Complaint: ***I am rejecting this response because: When I started the program with Sandpoint Family medicine I had a very long and extensive talk with Dr*** about the program and what the requirements of the program wereI explained to him I did not have medical insurance and I opened up to him about my financial situation and how I was the sole provider of a family of and how my wife of years had passed awayHe seemed to be understanding and he stated there was testing and blood work that normally has to be done when a patient starts the program but based on my situation he agreed that the necessary blood or lab work could be done my first appointment in January because that's when my medical insurance through my employer would startIn fact there was several appointments when the nurse asked me and was surprised that I did not have the blood work done yet because all other patients have to have it done up frontThe Doctor on repeated occasions confirmed our agreement to wait until January to have any work done and it is documented on my medical file from Sandpoint Family medicineOn top of that when I had the appointment in question no one told me they were sending my blood offI stated I thought my blood sugar was affecting how I felt on a daily basis and agreed to have my blood taken based upon being told my blood was being tested in house and that the cost for the test would cost me a total of $If I was suppose to pay the bill from lab corp why was I not informed, why did it take over months to receive a bill from them, and why did *** in billing tell me I didn't have to pay it after I found out about itAs far as only prescribing suboxone and not prescribing generic buprenorphin when why was I prescribed buprenorphin every month I was seen except the last monthThey do offer a discount card that saves you a couple hundred dollars a month but I still would have been paying almost $a month which isn't affordable to me or anyone else and even if it was affordable to another patient they would be throwing away so much money when they could just go down the street and get a generic for a tenth the costI don't see how you could even be okay with knowing what your prescribing is costing patients who don't have a lot of money $a monthI knew Sandpoint Family medicine would try and get out of having to take responsibility for the bill I am getting from labcorp and for all the trouble they have caused meFrom the Doctor sharing a very innapropriate personal experience with me to him raising his voice at me, to being hung up on, mistreated and misinformed on over a dozen times and now thisI just don't know what to think anymoreFrom When the Doctor wrote me the prescription for the very expensive medication until I found a new doctor it cost me close to $and now I am suppose to pay lab corp $I've never had to deal with such a terrible company in my life
Sincerely,*** ***
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 complaintFor your reference, details of the offer I reviewed appear below.Regards,*** ***
I called Sandpoint family Medicine to schedule a wellness appointment which was covered at no costJan 31st they called me to go over my lab work and they charged me for that on 2-27-
The reason they charged me for my "free" wellness is because I had refills
I was upset when I disputed my bill, but Courtney was way rude
Told me if I didn't pay it she was going to collectionsI reluctantly paid itThe next day I get a letter saying I'm not allowed on their property and they cancelled my prescriptions I paid forSo I'm disputing my credit card
***SUPPORTING DOCUMENTS REDACTED BY Revdex.com***
We are writing in response to ID [redacted] and the dispute involving the payment of $654.29. Without sharing protected personal information, questions regarding this dispute can be answered by way of general billing and office policy. In billing Insurances for wellness and diagnostic visits, It's...
important to understand that insurance plans process differently for preventative/wellness/routine care as opposed to diagnostic care. The distinction exists not only with respect to processing, but also in documentation and treatment. Simply stated, the care is not the same and isn't processed by insurance plans in the same way. Because many plans offer wellness/preventative/routine benefits, many patients are under the impression that anything occurring during the visit is covered at 100% by the plan if it's mentioned that they want it to be billed as wellness. The resulting situation is that patients often end up with balances they feel should have been covered by their insurance plans. With this case, appeals were filed to the Insurance plan not once, but twice. After the second appeal submission, our office was contacted by the claims examiner who asked us not to appeal again and that the balances were patient responsibility. The patient had been made aware of the balance and efforts to collect from the insurance, but strongly disagreed with being responsible for charges. Balances for other visits were also outstanding, so the final payment was applied in large part to one service date the patient contested, but also to other dates of service as well. As a healthcare facility, our office is reluctant to terminate patients from the practice. Patients are occasionally fired from the practice for various reasons including, but not limited to, non-compliance, medication diversion, and Inappropriate behavior. The release of a patient is something that's taken seriously by our medical providers and management staff. In the event of a patient termination, medication refills are cancelled as we are unable to perform prescription management for patients we no longer see. While we can appreciate the frustration inherent to healthcare expenses, the services were provided, the patient was billed for the residual balance after the Insurance processed, and his Insurance carrier's determination(s) were appealed at the patient's (multiple) requests.
