Please provide specific details on charges that are being disputedCharges are reflecting patient responsibility that is owed based off client's health insurance policy
I am rejecting this response because: We relied on their service to their detriment, had we got the bill we would have dropped outDanielle ***, an employee of Skill sprout, was in a position to speak on behalf of the institute, when she told us that she would set us up for an orientation once she got the ok from insurance about coverageI have this in an email that she received all of my insurance information prior to the orientation dateThe contract also states that, payments are due at the time of the serviceIf insurance did not cover the first visit that was billed, then why did they not inform us? My husband was at the center every week waiting, when my daughter was in the classThey could have spoken to him and rightfully so, could have denied further classes until a payment was madeHowever, we did not hear about the bills until end of June, which is almost months laterEven till date, we have not received any bill from themThis inactivity, led us to believe that the payments were being made by the insurance company as we were previously told by Danielle ***Had we known of the charges after the first session of service, we would have taken our child out of skill sprout and sought service elsewhereWe live in a small community but yet, there are a several other speech therapy places within Bloomington, some of which are even free for a childWe feel Skill sprout deliberatley withheld information inorder to collect more money and a way of keeping us from seeking service from other organizations within BLoomingtonDue to this conduct we don’t feel like we are obligated to make any payments to them
Our billing department returned phone calls to this family with no response, after multiple follow ups sent this to our 3rd party collection agency who is actively collecting on the accountThe client requested a settlement of 1/of the account which was deniedThe amount owed is a result of
patient responsibility after insurance paymentCharges are for services from No detailed information has been provided regarding disputed dates of service
I am rejecting this response because:
Response: As I've mentioned previously, it is difficult to ascertain how much of and adjustment should be made Unfortunately, I did not keep detailed notes, as I didn't anticipate issues Also, payments I've made were credited to the oldest dates of serviceeven though some of those dates of service were dates in question The biggest problems started in March, when *** *** started as our BCBA The problems were largely related to her lack of communication and willingness to work with us regarding program planning for our son In email messages dated March 22, 2017, *** indicated she could not find the reading comprehension program started by his previous SkillSprout BCBA and indicated she had sliced some of our son's targets back These changes to our son's programming were made after observing our son once for two hours, and she had not consulted with us (his parents) before making these changes I sent an email reply indicating my concerns, and asked for a detailed list of hours billed for March I then spoke with *** ***, Regional Manager of ***, and well as communicated with her by email on March 23, to raise these concerns I forwarded *** an email sent to Ben's team (line therapists) in which *** asked the line therapists to implement the new targets immediately I expressed my concerns with *** about this, as *** had not even met with the line therapists to go over the changes before asking them to implement them *** indicated she would work with *** and asked me to be patient; I believe she tried, but unfortunately, things did not improve *** apologized for not communicating as they should have over the last few months of services from SkillSpout The level of service provided was not satisfactory, which even their Regional *** Manager acknowledged I should not have to pay full charges for unsatisfactory service The statements received from SkillSprout did not provide details related to hours billed Thus, we had an agreement with SkillSprout that our BCBA would send us emails indicating the dates of service, therapist's name and specific service provided Once *** started as our BCBA, I asked her to continue this practice On April 1st, I received an email from her with the requested information In total for the month of March 2015, our son received hours of in-home therapy (hours per week) We were billed hours for the month of March Thus, an additional hours for data review, program planning & supervision During of our son's 2-hour sessions in March, either *** or another staff person attended the session with the line therapists for the purpose of training the therapistswe were billed for hours of therapy on each of these dates, hours for both the supervisor and line therapiststhus, even though our son received hours of therapy, we paid double to cover the