan, and Blue Cross applied a large portion of the covered amount to her deductible. It is the consumer's own responsibility to be familiar with their own insurance plans. She was apparently not aware that she has a high deductible plan, nor does she seem aware that her deductible and coinsurance hadn't been met. Blue Cross can provide up-to-date benefits to their members with a phone call. There is a Member Services phone number for Blue Cross printed on the back of Ms. [redacted]'s Blue Cross identification card. I believe Blue Cross members can also create a log-in for their plan, and track their deductible and coinsurance. As a business, we can't absorb consumer's deductibles.
Complaint 3: "Justification for the expense" was not provided when requested
Response: Her physician referred her for an in-lab polysomnography with sleep staging with four or more additional parameters of sleep, attended by a technologist. I am not sure what she would like to be justified. This is the study for which she was referred
Complaint 4: Our bill was "over $3,300".
Response: That is incorrect; our total charge was $2,704.93.
Complaint 5: We "provided no disclosure" for a patient balance that ended up being as high as it was.
Response: See response to Complaint 1
Complaint 6: "I paid $308 in October..."
Response: We did not receive a payment of $308.00 in October. To date, we have received two payments from Ms. [redacted]. We received a payment of $250.00 in December, and a payment of $100.00 in January. Her current balance is $1,123.16.
Complaint 7: Her desired resolution states that she wants to know our "process to ensure patients have a clear understanding of the expenses".
Response: See response to Complaint 1. We provide an estimate if it is requested.
Complaint 8: Her desired resolution states that she wants "to ensure patients have the ability to pay our expenses prior to the services being rendered"
Response: When a patient presents their insurance card, we bill their insurance. If she had wanted to pay cash up-front, she should have mentioned that at the time of scheduling. There is no formal policy if a patient prefers to pay in advance. There are zero circumstances where a consumer has presented their insurance card, yet wants to pay cash in advance.
Complaint 9: She requests an explanation of the difference between and EOB (Explanation of Benefit) for $635 and the EOB for $2,704.93.
Response: Our bill was for $2,704.93. It sounds like she has a question about a separate bill from a different provider for $635.00. Is this the bill from the clinic, or for the interpretation?
I have attached additional copies of documents to support our position.