-Patient presented to our office 2/25/for a TMJ evaluationHe was told at this time (after we contacted insurance company) that his insurance plan requires a referral from his primary care physician for out of network care-Patient signed our standard financial agreement on his first visitOur customary routine for new patients is for the doctor to speak to the patient after the exam explaining his diagnosis and suggested treatment planAfter that, a member of the office staff goes over the financial aspects of the treatment plan discussing any deductibles, co-pays, prior authorizations or referrals required by the insurance carrierThis patient was told he needed to obtain a referral from his PCPUnderstanding that this is a lot of information for the patient to absorb, we also provide this information in writing and have the patient sign the document stating they understand what was explained to them, but they are not obligated to move forward with the treatment planWe also keep a copy of this form on file, for our own records(copy attached) The patient signed this document, which clearly states he needs a referral from his pcp-We never received a referral and patient did not return for treatment In May 2015, while conducting a periodic cleanup of past due accounts, we noticed this patient’s evaluation had not been paidAfter investigating further, we realized this was because we never received the referral and thus did not submit a claim-Realizing over a year had passed since his initial appointment; we decided to reduce the amount owed from $to $as a courtesy for not following up with him earlier.-We received an email from the patient on 6/21/stating, “I provided my insurance information at that time and I’m sure you submitted it and got paid” and “I’m sorry but I’m not paying this bill.” Weresponded by email that same day explaining that we never received his referral and did not get paid by his insurance, but that we had given him an almost 50% discount(email attached) We also followed up by mail, sending him a statement along with a copy of the original signed financial agreement that specified getting a referral(copy attached)After that, the only communication on this matter was when we received the document from Revdex.com informing us that the patient had filed a complaint
-Patient presented to our office 2/25/for a TMJ evaluationHe was told at this time (after we contacted insurance company) that his insurance plan requires a referral from his primary care physician for out of network care-Patient signed our standard financial agreement on his first visitOur customary routine for new patients is for the doctor to speak to the patient after the exam explaining his diagnosis and suggested treatment planAfter that, a member of the office staff goes over the financial aspects of the treatment plan discussing any deductibles, co-pays, prior authorizations or referrals required by the insurance carrierThis patient was told he needed to obtain a referral from his PCPUnderstanding that this is a lot of information for the patient to absorb, we also provide this information in writing and have the patient sign the document stating they understand what was explained to them, but they are not obligated to move forward with the treatment planWe also keep a copy of this form on file, for our own records(copy attached) The patient signed this document, which clearly states he needs a referral from his pcp-We never received a referral and patient did not return for treatment In May 2015, while conducting a periodic cleanup of past due accounts, we noticed this patient’s evaluation had not been paidAfter investigating further, we realized this was because we never received the referral and thus did not submit a claim-Realizing over a year had passed since his initial appointment; we decided to reduce the amount owed from $to $as a courtesy for not following up with him earlier.-We received an email from the patient on 6/21/stating, “I provided my insurance information at that time and I’m sure you submitted it and got paid” and “I’m sorry but I’m not paying this bill.” Weresponded by email that same day explaining that we never received his referral and did not get paid by his insurance, but that we had given him an almost 50% discount(email attached) We also followed up by mail, sending him a statement along with a copy of the original signed financial agreement that specified getting a referral(copy attached)After that, the only communication on this matter was when we received the document from Revdex.com informing us that the patient had filed a complaint