Hello Revdex.com,
I appreciate you contacting me regarding this complaintI am sorry that this issue has escalated to the point of needing assistance from the RevDex.com , however I welcome the assistance you may offerI run a small, private physical therapy practice with goals of
helping people healI am disturbed by the way this situation has evolved, however I, at no point, misrepresented myself to Ms*** or her father (the person who originally filed a complaint with you regarding this same situation).If I may give you some background on this situation: This is a medical billing problem with Ms***s' insurance planI run a small, private physical therapy clinic and *** *** was seen, by me, for physical therapy treatment of an injury between 7/17/and 9/3/We have all of our patients sign our financial policy before treatment, that states that they are ultimately responsible for payment of services rendered, regardless of insurance coverageMs*** signed this policy, at her first session, and I have attached it below. There has been discrepancies in Ms***s' insurance coverage for several of the dates of service for treatment provided to her. We accept many major insurance plans for coverage of services, and Ms*** had plans with two companies, a primary and a secondaryShe was not the policy holder on either; her primary insurance is her father's policy, and her secondary insurance is her mother's policyWe are in -network with the primary insurance company, but out of network with the secondary insuranceAnytime a patient has primary and secondary insurance coverage, the primary insurance plan must be billed first, then either paid or denied, then any outstanding costs can be billed to the secondary insurance.When we called to verify insurance benefits for both of Ms***s' plans, we were told that she had high deductibles, that had not been met, for both insurance policies; meaning that she would need to pay for some visits, until the deductible had been metWe billed the primary insurance company, then billed the secondary insurance company for all of her visitsOnce the primary insurance deductible had been met, they began covering her visits, however the first visits were not covered by the primary insurance. Her secondary insurance company, Sound Health and Wellness, does not do their own billing, they use another company to process their claims, AetnaWhen we bill for services, we bill directly to Aetna, then Aetna communicates to Sound Health about the claim, and Sound Health gives final word on if they will pay or if they deny the claimBased on Ms***s' plan, Sound Health and Wellness should not be responsible for payment, because the deductible had not been metHowever, Sound Health had made many mistakes and had poor communication with their billing service (Aetna), this may be the reason they decided to tell Ms*** hat they would cover the visits, they simply tell Ms*** that they have not received the EOB from the primary insurance company, thus the reason for the denial.Each time we billed services to Aetna, Sound Health denied the claims, stating that they had not received the Explanation of Benefits (EOB) from the primary insurance companyWe have sent the EOB from the primary insurance on every single attempt to recover paymentWhen we called Aetna to verify that they had received the EOB, they said that they hadThere was a constant miscommunication between Aetna and Sound Health, NOT between us and Aetna or us and Sound Health. We communicated this fact to Ms*** often, but she did not seem to want to believe us, because her insurance company, Sound Health, informs her that they had not received the EOB from the primary insurance companyI completely understand how confusing this is to Ms*** (and possibly to you as well), but we have tried to inform her of all of our communications with her insurance company.As it stands, we have been told by Sound Health, on several occasions that they have in fact received the EOB's in question and that we will receive payment within 7-business daysHowever, we eventually end up receiving a denial letter from them instead of paymentWe have documented our communication with Ms***s, her father, and both Aetna (billing company) and Sound Health and Wellness (policy holder), and I have attached them belowThere has been extensive communication, on a weekly basis, between us and the insurance companies, in order to receive payment.We have done everything in our power to resolve this matter without billing the patient, however, there is nothing we can do when the insurance policy has a deductible that has not been met, or if the insurance company is not processing their claims accuratelyWe have billed Sound Health and Wellness (through Aetna) multiple times, and received denials every time for various reasonsUnfortunately, not all insurance companies are created equal and that is why we ultimately have to hold the patients financially responsible for payment of services rendered
