Revdex.com:I have reviewed the response made by the business in reference to complaint ID [redacted].
Revdex.com:I have received my final payment from the business. I 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 excuses. They have lost a client.
In response to the business,
1.I started my treatment on 7/17/2015 and one question I have is why I never was notified that there a balance on my account for each visit until 9/3/2015. it is bullying and intimidation when on 9/3/2015 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 $551 for all the services of 10 visits, I was never informed me my secondary insurance denied my claim. I felt as if I couldn't leave the office so I called my father to get some advise and this where he stepped in. Normally when a claim is denied I have to appeal the decision, this was not the case for these visits, they paid
2. 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 7/22/2015. I was told my the office manager that I they billed for they 3 visits that it would count and 3 extra visits. I called both blue cross and blue shield and sound health and both companies explained to me that this was not the case and was false information. At this time I felt I was getting the run around and realized they are not giving me correct information.
3. Gave me 30 minutes to pay or they will send it to collections and charge are $100 collection fee, threatening to damage my credit. Even when they were told by my secondary insurance that they have to wait and claims will be processed as being paid and it takes 2 weeks for the checks to be processed.
4. Constantly sending in the wrong information and to the wrong address.
5. 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 7/20/2015 to see if they was something wrong on their end and the claim was processed and paid with no delay.
6. My final payment obligation was $320 not $551 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 3 different times with different amounts(primary insurance could not explain why but stated that was unusual).
8. 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 completed. To collect money. Put your customer first. You 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, [redacted]s
Sincerely, [redacted]
Hello Revdex.com,
I appreciate you contacting me regarding this complaint. I am sorry that this issue has escalated to the point of needing assistance from the Revdex.com , however I welcome the assistance you may offer. I run a small, private physical therapy practice with goals of...
helping people heal. I am disturbed by the way this situation has evolved, however I, at no point, misrepresented myself to Ms. [redacted] 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. [redacted]s' insurance plan. I run a small, private physical therapy clinic and [redacted] was seen, by me, for physical therapy treatment of an injury between 7/17/15 and 9/3/15. 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 coverage. Ms. [redacted] signed this policy, at her first session, and I have attached it below. There has been discrepancies in Ms. [redacted]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. [redacted] had plans with two companies, a primary and a secondary. She was not the policy holder on either; her primary insurance is her father's policy, and her secondary insurance is her mother's policy. We are in -network with the primary insurance company, but out of network with the secondary insurance. Anytime 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. [redacted]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 met. We billed the primary insurance company, then billed the secondary insurance company for all of her visits. Once the primary insurance deductible had been met, they began covering her visits, however the first 2 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, Aetna. When 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 claim. Based on Ms. [redacted]s' plan, Sound Health and Wellness should not be responsible for payment, because the deductible had not been met. However, 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. [redacted] hat they would cover the visits, they simply tell Ms. [redacted] 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 company. We have sent the EOB from the primary insurance on every single attempt to recover payment. When we called Aetna to verify that they had received the EOB, they said that they had. There 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. [redacted] 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 company. I completely understand how confusing this is to Ms. [redacted] (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 7-10 business days. However, we eventually end up receiving a denial letter from them instead of payment. We have documented our communication with Ms. [redacted]s, her father, and both Aetna (billing company) and Sound Health and Wellness (policy holder), and I have attached them below. There 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 accurately. We have billed Sound Health and Wellness (through Aetna) multiple times, and received denials every time for various reasons. Unfortunately, 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 7-10 business days (as they had an 3 previous occasions). I communicated to Ms [redacted] 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 payment. Well, Sound Health denied the claims the following week, and we tried for a week to collect payment from them, then informed Ms. [redacted] that she would be responsible for the balance. We, in no way threatened Ms. [redacted]s, we simply informed her that we would be implementing our financial policy, after 4 months of denials from her insurance company. She 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. [redacted] for that amount, in less that 24 hours.I appreciate your attention and assistance in resolving this complaint. I apologize for utilizing your time and resources and if you need anything from me or my clinic, please do not hesitate to ask. We would love to resolve this issue. Attached are the notes on my office manager's phone conversations with the [redacted]s' and the insurance companies, as well as [redacted]'s signed financial policy. I can also make available all of the email correspondence with myself or my office manager and The [redacted]s's if needed.