cost of them providing training Our son didn't receive any additional services to benefit him To be billed for hours of service when only direct hours of therapy provided is excessive Unfortunately, I don't have emails from *** for the hours billed for April or beyond However, March provides a clear picture of the excess charges and why we have requested an adjustment **I'd like to add that under ***'s supervision, the therapists used the last minutes of each hour session to submit their data/notes for the session Therefore, there was no reason we were billed an additional 1/hour each week (hours total in March 2015) for data review If that much time was being spent on submitting data, the process is clearly inefficient (I might add that we have worked with many therapy providers over the years for ***, Speech, and OT for both center-based and in-home based therapy services SkillSprout has been the ONLY company who billed for anything more than the direct service hours When providers have had therapists attend a session for the purpose of training or introducing new staff to our son, SkillSprout is the only provider we've ever worked with who billed for both therapists hours, even though there was no additional benefit to our son For example, our current *** provider is providing hours of in-home therapy per weekwe are simply billed hours per week We are not billed additionally for data review, program planning, supervision/training of therapists, report prepping, etc There is no reason SkillSprout should have billed for 50% more hours in a month for these administrative tasks.) On April 16, I received an email from *** indicating she wanted to schedule a meeting with Ben's entire therapy team to go over Ben's quarterly report I questioned how this meeting would be billed, as in years with SkillSprout we'd never had a meeting with the entire team In an email dated 4/20/*** indicated EACH team member (4, including herself) would bill as "team meeting" for hour She did not indicate a rate She also indicated we'd be billed hours for report prepping by Elise and 2-hours for her to complete the report I replied asking for the team meeting rate, and explained I did not wish to be charged for hours of staff time for a hour meeting in addition to 4-hours to prep the report (thus 8-total billable hours) I explained that seemed excessive and indicated the previous quarterly report had only resulted in about billable hours I received a follemail on 4/22/indicating *** was waiting to hear back from her supervisor about my questions related I received another email the next day indicating her supervisor was waiting to hear back from someone in the billing department Thus, the meeting was delayed I was never provided with the requested rate I didn't even receive the report until June 17, 2015, along with our discharge report (both of which were delayed) I'm not refusing to pay SkillSprout I just don't think we should have to pay the full amount for less than satisfactory services, especially when the billed hours were excessive Thus, I asked for an adjustment and was told by their rep, Nathan, that he'd work with management to offer the adjustment I'd like nothing more than to resolve this issue
Please provide specific details on charges that are being disputed. Charges are reflecting patient responsibility that is owed based off client's health insurance policy.
I am rejecting this response because:
We relied on their service to their detriment, had we got the bill we would have dropped out. Danielle [redacted], an employee of Skill sprout, was in a position to speak on behalf of the institute, when she told us that she would set us up for an orientation once she got the ok from insurance about coverage. I have this in an email that she received all of my insurance information prior to the orientation date. The contract also states that, payments are due at the time of the service. If insurance did not cover the first visit that was billed, then why did they not inform us? My husband was at the center every week waiting, when my daughter was in the class. They could have spoken to him and rightfully so, could have denied further classes until a payment was made. However, we did not hear about the bills until end of June, which is almost 4 months later. Even till date, we have not received any bill from them. This inactivity, led us to believe that the payments were being made by the insurance company as we were previously told by Danielle [redacted]. Had we known of the charges after the first session of service, we would have taken our child out of skill sprout and sought service elsewhere. We live in a small community but yet, there are a several other speech therapy places within Bloomington, some of which are even free for a child. We feel Skill sprout deliberatley withheld information inorder to collect more money and a way of keeping us from seeking service from other organizations within BLoomington. Due to this conduct we don’t feel like we are obligated to make any payments to them.