On November 13th, Sound Health promised payment within 7-business days (as they had an previous occasions)I communicated to Ms *** that Sound Health promised payment again, however that this would be the final attempt on our part to bill her secondary insurance, and if they denied the claims again, she would be responsible for paymentWell, Sound Health denied the claims the following week, and we tried for a week to collect payment from them, then informed Ms*** that she would be responsible for the balanceWe, in no way threatened Ms***s, we simply informed her that we would be implementing our financial policy, after months of denials from her insurance companyShe made payment for the two visits and we informed her that if her insurance company eventually came through with payment for the visits, that we would reimburse her the money she had paid
We received payment, from Sound Health, for one of the visits last week, and we reimbursed Ms*** for that amount, in less that hours.I appreciate your attention and assistance in resolving this complaintI apologize for utilizing your time and resources and if you need anything from me or my clinic, please do not hesitate to askWe would love to resolve this issueAttached are the notes on my office manager's phone conversations with the ***s' and the insurance companies, as well as ***'s signed financial policyI can also make available all of the email correspondence with myself or my office manager and The ***s's if needed
I would like to note some facts of this matter
Ms*** signed a financial agreement, that I would be paid for my services within days of providing itThis proves that she agreed to the terms of service, before receiving the service, and that she was aware that she was responsible for payment and that I never mis-represented myself to her
2. I provided a service to Ms***s, for physical therapy
I billed Ms***s, for claims denied by her primary AND secondary insurance companies, on her last visit (more than days after services provided), in the amount of $
She refused to pay for the services at that time
I re-billed her secondary insurance company several times, only to be denied each time
months after providing the service to Ms***s, and after being denied payment by both her primary and secondary insurance company several times, I billed the remaining balance to her, in the amount of $320.16; with the promise that if we ever received payment for these visits, I would reimburse the amount to herI had sent her an email, three weeks prior to billing her for the services, noting that we would be billing her for the services, if her insurance company denied the claims another time (after promising that they would pay)
Last week, we received payment for one of the visits, by her secondary insurance companyIn less than hours, I sent Ms*** a check of reimbursementYesterday, we received payment for the last visit, from her secondary insurance and I sent her a check of reimbursement
I never wanted to bill the patient for these services, but I deserve to be paid for my work and Ms*** signed an agreement that she would be accountable for payment within days of services renderedIf my goal had been to bill *** for services, I would have done it before each visit, avoiding this whole mess with the insurance companiesI would not wait months and call her insurance company 3-times a week trying to collect payment I fail to see how my many attempts to receive payment from Ms***s' insurance companies is an act of discrimination or bullying tacticsI provided a serviceMs*** was responsible for the reimbursement of that serviceI elicited standard billing practices to receive payment from her insurance companyThey refused to pay for months, and it was only when I billed the patient, that the insurance company finally paid for the servicesMs *** has received reimbursement for payment received both by her and her insurance company
Complaint: ***I am rejecting this response because:
I reject their response for multiple reasons: my father is not doing this on his own he is helping through this since this company uses bulling tactics to get paymentAs I stated before Ashley the owner and Maria has treated like a kid when she almost did not let me walk out of the office without initially paying $I had to call my father and pull him out of meetings at work to assist meSound health and wellness has always informed me that the reasons for denial is not the fault of me and had advised me not to pay since it was nothing they or myself could do it was all up to Ashley and MariaThey have told me that it will never be paid due to high deductible on primary insurance and that if they processed the claim for these dates: 7/20/2015, 7.17/2015, and 7/22/and they will count as more visits since I was only approved for and that would put me over, this was information another tactic for me to payI dd not pay at that timeThey processing these dates through my primary insurance additional times each with different amounts, the representative from Blue Cross and Blue Shield did not understand that and they informed that since I have insurances that they need to process all bills with a balance through the secondary insurance, and the extra count of the visits is and that would not happenThey would process the incorrect amounts, the wrong documents and call me telling me that sound health and wellness denial is because of the high decibel from my primary insuranceEach I call sound health and wellness they stated no claimed was received from *** *** **, another statement