Revdex.com:I have reviewed the response made by the business in reference to complaint ID [redacted].
Revdex.com:I have received my final payment from the business. I 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 excuses. They have lost a client.
In response to the business,
1.I started my treatment on 7/17/2015 and one question I have is why I never was notified that there a balance on my account for each visit until 9/3/2015. it is bullying and intimidation when on 9/3/2015 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 $551 for all the services of 10 visits, I was never informed me my secondary insurance denied my claim. I felt as if I couldn't leave the office so I called my father to get some advise and this where he stepped in. Normally when a claim is denied I have to appeal the decision, this was not the case for these visits, they paid
2. 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 7/22/2015. I was told my the office manager that I they billed for they 3 visits that it would count and 3 extra visits. I called both blue cross and blue shield and sound health and both companies explained to me that this was not the case and was false information. At this time I felt I was getting the run around and realized they are not giving me correct information.
3. Gave me 30 minutes to pay or they will send it to collections and charge are $100 collection fee, threatening to damage my credit. Even when they were told by my secondary insurance that they have to wait and claims will be processed as being paid and it takes 2 weeks for the checks to be processed.
4. Constantly sending in the wrong information and to the wrong address.
5. 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 7/20/2015 to see if they was something wrong on their end and the claim was processed and paid with no delay.
6. My final payment obligation was $320 not $551 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 3 different times with different amounts(primary insurance could not explain why but stated that was unusual).
8. 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 completed. To collect money. Put your customer first. You 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, [redacted]s
Sincerely, [redacted]
Hello Revdex.com,
I appreciate you contacting me regarding this complaint. I am sorry that this issue has escalated to the point of needing assistance from the Revdex.com , however I welcome the assistance you may offer. I run a small, private physical therapy practice with goals of...
helping people heal. I am disturbed by the way this situation has evolved, however I, at no point, misrepresented myself to Ms. [redacted] 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. [redacted]s' insurance plan. I run a small, private physical therapy clinic and [redacted] was seen, by me, for physical therapy treatment of an injury between 7/17/15 and 9/3/15. 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 coverage. Ms. [redacted] signed this policy, at her first session, and I have attached it below. There has been discrepancies in Ms. [redacted]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. [redacted] had plans with two companies, a primary and a secondary. She was not the policy holder on either; her primary insurance is her father's policy, and her secondary insurance is her mother's policy. We are in -network with the primary insurance company, but out of network with the secondary insurance. Anytime 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. [redacted]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 met. We billed the primary insurance company, then billed the secondary insurance company for all of her visits. Once the primary insurance deductible had been met, they began covering her visits, however the first 2 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, Aetna. When 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 claim. Based on Ms. [redacted]s' plan, Sound Health and Wellness should not be responsible for payment, because the deductible had not been met. However, 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. [redacted] hat they would cover the visits, they simply tell Ms. [redacted] 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 company. We have sent the EOB from the primary insurance on every single attempt to recover payment. When we called Aetna to verify that they had received the EOB, they said that they had. There 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. [redacted] 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 company. I completely understand how confusing this is to Ms. [redacted] (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 7-10 business days. However, we eventually end up receiving a denial letter from them instead of payment. We have documented our communication with Ms. [redacted]s, her father, and both Aetna (billing company) and Sound Health and Wellness (policy holder), and I have attached them below. There 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 accurately. We have billed Sound Health and Wellness (through Aetna) multiple times, and received denials every time for various reasons. Unfortunately, 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 7-10 business days (as they had an 3 previous occasions). I communicated to Ms [redacted] 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 payment. Well, Sound Health denied the claims the following week, and we tried for a week to collect payment from them, then informed Ms. [redacted] that she would be responsible for the balance. We, in no way threatened Ms. [redacted]s, we simply informed her that we would be implementing our financial policy, after 4 months of denials from her insurance company. She 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. [redacted] for that amount, in less that 24 hours.I appreciate your attention and assistance in resolving this complaint. I apologize for utilizing your time and resources and if you need anything from me or my clinic, please do not hesitate to ask. We would love to resolve this issue. Attached are the notes on my office manager's phone conversations with the [redacted]s' and the insurance companies, as well as [redacted]'s signed financial policy. I can also make available all of the email correspondence with myself or my office manager and The [redacted]s's if needed.