In response to the complaint filed by Don & [redacted] on December 27, 2017. Skill Sprout is very sorry to hear about this unfortunate situation. Skill Sprout staff did services for this family from February until June of 2017 when the family decided to stop services. Skill Sprout staff...
completed a benefits check on February 8th, 2017. When Skill Sprout’s employee called insurance and received benefits information, they were informed that the information was a quote of benefits and it is not a guarantee of payment. On February 23, 2017 we had the family sign a contract stating they understood any insurance information provided to them from Skill Sprout was a quote of benefits, not a guarantee of payment. During that benefits check we were informed that services were covered based on the preliminary information which starts a case. The documentation from that call shows services are covered which is why we informed the family with the stipulation that it was a quote, not a guarantee of payment.When we received the first denial for these services on March 24th, 2017 we immediately sent them back to insurance to fight for the family for services to be covered. This is a courtesy we offer to our families as we understand many need support when it comes to insurance rules and regulations. After the an appeal was denied. We did reach out to the family on May 17th, 2017 and left a voicemail for the family. Two different staff members attempted several times after this initial call to try and converse with the family. We then sent them an invoice with all services listed which is when the family decided to stop services. We continued to receive denials for these claims and continued to send them back for reprocessing from insurance. When we got the final denial for claims on November 21st, 2017 staff worked to contact the family to inform them that insurance would not change their position and pay the claims. We called [redacted] twice, November 22nd and November 27th, 2017. When we still did not receive a reply we sent a letter on December 6th, 2017 asking [redacted] to reach out to us or the full cost of services would be applied to her. Mom called us on december 12th, 2017 in response to the letter we sent. The billing specialist she reached out to was unable to help resolve the situation and asked for [redacted], the Director of Quality Improvement, to take the call. The Director spoke with [redacted] and told her the billing team would try one last time to contact insurance on her behalf to see if they would change their decision. The Director called [redacted] back later that day explaining that insurance would not change their decision. She was informed of an option to bring the appointment cost down to the company’s private pay rates with an additional 30% discount off of those rates in an effort to help resolve the situation and ease the financial burden of the services we provided her. [redacted] refused this offer and said she would not move forward with resolving this issue unless we removed the charges completely. She told the Director of Quality Improvement she planned to sue the company and take the situation to the “media”.Since that conversation Skill Sprout staff have had no further communication with this family and this account has been turned over to collections with an outside collection agency.
This is our second response to this family in order to try to clarify [redacted]’s concerns. The additional concerns [redacted] has were not answered in our previous response as Skill Sprout feels they do not have merit in terms of this complaint. The Intake Specialist who quoted the family their benefits gave the family a quote. We have stipulations stating any information we give families about insurance is not a guarantee of payment. When the family signed the contract they agreed to this term. A copy of the signed contract was sent over to the family on December 13th, 2017 at the request of [redacted]. Also, I cannot find any evidence on this account that shows one of our previous staff members caused this issue. Insurance denied payment for a reason outside of Skill Sprout’s control, therefore, our staff cannot be the cause of this particular issue. At this time Skill Sprout does not see any further action we can take in order to solve the complaint with this family as they agreed to the terms of Skill Sprout’s involvement with their insurance when they signed up for services.
Please provide specific details on charges that are being disputedCharges are reflecting patient responsibility that is owed based off client's health insurance policy
I am rejecting this response because: We relied on their service to their detriment, had we got the bill we would have dropped outDanielle ***, an employee of Skill sprout, was in a position to speak on behalf of the institute, when she told us that she would set us up for an orientation once she got the ok from insurance about coverageI have this in an email that she received all of my insurance information prior to the orientation dateThe contract also states that, payments are due at the time of the serviceIf insurance did not cover the first visit that was billed, then why did they not inform us? My husband was at the center every week waiting, when my daughter was in the classThey could have spoken to him and rightfully so, could have denied further classes until a payment was madeHowever, we did not hear about the bills until end of June, which is almost months laterEven till date, we have not received any bill from themThis inactivity, led us to believe that the payments were being made by the insurance company as we were previously told by Danielle ***Had we known of the charges after the first session of service, we would have taken our child out of skill sprout and sought service elsewhereWe live in a small community but yet, there are a several other speech therapy places within Bloomington, some of which are even free for a childWe feel Skill sprout deliberatley withheld information inorder to collect more money and a way of keeping us from seeking service from other organizations within BLoomingtonDue to this conduct we don’t feel like we are obligated to make any payments to them
Our billing department returned phone calls to this family with no response, after multiple follow ups sent this to our 3rd party collection agency who is actively collecting on the accountThe client requested a settlement of 1/of the account which was deniedThe amount owed is a result of