from themThis has went on back and forth way too long, and they demanded me to pay even after they were told by sound health and wellness the claim 7/17/would be paid, and again they demanded I make a payment within minutes or it will go to collections, and I did not make that payment since my and my father was online for about an hour with sound health and that time expired, but when the call was ended we had confirmation from them that they will make the payments ad advised me again not to pay them since it was not my fault and they were making paymentYes Sound health and wellness as well as other insurance companies have their claims processed by another partyI have never dealt with this before where a business puts so much stress on their patients and employ a manager that disrespects at the insurance company on the phone, Sound health and wellness stated Maria is very pushy and is difficult to deal with very aggressiveThe following Monday I received an email from Ashley stating I need to pay for this will go through collections and I will incur an additional $collection (this seems very excessive), even though they knew the payment was being processedI paid to avoid any damage to my credit report since I am and accountant holding a CPA license and can't afford any possible damage to my credit, I believe they used this against me to payyes I have receive a check from them for the 7/17/visit but not the 7/20/This is very frustrating and this company is very difficult to deal withThis is not the only practice I went to and I have never had any secondary billing issues at all from no one except themOne more thing even though I signed the patient responsibility form, they knew the payment was coming and employed collection tactics on meThis is not fair for a consumer to deal with these situations.Sincerely,*** ***
Revdex.com:I have reviewed the response made by the business in reference to complaint ID ***
Revdex.com:I have received my final payment from the businessI have had this insurance all my life and never had any problems like this, This is awful no one should have to fight a business that constantly make excusesThey have lost a client.
In response to the business,
1.I started my treatment on 7/17/and one question I have is why I never was notified that there a balance on my account for each visit until 9/3/it is bullying and intimidation when on 9/3/you tell me I need to put a credit card on file and talk condescending to me as if I was a kid, they presented me a bill of $for all the services of visits, I was never informed me my secondary insurance denied my claimI felt as if I couldn't leave the office so I called my father to get some advise and this where he stepped inNormally when a claim is denied I have to appeal the decision, this was not the case for these visits, they paid
Told me they filed a claim and when verified they did not have any claims of file for these dates 7/17/2015, 7/20/2015, and 7/22/I was told my the office manager that I they billed for they visits that it would count and extra visitsI called both blue cross and blue shield and sound health and both companies explained to me that this was not the case and was informationAt this time I felt I was getting the run around and realized they are not giving me correct information
Gave me minutes to pay or they will send it to collections and charge are $collection fee, threatening to damage my creditEven when they were told by my secondary insurance that they have to wait and claims will be processed as being paid and it takes weeks for the checks to be processed
Constantly sending in the wrong information and to the wrong address
Tried to make me believe that my secondary insurance will never pay, I never received a denial of benefits from them not wanting to pay, but for the provider not sending in the explanation of benefits, This is the sole responsibility of the provider to send those documents in, granted they accepted an explanation of benefits from me for 7/20/to see if they was something wrong on their end and the claim was processed and paid with no delay
My final payment obligation was $not $from their first initial bill.
7.I had to have my father take time away from his business and call the insurance company with me on the phone to figure out what my options were and I was always advised by sound health and wellness not to pay (this is recorded on their record that these claims is denial not because a fault of myself it was because the business kept re billing my primary insurance different times with different amounts(primary insurance could not explain why but stated that was unusual).
There was too many inconsistent statements from the owner and manager, I felt I was up against the wall and mail a check out cover because of the threats.
Here is a piece of advise to the business next time inform the patient on their next visit that they have a balance, I was told on my 2nd visit and not the 10th I would've stopped going until this was resolved, which led me to believe they wanted to get all they can get and waited until my treatment was completedTo collect moneyPut your customer firstYou put a great deal of stress on me by threatening to damage someone's credit when you know it is not their fault.
