Simmer Down Catering, LLC

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID ***, and find that this resolution would be satisfactory to me. I will wait until for the business to perform this action and, if it does, will consider this complaint resolved
Regards,
*** ***

To whom it may concern,     This letter is in regards to complaint #11312180, on [redacted]. The complaint is in regards to a surgical procedure and a bill the patient received after the insurance denied payment to Mr. [redacted]. The insurance in question denied payment because Mr....

[redacted] is an out of network provider, which is not by choice by Mr. [redacted]. Aetna, the insurance carrier will not give a contract to Mr. [redacted] or any other Surgical Assistants that provider similar services. Occasionally Aetna will pay for the services rendered, but sometimes they do not pay in which the patient will receive a bill for the deductible amount which is appropriate by the medical billing standards. As an out of network provider, I can bill the up to $1500-2000 dollars, but I do not believe that is fair to patients so I bill what the deductible is, which in this case it was $330 dollars. The hospital has a policy that a surgeon must have a surgical assistant for major surgeries which is what this patient in particular had done. The billing service had contacted her with regards to payment of the $330 amount. Patient stated here in her complaint that this was not the deductible per Aetna. I have a copy of the Explanation of Benefits from Aetna that states this is the deductible amount. The patient had been in contact with the billing service from dates 10/9/2015, 11/18/15, 11/25/15....patient was to contact Aetna regarding appeal. The billing service had not heard from her, and has notes on 12/22/15, 1/22/16 about nothing new or did they hear from her and they added her name to the collection agency list. On 3/2/16 her information was sent to the collection agency and the upcharge went up to $495 due to the agency costs. On 3/29/16 she wanted to pay the account, and there was some discussion about her not receiving anything from the billing company via email which on 11/25/15 the patient stated to send everything via email. There was discussion about my information the patient requested per she was going to report this, etc. When I received this complaint I immediately called the surgeon to discuss this because what I bill is minute compared to other surgical assistants. I gave him all the information and the complaints and he agreed I should be paid for my services. He then called the patient to discuss this and inform her that I work with him and was authorized by the surgical consent she signed and that what I was billing was very appropriate and was lower than what I could have billed. She never returned his call and I believe he called her between May 1st-2nd. I waited a few days to respond to her in the event she called him to talk to him. I responded on May 4th, and informed her that I was responding to the complaint and explained about why and how the insurance company didn't pay and why, and also explained how I could've billed more but I didn't. I also explained that I do not like billing patients and try not to do that and in the past Aetna had no problem paying but until the recent changes with Affordable Care Act that they are denying payments more often. I also told her that I would be willing to work something out with her and reduce the amount from the $495 back to the original $330 fee. I am mostly unaware when patients are sent to the collection agency, but I am more than happy to accommodate patients with regard to payments. I explained that I can take payments and she does not have to pay it all at once, etc. She responded on May 6th, and gave me her phone number which was the same number on the Revdex.com complaint and said she would like to discuss the matter and said she'd be home all day. The email was sent at 0813 in the morning but I called her on May 6th at 5:40 pm after I was done with surgeries. I did not call earlier because I was at work and did not have any of the information with regards to this matter on me. I never received a call back or follow up email nor has the surgeon. As stated before, I am more than happy to accommodate her and get it removed from the collection agency but without any correspondence I have no way of working this out with her. If she wishes to do payment option, I have instructed the billing service to get it removed from the agency if she wants to work out a payment plan but she has to contact them in order to do this. I waited to respond to the Revdex.com for the reasons I was giving time to her to contact the surgeon, myself or the billing company and plus it was mothers day on Sunday and I am aware she has children and probably wanted to spend the day with her family.Sincerely,[redacted]RN,BSN, CNOR, CRNFA