patient responsibility after insurance paymentCharges are for services from No detailed information has been provided regarding disputed dates of service
I am rejecting this response because:
Response: As I've mentioned previously, it is difficult to ascertain how much of and adjustment should be made Unfortunately, I did not keep detailed notes, as I didn't anticipate issues Also, payments I've made were credited to the oldest dates of serviceeven though some of those dates of service were dates in question The biggest problems started in March, when *** *** started as our BCBA The problems were largely related to her lack of communication and willingness to work with us regarding program planning for our son In email messages dated March 22, 2017, *** indicated she could not find the reading comprehension program started by his previous SkillSprout BCBA and indicated she had sliced some of our son's targets back These changes to our son's programming were made after observing our son once for two hours, and she had not consulted with us (his parents) before making these changes I sent an email reply indicating my concerns, and asked for a detailed list of hours billed for March I then spoke with *** ***, Regional Manager of ***, and well as communicated with her by email on March 23, to raise these concerns I forwarded *** an email sent to Ben's team (line therapists) in which *** asked the line therapists to implement the new targets immediately I expressed my concerns with *** about this, as *** had not even met with the line therapists to go over the changes before asking them to implement them *** indicated she would work with *** and asked me to be patient; I believe she tried, but unfortunately, things did not improve *** apologized for not communicating as they should have over the last few months of services from SkillSpout The level of service provided was not satisfactory, which even their Regional *** Manager acknowledged I should not have to pay full charges for unsatisfactory service The statements received from SkillSprout did not provide details related to hours billed Thus, we had an agreement with SkillSprout that our BCBA would send us emails indicating the dates of service, therapist's name and specific service provided Once *** started as our BCBA, I asked her to continue this practice On April 1st, I received an email from her with the requested information In total for the month of March 2015, our son received hours of in-home therapy (hours per week) We were billed hours for the month of March Thus, an additional hours for data review, program planning & supervision During of our son's 2-hour sessions in March, either *** or another staff person attended the session with the line therapists for the purpose of training the therapistswe were billed for hours of therapy on each of these dates, hours for both the supervisor and line therapiststhus, even though our son received hours of therapy, we paid double to cover the cost of them providing training Our son didn't receive any additional services to benefit him To be billed for hours of service when only direct hours of therapy provided is excessive Unfortunately, I don't have emails from *** for the hours billed for April or beyond However, March provides a clear picture of the excess charges and why we have requested an adjustment **I'd like to add that under ***'s supervision, the therapists used the last minutes of each hour session to submit their data/notes for the session Therefore, there was no reason we were billed an additional 1/hour each week (hours total in March 2015) for data review If that much time was being spent on submitting data, the process is clearly inefficient (I might add that we have worked with many therapy providers over the years for ***, Speech, and OT for both center-based and in-home based therapy services SkillSprout has been the ONLY company who billed for anything more than the direct service hours When providers have had therapists attend a session for the purpose of training or introducing new staff to our son, SkillSprout is the only provider we've ever worked with who billed for both therapists hours, even though there was no additional benefit to our son For example, our current *** provider is providing hours of in-home therapy per weekwe are simply billed hours per week We are not billed additionally for data review, program planning, supervision/training of therapists, report prepping, etc There is no reason SkillSprout should have billed for 50% more hours in a month for these administrative tasks.) On April 16, I received an email from *** indicating she wanted to schedule a meeting with Ben's entire therapy team to go over Ben's quarterly report I questioned how this meeting would be billed, as in years with SkillSprout we'd never had a meeting with the entire team In an email dated 4/20/*** indicated EACH team member (4, including herself) would bill as "team meeting" for hour She did not indicate a rate She also indicated we'd be billed hours for report prepping by Elise and 2-hours for her to complete the report I replied asking for the team meeting rate, and explained I did not wish to be charged for hours of staff time for a hour meeting in addition to 4-hours to prep the report (thus 8-total billable hours) I explained that seemed excessive and indicated the previous quarterly report had only resulted in about billable hours I received a follemail on 4/22/indicating *** was waiting to hear back from her supervisor about my questions related I received another email the next day indicating her supervisor was waiting to hear back from someone in the billing department Thus, the meeting was delayed I was never provided with the requested rate I didn't even receive the report until June 17, 2015, along with our discharge report (both of which were delayed) I'm not refusing to pay SkillSprout I just don't think we should have to pay the full amount for less than satisfactory services, especially when the billed hours were excessive Thus, I asked for an adjustment and was told by their rep, Nathan, that he'd work with management to offer the adjustment I'd like nothing more than to resolve this issue
Please provide specific details on charges that are being disputed. Charges are reflecting patient responsibility that is owed based off client's health insurance policy.