I just want the public to beware of these situations I had to deal with.Sincerely, *** ***s
Sincerely, *** ***
Hello Revdex.com,
I appreciate you contacting me regarding this complaintI am sorry that this issue has escalated to the point of needing assistance from the RevDex.com , however I welcome the assistance you may offerI run a small, private physical therapy practice with goals of
helping people healI am disturbed by the way this situation has evolved, however I, at no point, misrepresented myself to Ms*** or her father (the person who originally filed a complaint with you regarding this same situation).If I may give you some background on this situation: This is a medical billing problem with Ms***s' insurance planI run a small, private physical therapy clinic and *** *** was seen, by me, for physical therapy treatment of an injury between 7/17/and 9/3/We have all of our patients sign our financial policy before treatment, that states that they are ultimately responsible for payment of services rendered, regardless of insurance coverageMs*** signed this policy, at her first session, and I have attached it below. There has been discrepancies in Ms***s' insurance coverage for several of the dates of service for treatment provided to her. We accept many major insurance plans for coverage of services, and Ms*** had plans with two companies, a primary and a secondaryShe was not the policy holder on either; her primary insurance is her father's policy, and her secondary insurance is her mother's policyWe are in -network with the primary insurance company, but out of network with the secondary insuranceAnytime a patient has primary and secondary insurance coverage, the primary insurance plan must be billed first, then either paid or denied, then any outstanding costs can be billed to the secondary insurance.When we called to verify insurance benefits for both of Ms***s' plans, we were told that she had high deductibles, that had not been met, for both insurance policies; meaning that she would need to pay for some visits, until the deductible had been metWe billed the primary insurance company, then billed the secondary insurance company for all of her visitsOnce the primary insurance deductible had been met, they began covering her visits, however the first visits were not covered by the primary insurance. Her secondary insurance company, Sound Health and Wellness, does not do their own billing, they use another company to process their claims, AetnaWhen we bill for services, we bill directly to Aetna, then Aetna communicates to Sound Health about the claim, and Sound Health gives final word on if they will pay or if they deny the claimBased on Ms***s' plan, Sound Health and Wellness should not be responsible for payment, because the deductible had not been metHowever, Sound Health had made many mistakes and had poor communication with their billing service (Aetna), this may be the reason they decided to tell Ms*** hat they would cover the visits, they simply tell Ms*** that they have not received the EOB from the primary insurance company, thus the reason for the denial.Each time we billed services to Aetna, Sound Health denied the claims, stating that they had not received the Explanation of Benefits (EOB) from the primary insurance companyWe have sent the EOB from the primary insurance on every single attempt to recover paymentWhen we called Aetna to verify that they had received the EOB, they said that they hadThere was a constant miscommunication between Aetna and Sound Health, NOT between us and Aetna or us and Sound Health. We communicated this fact to Ms*** often, but she did not seem to want to believe us, because her insurance company, Sound Health, informs her that they had not received the EOB from the primary insurance companyI completely understand how confusing this is to Ms*** (and possibly to you as well), but we have tried to inform her of all of our communications with her insurance company.As it stands, we have been told by Sound Health, on several occasions that they have in fact received the EOB's in question and that we will receive payment within 7-business daysHowever, we eventually end up receiving a denial letter from them instead of paymentWe have documented our communication with Ms***s, her father, and both Aetna (billing company) and Sound Health and Wellness (policy holder), and I have attached them belowThere has been extensive communication, on a weekly basis, between us and the insurance companies, in order to receive payment.We have done everything in our power to resolve this matter without billing the patient, however, there is nothing we can do when the insurance policy has a deductible that has not been met, or if the insurance company is not processing their claims accuratelyWe have billed Sound Health and Wellness (through Aetna) multiple times, and received denials every time for various reasonsUnfortunately, not all insurance companies are created equal and that is why we ultimately have to hold the patients financially responsible for payment of services rendered