We recently received your letter regarding a patient complaint involving [redacted] for services on [redacted], including an invoice from Labcorp labeled [redacted]. Our compliance policy requires that complaintsby patients and/or other agencies involved in patient care are reviewed...
in order to determine if errors occurred and if company protocol must be adjusted. In order to accomplish this or any other review, staff members from different departments work to evaluate different components of office protocol. If changes are deemed necessary following a review, deparbnent heads meet to make the appropriate adjustments.In his letter, the patient referenced multiple issues including his contention with the cost of.treatment at our facility, the lab utilized by Sandpoint Family Medicine (heretofore referred to as SFM), and the pharmacy. Inorder to protect the patient's privacy, our response to [redacted] complaint includes policy-specific answers to explain the guidelines implemented at our practice. Upon review, however, inconsistencies exist between the patient's version ofevents and notations in the medical record made by the provider(s).As the result of extensive research, policy guidelines on abuse behavior necessitated the implementation of patient-wide protocol dictating that all patients should be on the brand name Suboxone or the generic fonnulation of Buprenorphine and Nalaxone. The efforts inherent in this policy are to prevent or discontinue opiate abuse. Each patient in the program receives education to include the program guidelines and the necessary compliance of the patient. In an effort to reasonably reduce out of pocket expenses for the patients, discount cards are providedto patients when filling their prescriptions.Contrary to [redacted] letter, labwork was completed prior to the dates listed and the corresponding charges were billed appropriately. Our office utilizes services provided by Labcorp in order to complete comprehensive testing not capable through the on-site lab at SFM. Patients are advised that at least once annually and possibly more often due to any abnormal findings via our in-house lab, urine specimen will be forwarded to an outside lab for qualitative testing. The testing avallable through Labcorp is a necessary component of our Suboxoneprogram because it allows for testing to determine the efficacy of the medication(s) prescribed in order to prevent overdose, accelerated consumption and the presence of diversion. Labcorp has agreed to work with our private pay patients on payment plans and/ or discounted charges. AdditionallyJ Labcorp contracts with some insurance carriers with whom SFM does not.Because the organizations are entirely separate, staff at SFM lack the authority to make financial arrangements or adjustments to Labcorp billing. Any information provided by SFM staff is strictly to offer general ideas regarding the cost of procedures, but in no way constitutes a financial agreement.Our billing office has reached out to the provider contact at Labcorp to determine how the balance of the patients charges has been handled. Per our representative, the charges are being reviewed.With respect to the amount refunded to the patient for services, definitive coverage information wasn't provided to our office when he presented for his visit. At the time of the visit, the patient was not aware that he had medical coverage. He paid for the services at the time and later contacted our office to request that we bill his insurance. He requested that we apply any overpayment to his next visit following the reimbursement of his carrier. The funds couldn't be applied to subsequent visit because he cancelled it. At the next refund cycle,which occurred in March, his overpayment was issued to him.In the last paragraph of his complaint, the patient indicates that the provider 'talked him into the testing'. The parameters of the Suboxone program are made clear to each patient enrolled. Definitive testing, as provided annually (or more frequently) by Labcorp is not optional. As previously stated, SFM does not control the billing done by Labcorp, so the timing of statements received from the lab is a moot point. The balance currently held by Labcorp has been requested to be reviewed and our office will take additional steps, should they be warranted, upon receipt of further information. In order to complete the necessary testing as part of the Suboxone program, the patient's information was forwarded to Labcorp. This wasdone as a means to fulfill a reasonable and necessary part of the program guidelines.
Sandpoint Family Medicine 302 South First Ave Sandpoint, Idaho 83864 P: 208.263.5109 F: 208.263.5112 Attention: Revdex.com RE: [redacted] 2/1/18 The above case number...
