Shasta Eye Medical Group

Response: I am in receipt of the complaint filed by patient “**” disputing the charges for services rendered recently by Dr***As I understand it, this patient was under the impression that treatment for the condition could be rendered that very day and was unhappy Dr [redacted] referred the patient to another specialistBecause of this perception the patient feels the charges are unethicalThis patient was originally seen by an optometrist who suspected a certain diagnosisOptometrist’s are not medical doctors and do not treat the condition this patient was suspected of havingThis patient was correct in that Dr [redacted] confirmed the optometrist’s suspicion; however, it was Dr***’s medical opinion that the patient should wait hours for blood to settle before commencing treatmentBecause Dr [redacted] was scheduled to leave the state for a conference within that time frame, the patient was referred to another medical doctor who specialized in the field that would be most appropriate for this patientAccording to [redacted] , a level new patient office visit must include elements: Medical history which includes a review of systems, past medical history, medications and family medical history; an examination which may or may not include diagnostic tests; and moderately complex decision making by the physicianAll of these elements were metThe medical history was taken and recorded by a medical assistant and confirmed by the physicianA diagnostic procedure was performed by a technician, an exam was performed by the physician, records were reviewed by the physician and discussed with the patient and a decision was made as to the next step in the patient’s careA significant component of the exam, the complexity of the decision making, requires the expertise of a specialistThe amount of time the doctor spends in direct contact with a patient is not necessarily a component in determining the level of service to be chargedBecause this office is contracted with this patient’s insurance companies, the patient is only responsible for that which the insurance company allowsThe insurance company sets the fee schedule, the physician does notIn this patient’s case the charge for the level visit was $175.00, the insurance allowed $The charge for the diagnostic test performed was $75.00, insurance allowed around $Had this patient met the annual deductible, the patient responsibility would have been about $Unfortunately, the deductible had not been met, placing responsibility for the entire amount on the patientThe services for which this patient was billed were performed according to our contractual agreement with the insurance companiesThe charges will not be reversedIn addition, due to our contractual agreement with the insurance companies, we cannot write off the balance owedSincerely, [redacted]

Response:I am in receipt of the complaint filed by patient “**” disputing the charges for services rendered recently by Dr***As I understand it, this patient was under the impression that treatment for the condition could be rendered that very day and was unhappy Dr*** referred the patient
to another specialistBecause of this perception the patient feels the charges are unethicalThis patient was originally seen by an optometrist who suspected a certain diagnosisOptometrist’s are not medical doctors and do not treat the condition this patient was suspected of havingThis patient was correct in that Dr*** confirmed the optometrist’s suspicion; however, it was Dr***’s medical opinion that the patient should wait hours for blood to settle before commencing treatmentBecause Dr*** was scheduled to leave the state for a conference within that time frame, the patient was referred to another medical doctor who specialized in the field that would be most appropriate for this patientAccording to *** *** ***, a level new patient office visit must include elements: Medical history which includes a review of systems, past medical history, medications and family medical history; an examination which may or may not include diagnostic tests; and moderately complex decision making by the physicianAll of these elements were metThe medical history was taken and recorded by a medical assistant and confirmed by the physicianA diagnostic procedure was performed by a technician, an exam was performed by the physician, records were reviewed by the physician and discussed with the patient and a decision was made as to the next step in the patient’s careA significant component of the exam, the complexity of the decision making, requires the expertise of a specialistThe amount of time the doctor spends in direct contact with a patient is not necessarily a component in determining the level of service to be chargedBecause this office is contracted with this patient’s insurance companies, the patient is only responsible for that which the insurance company allowsThe insurance company sets the fee schedule, the physician does notIn this patient’s case the charge for the level visit was $175.00, the insurance allowed $The charge for the diagnostic test performed was $75.00, insurance allowed around $Had this patient met the annual deductible, the patient responsibility would have been about $Unfortunately, the deductible had not been met, placing responsibility for the entire amount on the patientThe services for which this patient was billed were performed according to our contractual agreement with the insurance companiesThe charges will not be reversedIn addition, due to our contractual agreement with the insurance companies, we cannot write off the balance owedSincerely, *** *** *** ***

Response:
I am in receipt of the complaint filed by patient “**” disputing the charges for services rendered recently by Dr. [redacted]. As I understand it,...

this patient was under the impression that treatment for the condition could be rendered that very day and was unhappy Dr. [redacted] referred the patient to another specialist. Because of this perception the patient feels the charges are unethical. This patient was originally seen by an optometrist who suspected a certain diagnosis. Optometrist’s are not medical doctors and do not treat the condition this patient was suspected of having. This patient was correct in that Dr. [redacted] confirmed the optometrist’s suspicion; however, it was Dr. [redacted]’s medical opinion that the patient should wait 48 hours for blood to settle before commencing treatment. Because Dr. [redacted] was scheduled to leave the state for a conference within that time frame, the patient was referred to another medical doctor who specialized in the field that would be most appropriate for this patient. According to [redacted], a level 4 new patient office visit must include 3 elements: Medical history which includes a review of systems, past medical history, medications and family medical history; an examination which may or may not include diagnostic tests; and moderately complex decision making by the physician. All of these elements were met. The medical history was taken and recorded by a medical assistant and confirmed by the physician. A diagnostic procedure was performed by a technician, an exam was performed by the physician, records were reviewed by the physician and discussed with the patient and a decision was made as to the next step in the patient’s care. A significant component of the exam, the complexity of the decision making, requires the expertise of a specialist. The amount of time the doctor spends in direct contact with a patient is not necessarily a component in determining the level of service to be charged. Because this office is contracted with this patient’s insurance companies, the patient is only responsible for that which the insurance company allows. The insurance company sets the fee schedule, the physician does not. In this patient’s case the charge for the level 4 visit was $175.00, the insurance allowed $171. The charge for the diagnostic test performed was $75.00, insurance allowed around $25.00. Had this patient met the annual deductible, the patient responsibility would have been about $40.00. Unfortunately, the deductible had not been met, placing responsibility for the entire amount on the patient. The services for which this patient was billed were performed according to our contractual agreement with the insurance companies. The charges will not be reversed. In addition, due to our contractual agreement with the insurance companies, we cannot write off the balance owed. Sincerely, [redacted]