On November 13th, Sound Health promised payment within 7-business days (as they had an previous occasions)I communicated to Ms *** that Sound Health promised payment again, however that this would be the final attempt on our part to bill her secondary insurance, and if they denied the claims again, she would be responsible for paymentWell, Sound Health denied the claims the following week, and we tried for a week to collect payment from them, then informed Ms*** that she would be responsible for the balanceWe, in no way threatened Ms***s, we simply informed her that we would be implementing our financial policy, after months of denials from her insurance companyShe made payment for the two visits and we informed her that if her insurance company eventually came through with payment for the visits, that we would reimburse her the money she had paid
We received payment, from Sound Health, for one of the visits last week, and we reimbursed Ms*** for that amount, in less that hours.I appreciate your attention and assistance in resolving this complaintI apologize for utilizing your time and resources and if you need anything from me or my clinic, please do not hesitate to askWe would love to resolve this issueAttached are the notes on my office manager's phone conversations with the ***s' and the insurance companies, as well as ***'s signed financial policyI can also make available all of the email correspondence with myself or my office manager and The ***s's if needed
I would like to note some facts of this matter
Ms*** signed a financial agreement, that I would be paid for my services within days of providing itThis proves that she agreed to the terms of service, before receiving the service, and that she was aware that she was responsible for payment and that I never mis-represented myself to her
2. I provided a service to Ms***s, for physical therapy
I billed Ms***s, for claims denied by her primary AND secondary insurance companies, on her last visit (more than days after services provided), in the amount of $
She refused to pay for the services at that time
I re-billed her secondary insurance company several times, only to be denied each time
months after providing the service to Ms***s, and after being denied payment by both her primary and secondary insurance company several times, I billed the remaining balance to her, in the amount of $320.16; with the promise that if we ever received payment for these visits, I would reimburse the amount to herI had sent her an email, three weeks prior to billing her for the services, noting that we would be billing her for the services, if her insurance company denied the claims another time (after promising that they would pay)
Last week, we received payment for one of the visits, by her secondary insurance companyIn less than hours, I sent Ms*** a check of reimbursementYesterday, we received payment for the last visit, from her secondary insurance and I sent her a check of reimbursement
I never wanted to bill the patient for these services, but I deserve to be paid for my work and Ms*** signed an agreement that she would be accountable for payment within days of services renderedIf my goal had been to bill *** for services, I would have done it before each visit, avoiding this whole mess with the insurance companiesI would not wait months and call her insurance company 3-times a week trying to collect payment I fail to see how my many attempts to receive payment from Ms***s' insurance companies is an act of discrimination or bullying tacticsI provided a serviceMs*** was responsible for the reimbursement of that serviceI elicited standard billing practices to receive payment from her insurance companyThey refused to pay for months, and it was only when I billed the patient, that the insurance company finally paid for the servicesMs *** has received reimbursement for payment received both by her and her insurance company
Complaint: ***I am rejecting this response because:
I reject their response for multiple reasons: my father is not doing this on his own he is helping through this since this company uses bulling tactics to get paymentAs I stated before Ashley the owner and Maria has treated like a kid when she almost did not let me walk out of the office without initially paying $I had to call my father and pull him out of meetings at work to assist meSound health and wellness has always informed me that the reasons for denial is not the fault of me and had advised me not to pay since it was nothing they or myself could do it was all up to Ashley and MariaThey have told me that it will never be paid due to high deductible on primary insurance and that if they processed the claim for these dates: 7/20/2015, 7.17/2015, and 7/22/and they will count as more visits since I was only approved for and that would put me over, this was information another tactic for me to payI dd not pay at that timeThey processing these dates through my primary insurance additional times each with different amounts, the representative from Blue Cross and Blue Shield did not understand that and they informed that since I have insurances that they need to process all bills with a balance through the secondary insurance, and the extra count of the visits is and that would not happenThey would process the incorrect amounts, the wrong documents and call me telling me that sound health and wellness denial is because of the high decibel from my primary insuranceEach I call sound health and wellness they stated no claimed was received from *** *** **, another statement from themThis has went on back and