S S C Security & Investigations

Hello We are a thrid party billing service and it appears that Ms [redacted] complaint is mainly with the provider of service at her surgery and not with our billing her insurance carrier for servicesI can provide some light on the situation Patient’s insurance did pay for the services of the assistant surgeon and sent check directly to Ms *** A call from us was made on 10/and a voice message left for the patient to contact us Patient returned call on 10/and stated she was not going to pay the surgical assist what the insurance had paid her because the provider is not a” surgeon” It was explained in detail to Ms [redacted] that the providers credentials ARNP (as well as RNFA’s) are qualified to assist at surgery and that is all they do is surgical assisting Additionally ,if she was not qualified to provide assisting surgery services the insurance would not have paid the claim for these services Certified letter was sent to Ms ***, 10/27( receipt of letter was signed by her father) notifiying her that the insurance sent her a check for payment of medical services provided by the surgical assist and that it she was now responsible for the bill of $ Which was the total amount of the check she received, after appropriate insurance adjustments taken Insurance confirmed that patient cashed the check $on 10/31/ This is the extent of our contact with Ms [redacted] Any other calls she received came from the provider of service directly and not our organization I understand a call was placed and father ansered and was informed that they were trying to locate Ms *** Ms [redacted] did file a complaint with the hospital which they dropped as there was no HIPPA violation as no protective health information was discussed or relayed Contacting someone regarding a bill or collection is not protective health information Ms [redacted] was informed in the letter on 10/that if she did not send in the check she received in payment for medical services provide that she would be turned over to collections Ms [redacted] is filing this complaint because she fraudently kept the insurance money and was turned over to collections Thank you Elizabeth M M***,Director of OperationsACOM Medical Billing [redacted] ***

This is in no way representative of the actual timeline of events.  I received not one single phone call from your agency, but multiple phone calls daily from your agency as well as your client until I contacted Risk Management at the hospital at which time they asked that you stop harassing me.  At that time, I had no knowledge of any check, but was receiving calls right left and center!  I was actually on the phone with risk management when I received a call from your office stating that ARNP was actually a surgeon and that is what she was passing her self off as.  Furthermore, the check that was issued did not have anyone else's name on it but mine.  If you want to talk about fraud, we certainly can.  I received the bill from the hospital with the actual charges from the surgeon (you client's boyfriend), as well as the certified nurse anesthetist.  Unbelievably, your client has charged [redacted] more than either of these two.  Yes the ARNP that I have never seen, never met and was not way authorized to care for me charged my insurance company more than the surgeon.  Furthermore, when I spoke with Risk Management about this situation, I was advised that if the hospital had provided the assistant (as they normally do), the charges would not have been nearly that much as they have employees that they bill standard fees for instead of bilking the insurance company.   So, yes, I have filed a complaint with the hospital and shame on Dr. R[redacted] for mixing his professional life with his personal life and expecting a good outcome with a woman that behaves so unprofessionally.  I have also filed a complaint with [redacted] and also have no problem filing one with Florida Board of Nursing.   Susan E. [redacted]

Hello We are a thrid party billing service and it appears that Ms [redacted] complaint is mainly with the provider of service at her surgery and not with our billing her insurance carrier for services. I can provide some light on the situation. 1.   Patient’s insurance did pay...

for the services of the assistant surgeon and sent check directly to Ms [redacted]2.   A call from us was made on 10/20 and a voice message left for the patient to contact us.   Patient returned call on 10/26 and stated she was not going to pay the surgical assist what the insurance had paid her because the provider is not a” surgeon”  It was explained in detail to Ms       [redacted] that the providers credentials ARNP (as well as RNFA’s) are qualified to assist at surgery and that is all they do is surgical assisting.   Additionally ,if she was not qualified to provide assisting surgery services the insurance would not have paid  the claim for these services3.  Certified letter was sent to Ms [redacted], 10/27( receipt of letter was signed by her father)  notifiying her that the insurance sent her a check for payment of medical services provided by the surgical assist and that it she was now responsible for the bill of $3748.80       Which was the total amount of the check she received, after appropriate insurance adjustments taken.       Insurance confirmed that patient cashed the check $3748.80 on 10/31/20164.  This is the extent of our contact with Ms [redacted]      Any other calls she received came from the provider of service directly and not our organization.    I understand a call was placed and father ansered and was informed that they were trying to locate Ms [redacted]5.  Ms [redacted] did file a complaint with the hospital which they dropped as there was no HIPPA violation as no protective health information was discussed or relayed.     Contacting someone regarding a bill or collection is not protective health information6   Ms [redacted] was informed in the letter on 10/20 that if she did not send in the check she received in payment for medical services provide that she would be turned over to collections7.   Ms [redacted] is filing this complaint because she fraudently kept the insurance money and  was turned over to collections.     Thank you  Elizabeth M M[redacted],Director of OperationsACOM Medical Billing[redacted]