Sheepscot Eye Associates

Revdex.com reference to complaint # [redacted] .I have discussed the matter on the phone with the businessthe business asked us to contact [redacted] and discover why, when the business submitted to [redacted] the bill for payment, it was was rejectedI contacted [redacted] ***It appears there was a lapse in our coverage but it was reinstated retroactive to the dates on the bill from the business [redacted] believes that we should be covered for part or all of the charges in dispute [redacted] asked us to request that the business resubmit the entire bill for reimbursementI have requested, by fax on dec 5th, that the business resubmit to [redacted] for payment, but have not heard back yet of any resultsI suggest giving weeks further to discover if partial coverage is availablegiven the holidays approaching we hope there are no delays in this process Regards, [redacted]

I have reviewed the complaint by [redacted] and found it to be baseless and containing numerous errorsFirstly because of HIPPA laws I can only address those issues she has released to you in her complaintAny additional information is privileged and cannot be released by me without the written permissionSecond, I have expertise in the area of coding and Billing and HIPPAA laws etc after having served on : [redacted] Third Party Chairman for the [redacted] Third Party Executive Committee to the [redacted] And have lectured on Billing and Coding [redacted] rule and reregulation and HIPPAI also currently serve as Education Chairman and member of the [redacted] in OptometryAs such everything we attempt to do is in accordance with the billing rules and regulation for [redacted] and amended as necessary by individual carriersSo, to address the issues: The patient was seen on 4/1/as a new patient comprehensive exam (***) The patient was billed for the two components of a comprehensive exam as per [redacted] [redacted] Medical Com Exam NP $ [redacted] Refraction $Total $The patient presented as [redacted] patient and the claim was filed several times with [redacted] and denied each time as they stated the patient was not eligible for those services at the time of the visitIt is the patient's insurance and [redacted] cannot tell us why she was not eligible for those services at the time of the visitIt is the patient's insurance and [redacted] cannot tell us why she was not eligibleIt is her responsibility to contact them and see if she can clear up the issueSince the claim was denied, the charges became the patient’s responsibility to pay and she was thusly bill appropriatelyIf she can clear up the matter with [redacted] ***, we will happily submit another claim to them if they don’t pay she will be billed againOn 4/1/she elected to purchase single vision distance glasses from the prescription I had provided her which was for bifocals [redacted] Frame $[redacted] Single Vision Lenses $98.00Total $213.00Our office policy is that at least 50% of the balance due on glasses is due before the glasses are ordered and the balance is due when they pick on the glassesIt appears that my staff allowed her to up a payment plan with monthly payments dueAccording to the copy of the statement she provided you, she paid the $co-pay on 4/1/and $on 8/19/for a total of $during the month periodOn 10/21/2015, she returned stating that she was uncomfortable reading with the glasses but her distance vision was fineI realized she had not gotten the bifocal glasses and demonstrated with trial lenses that she need to have bifocals and or progressives to see to read for close workI mentioned to her that we would redo the lenses and subtract the cost of the single vision lenses for the price of whatever she decided to obtainShe went out to my staff who discussed lens options with herSo, for 10/21/2015, no charges were made for the visit with meShe was charged for: [redacted] progressive lenses $360.00-= $So to the errors in her complaint 1-The claim was filed numerous times with [redacted] and denied for eligibilityAs such patient responsibility to contact [redacted] and or pay the bill2-No charges applied to her account for the visit on 10/21/She was never billed for a second exam3-She was not sold two pair of glasses, we replaced single vision lenses with more expensive progressive and charged her the difference4-No error was made on my partIt was her decision not to fill the original prescription as a multi focal was not my decisionWe will not accept $or the return of the glassesShe had the glasses for months before she contacted us and has not met the terms of her payment agreementWe acted in good faith and appropriately in all aspectsEven to the extent of my staff granting her a payment plan which I did not approveSituations like this are unfortunate but do occur and we are happy to work with her to meet her needs

I am in receipt of your letter which included comments from [redacted] , husband of the complaint, [redacted] He provided you with a brief and partial synopsis of your conversation which I believe occurred on 12/4/after I had forwarded a copy of my response to you to his wifeI would to expand his synopsis to include more of the discussionHe called me when I was out of the office at lunchI returned his call and began the discussion by offering me an apology in writing if I wished and stated that everything that I had written to the Revdex.com was accurate and correctThat said, I was happy to accept his apology and did discuss with him all the issues raised in her complaintThe insurance problems and his wife's problems with her glassesI asked him to contact [redacted] about the eligibility issues which he did later that dayWe have resubmitted the claim, and we are awaiting a response from the state in order to address the issues again if it remains unresolvedRegarding the glasses, we did leave that open for future resolution since I had made several suggestions to him that I hope she would respond toHe stated she was having problems with the progressiveI suggested that it could be adaptive and that some people do have problems with adjusting to progressives and that we and our labs have policies in place to help non adaptorsI suggested that she return, we discuss her problem with the pro's and see if they can be resolvedwe discussed the difference in price and I offered to attempt to reach a mutually acceptable agreement on priceThe complainant has not returned as yet and since that conversation, we have not received any payments as per the payment agreement of 5/I intend to wait until we hear from [redacted] regarding the exam fee and will be sending a statement to them as soon as we hear from the state of Maine requesting some form of good faith payment and the wife agreement to return for a discussionFailing that will assume a bad faith agreement and will take such actions as necessary to collect the debt