involves a visit that was billed to the patient’s insurance. The claim went unpaid by the insurance as well as the patient. Upon receiving a call from the patient, we investigated an error involving one line of the claim. It was corrected and resubmitted to the carrier with a notation to reflect as much. The carrier denied the charges in error. Recently in a phone call in January of 2018, the carrier contacted our office as part of a conference call with the patient’s wife and informed our billing office that they would be reprocessing the charges. In that call, the carrier assured our billing staff that they already had all they needed to process the charges and that the denial had been done in error. [redacted] has not reported the balance for this claim to be permanently reflected on the patient’s credit file. In fact, they were notified that the insurance carrier would be reprocessing the charges to remit payment and that no further action could occur. As per their policy, [redacted] concurred and put the account on hold. The patient was made aware of this policy and chain of events during the phone call on January 18, 2018. Today, the patient’s insurance carrier was contacted once again and assured our office that payment was made on 1/24/18, but perhaps that payment hadn’t been received by our office yet. This information, (call ref# Mark F. 3:08 [redacted]) was shared with [redacted] to ensure, once again, permanent reporting would not occur related to the patient. [redacted] was notified of this information today, 2/2/18 by leaving a message with a representative there. Please contact our office if you have additional questions or require additional information. ...⇄ Sincerely, ...⇄ ...⇄ Jeanette J[redacted] ...⇄ Practice Manager ...⇄ Sandpoint Family Medic
Complaint: ***I am rejecting this response because: When I started the program with Sandpoint Family medicine I had a very long and extensive talk with Dr*** about the program and what the requirements of the program wereI explained to him I did not have medical insurance and I opened up to him about my financial situation and how I was the sole provider of a family of and how my wife of years had passed awayHe seemed to be understanding and he stated there was testing and blood work that normally has to be done when a patient starts the program but based on my situation he agreed that the necessary blood or lab work could be done my first appointment in January because that's when my medical insurance through my employer would startIn fact there was several appointments when the nurse asked me and was surprised that I did not have the blood work done yet because all other patients have to have it done up frontThe Doctor on repeated occasions confirmed our agreement to wait until January to have any work done and it is documented on my medical file from Sandpoint Family medicineOn top of that when I had the appointment in question no one told me they were sending my blood offI stated I thought my blood sugar was affecting how I felt on a daily basis and agreed to have my blood taken based upon being told my blood was being tested in house and that the cost for the test would cost me a total of $If I was suppose to pay the bill from lab corp why was I not informed, why did it take over months to receive a bill from them, and why did *** in billing tell me I didn't have to pay it after I found out about itAs far as only prescribing suboxone and not prescribing generic buprenorphin when why was I prescribed buprenorphin every month I was seen except the last monthThey do offer a discount card that saves you a couple hundred dollars a month but I still would have been paying almost $a month which isn't affordable to me or anyone else and even if it was affordable to another patient they would be throwing away so much money when they could just go down the street and get a generic for a tenth the costI don't see how you could even be okay with knowing what your prescribing is costing patients who don't have a lot of money $a monthI knew Sandpoint Family medicine would try and get out of having to take responsibility for the bill I am getting from labcorp and for all the trouble they have caused meFrom the Doctor sharing a very innapropriate personal experience with me to him raising his voice at me, to being hung up on, mistreated and misinformed on over a dozen times and now thisI just don't know what to think anymoreFrom When the Doctor wrote me the prescription for the very expensive medication until I found a new doctor it cost me close to $and now I am suppose to pay lab corp $I've never had to deal with such a terrible company in my life
Sincerely,*** ***
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 complaintFor your reference, details of the offer I reviewed appear below.Regards,*** ***
I called Sandpoint family Medicine to schedule a wellness appointment which was covered at no costJan 31st they called me to go over my lab work and they charged me for that on 2-27-
The reason they charged me for my "free" wellness is because I had refills
I was upset when I disputed my bill, but Courtney was way rude
Told me if I didn't pay it she was going to collectionsI reluctantly paid itThe next day I get a letter saying I'm not allowed on their property and they cancelled my prescriptions I paid forSo I'm disputing my credit card
***SUPPORTING DOCUMENTS REDACTED BY Revdex.com***
We are writing in response to ID [redacted] and the dispute involving the payment of $654.29. Without sharing protected personal information, questions regarding this dispute can be answered by way of general billing and office policy. In billing Insurances for wellness and diagnostic visits, It's...
important to understand that insurance plans process differently for preventative/wellness/routine care as opposed to diagnostic care. The distinction exists not only with respect to processing, but also in documentation and treatment. Simply stated, the care is not the same and isn't processed by insurance plans in the same way. Because many plans offer wellness/preventative/routine benefits, many patients are under the impression that anything occurring during the visit is covered at 100% by the plan if it's mentioned that they want it to be billed as wellness. The resulting situation is that patients often end up with balances they feel should have been covered by their insurance plans. With this case, appeals were filed to the Insurance plan not once, but twice. After the second appeal submission, our office was contacted by the claims examiner who asked us not to appeal again and that the balances were patient responsibility. The patient had been made aware of the balance and efforts to collect from the insurance, but strongly disagreed with being responsible for charges. Balances for other visits were also outstanding, so the final payment was applied in large part to one service date the patient contested, but also to other dates of service as well. As a healthcare facility, our office is reluctant to terminate patients from the practice. Patients are occasionally fired from the practice for various reasons including, but not limited to, non-compliance, medication diversion, and Inappropriate behavior. The release of a patient is something that's taken seriously by our medical providers and management staff. In the event of a patient termination, medication refills are cancelled as we are unable to perform prescription management for patients we no longer see. While we can appreciate the frustration inherent to healthcare expenses, the services were provided, the patient was billed for the residual balance after the Insurance processed, and his Insurance carrier's determination(s) were appealed at the patient's (multiple) requests.