forth way too long, and they demanded me to pay even after they were told by sound health and wellness the claim 7/17/would be paid, and again they demanded I make a payment within minutes or it will go to collections, and I did not make that payment since my and my father was online for about an hour with sound health and that time expired, but when the call was ended we had confirmation from them that they will make the payments ad advised me again not to pay them since it was not my fault and they were making paymentYes Sound health and wellness as well as other insurance companies have their claims processed by another partyI have never dealt with this before where a business puts so much stress on their patients and employ a manager that disrespects at the insurance company on the phone, Sound health and wellness stated Maria is very pushy and is difficult to deal with very aggressiveThe following Monday I received an email from Ashley stating I need to pay for this will go through collections and I will incur an additional $collection (this seems very excessive), even though they knew the payment was being processedI paid to avoid any damage to my credit report since I am and accountant holding a CPA license and can't afford any possible damage to my credit, I believe they used this against me to payyes I have receive a check from them for the 7/17/visit but not the 7/20/This is very frustrating and this company is very difficult to deal withThis is not the only practice I went to and I have never had any secondary billing issues at all from no one except themOne more thing even though I signed the patient responsibility form, they knew the payment was coming and employed collection tactics on meThis is not fair for a consumer to deal with these situations.Sincerely,*** ***
Revdex.com:I have reviewed the response made by the business in reference to complaint ID ***
Revdex.com:I have received my final payment from the businessI have had this insurance all my life and never had any problems like this, This is awful no one should have to fight a business that constantly make excusesThey have lost a client.
In response to the business,
1.I started my treatment on 7/17/and one question I have is why I never was notified that there a balance on my account for each visit until 9/3/it is bullying and intimidation when on 9/3/you tell me I need to put a credit card on file and talk condescending to me as if I was a kid, they presented me a bill of $for all the services of visits, I was never informed me my secondary insurance denied my claimI felt as if I couldn't leave the office so I called my father to get some advise and this where he stepped inNormally when a claim is denied I have to appeal the decision, this was not the case for these visits, they paid
Told me they filed a claim and when verified they did not have any claims of file for these dates 7/17/2015, 7/20/2015, and 7/22/I was told my the office manager that I they billed for they visits that it would count and extra visitsI called both blue cross and blue shield and sound health and both companies explained to me that this was not the case and was informationAt this time I felt I was getting the run around and realized they are not giving me correct information
Gave me minutes to pay or they will send it to collections and charge are $collection fee, threatening to damage my creditEven when they were told by my secondary insurance that they have to wait and claims will be processed as being paid and it takes weeks for the checks to be processed
Constantly sending in the wrong information and to the wrong address
Tried to make me believe that my secondary insurance will never pay, I never received a denial of benefits from them not wanting to pay, but for the provider not sending in the explanation of benefits, This is the sole responsibility of the provider to send those documents in, granted they accepted an explanation of benefits from me for 7/20/to see if they was something wrong on their end and the claim was processed and paid with no delay
My final payment obligation was $not $from their first initial bill.
7.I had to have my father take time away from his business and call the insurance company with me on the phone to figure out what my options were and I was always advised by sound health and wellness not to pay (this is recorded on their record that these claims is denial not because a fault of myself it was because the business kept re billing my primary insurance different times with different amounts(primary insurance could not explain why but stated that was unusual).
There was too many inconsistent statements from the owner and manager, I felt I was up against the wall and mail a check out cover because of the threats.
Here is a piece of advise to the business next time inform the patient on their next visit that they have a balance, I was told on my 2nd visit and not the 10th I would've stopped going until this was resolved, which led me to believe they wanted to get all they can get and waited until my treatment was completedTo collect moneyPut your customer firstYou put a great deal of stress on me by threatening to damage someone's credit when you know it is not their fault.
I just want the public to beware of these situations I had to deal with.Sincerely, *** ***s
Sincerely, *** ***