I am in receipt of your letter which included comments from [redacted], husband of the complaint, [redacted]. He provided you with a brief and partial synopsis of your conversation which I believe occurred on 12/4/2015 after I had forwarded a copy of my response to you to his wife. I would to expand his synopsis to include more of the discussion. He called me when I was out of the office at lunch. I returned his call and began the discussion by offering me an apology in writing if I wished and stated that everything that I had written to the Revdex.com was accurate and correct. That said, I was happy to accept his apology and did discuss with him all the issues raised in her complaint. The insurance problems and his wife's problems with her glasses. I asked him to contact [redacted] about the eligibility issues which he did later that day. We have resubmitted the claim, and we are awaiting a response from the state in order to address the issues again if it remains unresolved. Regarding the glasses, we did leave that open for future resolution since I had made several suggestions to him that I hope she would respond to. He stated she was having problems with the progressive. I suggested that it could be adaptive and that some people do have problems with adjusting to progressives and that we and our labs have policies in place to help non adaptors. I suggested that she return, we discuss her problem with the pro's and see if they can be resolved. we discussed the difference in price and I offered to attempt to reach a mutually acceptable agreement on price. The complainant has not returned as yet and since that conversation, we have not received any payments as per the payment agreement of 5/2015. I intend to wait until we hear from [redacted] regarding the exam fee and will be sending a statement to them as soon as we hear from the state of Maine requesting some form of good faith payment and the wife agreement to return for a discussion. Failing that will assume a bad faith agreement and will take such actions as necessary to collect the debt.

Revdex.com
reference to complaint # [redacted].I have discussed the matter on the phone with the business. the business asked us to contact [redacted] and discover why, when the business submitted to [redacted] the bill for payment, it was was rejected. I contacted [redacted]. It appears there was a lapse in our coverage but it was reinstated retroactive to the dates on the bill from the business. [redacted] believes that we should be covered for part or all of the charges in dispute. [redacted] asked us to request that the business resubmit the entire bill for reimbursement. I have requested, by fax on dec 5th, that the business resubmit to [redacted] for payment, but have not heard back yet of any results. I suggest giving 2 weeks further to discover if partial coverage is available. given the holidays approaching we hope there are no delays in this process. 
Regards,
[redacted]

I have reviewed the complaint by [redacted] and found it to be baseless and containing numerous errors. Firstly because of HIPPA laws I can only address those issues she has released to you in her complaint. Any additional information is privileged and cannot be released by me without the...

written permission. Second, I have expertise in the area of coding and Billing and HIPPAA laws etc after having served on : [redacted] Third Party Chairman for the [redacted] Third Party Executive Committee to the [redacted]. And have lectured on Billing and Coding. [redacted] rule and reregulation and HIPPA. I also currently serve as Education Chairman and member of the [redacted] in Optometry. As such everything we attempt to do is in accordance with the billing rules and regulation for [redacted] and amended as necessary by individual carriers. So, to address the issues: The patient was seen on 4/1/2015 as a new patient comprehensive exam ([redacted]) The patient was billed for the two components of a comprehensive exam as per [redacted]. [redacted] Medical Com Exam NP $155.00  [redacted] Refraction $35.00 Total $190.00. The patient presented as  [redacted] patient and the claim was filed several times with [redacted] and denied each time as they stated the patient was not eligible for those services at the time of the visit. It is the patient's insurance and [redacted] cannot tell us why she was not eligible for those services at the time of the visit. It is the patient's insurance and [redacted] cannot tell us why she was not eligible. It is her responsibility to contact them and see if she can clear up the issue. Since the claim was denied, the charges became the patient’s responsibility to pay and she was thusly bill appropriately. If she can clear up the matter with [redacted], we will happily submit another claim to them if they don’t pay she will be billed again. On 4/1/2014 she elected to purchase single vision distance glasses from the prescription I had provided her which was for bifocals. [redacted] Frame $115.00[redacted] Single Vision Lenses $98.00Total $213.00Our office policy is that at least 50% of the balance due on glasses is due before the glasses are ordered and the balance is due when they pick on the glasses. It appears that my staff allowed her to up a payment plan with monthly payments due. According to the copy of the statement she provided you, she paid the $3.00 co-pay on 4/1/2015 and $20.00 on 8/19/2015 for a total of $23.00 during the 5 month period. On 10/21/2015, she returned stating that she was uncomfortable reading with the glasses but her distance vision was fine. I realized she had not gotten the bifocal glasses and demonstrated with trial lenses that she need to have bifocals and or progressives to see to read for close work. I mentioned to her that we would redo the lenses and subtract the cost of the single vision lenses for the price of whatever she decided to obtain. She went out to my staff who discussed lens options with her. So, for 10/21/2015, no charges were made for the visit with me. She was charged for: [redacted] progressive lenses $360.00-98.00 = $262.00. So to the errors in her complaint 1-The claim was filed numerous times with [redacted] and denied for eligibility. As such patient responsibility to contact [redacted] and or pay the bill. 2-No charges applied to her account for the visit on 10/21/2015. She was never billed for a second exam. 3-She was not sold two pair of glasses, we replaced single vision lenses with more expensive progressive and charged her the difference. 4-No error was made on my part. It was her decision not to fill the original prescription as a multi focal was not my decision. We will not accept $200 or the return of the glasses. She had the glasses for 5 months before she contacted us and has not met the terms of her payment agreement. We acted in good faith and appropriately in all aspects. Even to the extent of my staff granting her a payment plan which I did not approve. Situations like this are unfortunate but do occur and we are happy to work with her to meet her needs