We recently received your letter regarding a patient complaint involving [redacted] for services on [redacted], including an invoice from Labcorp labeled [redacted]. Our compliance policy requires that complaintsby patients and/or other agencies involved in patient care are reviewed...
in order to determine if errors occurred and if company protocol must be adjusted. In order to accomplish this or any other review, staff members from different departments work to evaluate different components of office protocol. If changes are deemed necessary following a review, deparbnent heads meet to make the appropriate adjustments.In his letter, the patient referenced multiple issues including his contention with the cost of.treatment at our facility, the lab utilized by Sandpoint Family Medicine (heretofore referred to as SFM), and the pharmacy. Inorder to protect the patient's privacy, our response to [redacted] complaint includes policy-specific answers to explain the guidelines implemented at our practice. Upon review, however, inconsistencies exist between the patient's version ofevents and notations in the medical record made by the provider(s).As the result of extensive research, policy guidelines on abuse behavior necessitated the implementation of patient-wide protocol dictating that all patients should be on the brand name Suboxone or the generic fonnulation of Buprenorphine and Nalaxone. The efforts inherent in this policy are to prevent or discontinue opiate abuse. Each patient in the program receives education to include the program guidelines and the necessary compliance of the patient. In an effort to reasonably reduce out of pocket expenses for the patients, discount cards are providedto patients when filling their prescriptions.Contrary to [redacted] letter, labwork was completed prior to the dates listed and the corresponding charges were billed appropriately. Our office utilizes services provided by Labcorp in order to complete comprehensive testing not capable through the on-site lab at SFM. Patients are advised that at least once annually and possibly more often due to any abnormal findings via our in-house lab, urine specimen will be forwarded to an outside lab for qualitative testing. The testing avallable through Labcorp is a necessary component of our Suboxoneprogram because it allows for testing to determine the efficacy of the medication(s) prescribed in order to prevent overdose, accelerated consumption and the presence of diversion. Labcorp has agreed to work with our private pay patients on payment plans and/ or discounted charges. AdditionallyJ Labcorp contracts with some insurance carriers with whom SFM does not.Because the organizations are entirely separate, staff at SFM lack the authority to make financial arrangements or adjustments to Labcorp billing. Any information provided by SFM staff is strictly to offer general ideas regarding the cost of procedures, but in no way constitutes a financial agreement.Our billing office has reached out to the provider contact at Labcorp to determine how the balance of the patients charges has been handled. Per our representative, the charges are being reviewed.With respect to the amount refunded to the patient for services, definitive coverage information wasn't provided to our office when he presented for his visit. At the time of the visit, the patient was not aware that he had medical coverage. He paid for the services at the time and later contacted our office to request that we bill his insurance. He requested that we apply any overpayment to his next visit following the reimbursement of his carrier. The funds couldn't be applied to subsequent visit because he cancelled it. At the next refund cycle,which occurred in March, his overpayment was issued to him.In the last paragraph of his complaint, the patient indicates that the provider 'talked him into the testing'. The parameters of the Suboxone program are made clear to each patient enrolled. Definitive testing, as provided annually (or more frequently) by Labcorp is not optional. As previously stated, SFM does not control the billing done by Labcorp, so the timing of statements received from the lab is a moot point. The balance currently held by Labcorp has been requested to be reviewed and our office will take additional steps, should they be warranted, upon receipt of further information. In order to complete the necessary testing as part of the Suboxone program, the patient's information was forwarded to Labcorp. This wasdone as a means to fulfill a reasonable and necessary part of the program guidelines.
Sandpoint Family Medicine 302 South First Ave Sandpoint, Idaho 83864 P: 208.263.5109 F: 208.263.5112 Attention: Revdex.com RE: [redacted] 2/1/18 The above case number...
involves a visit that was billed to the patient’s insurance. The claim went unpaid by the insurance as well as the patient. Upon receiving a call from the patient, we investigated an error involving one line of the claim. It was corrected and resubmitted to the carrier with a notation to reflect as much. The carrier denied the charges in error. Recently in a phone call in January of 2018, the carrier contacted our office as part of a conference call with the patient’s wife and informed our billing office that they would be reprocessing the charges. In that call, the carrier assured our billing staff that they already had all they needed to process the charges and that the denial had been done in error. [redacted] has not reported the balance for this claim to be permanently reflected on the patient’s credit file. In fact, they were notified that the insurance carrier would be reprocessing the charges to remit payment and that no further action could occur. As per their policy, [redacted] concurred and put the account on hold. The patient was made aware of this policy and chain of events during the phone call on January 18, 2018. Today, the patient’s insurance carrier was contacted once again and assured our office that payment was made on 1/24/18, but perhaps that payment hadn’t been received by our office yet. This information, (call ref# Mark F. 3:08 [redacted]) was shared with [redacted] to ensure, once again, permanent reporting would not occur related to the patient. [redacted] was notified of this information today, 2/2/18 by leaving a message with a representative there. Please contact our office if you have additional questions or require additional information. ...⇄ Sincerely, ...⇄ ...⇄ Jeanette J[redacted] ...⇄ Practice Manager ...⇄ Sandpoint Family Medic