I am rejecting this response because:
We relied on their service to their detriment, had we got the bill we would have dropped out. Danielle [redacted], an employee of Skill sprout, was in a position to speak on behalf of the institute, when she told us that she would set us up for an orientation once she got the ok from insurance about coverage. I have this in an email that she received all of my insurance information prior to the orientation date. The contract also states that, payments are due at the time of the service. If insurance did not cover the first visit that was billed, then why did they not inform us? My husband was at the center every week waiting, when my daughter was in the class. They could have spoken to him and rightfully so, could have denied further classes until a payment was made. However, we did not hear about the bills until end of June, which is almost 4 months later. Even till date, we have not received any bill from them. This inactivity, led us to believe that the payments were being made by the insurance company as we were previously told by Danielle [redacted]. Had we known of the charges after the first session of service, we would have taken our child out of skill sprout and sought service elsewhere. We live in a small community but yet, there are a several other speech therapy places within Bloomington, some of which are even free for a child. We feel Skill sprout deliberatley withheld information inorder to collect more money and a way of keeping us from seeking service from other organizations within BLoomington. Due to this conduct we don’t feel like we are obligated to make any payments to them.
In response to the complaint filed by Don & [redacted] on December 27, 2017. Skill Sprout is very sorry to hear about this unfortunate situation. Skill Sprout staff did services for this family from February until June of 2017 when the family decided to stop services. Skill Sprout staff...
completed a benefits check on February 8th, 2017. When Skill Sprout’s employee called insurance and received benefits information, they were informed that the information was a quote of benefits and it is not a guarantee of payment. On February 23, 2017 we had the family sign a contract stating they understood any insurance information provided to them from Skill Sprout was a quote of benefits, not a guarantee of payment. During that benefits check we were informed that services were covered based on the preliminary information which starts a case. The documentation from that call shows services are covered which is why we informed the family with the stipulation that it was a quote, not a guarantee of payment.When we received the first denial for these services on March 24th, 2017 we immediately sent them back to insurance to fight for the family for services to be covered. This is a courtesy we offer to our families as we understand many need support when it comes to insurance rules and regulations. After the an appeal was denied. We did reach out to the family on May 17th, 2017 and left a voicemail for the family. Two different staff members attempted several times after this initial call to try and converse with the family. We then sent them an invoice with all services listed which is when the family decided to stop services. We continued to receive denials for these claims and continued to send them back for reprocessing from insurance. When we got the final denial for claims on November 21st, 2017 staff worked to contact the family to inform them that insurance would not change their position and pay the claims. We called [redacted] twice, November 22nd and November 27th, 2017. When we still did not receive a reply we sent a letter on December 6th, 2017 asking [redacted] to reach out to us or the full cost of services would be applied to her. Mom called us on december 12th, 2017 in response to the letter we sent. The billing specialist she reached out to was unable to help resolve the situation and asked for [redacted], the Director of Quality Improvement, to take the call. The Director spoke with [redacted] and told her the billing team would try one last time to contact insurance on her behalf to see if they would change their decision. The Director called [redacted] back later that day explaining that insurance would not change their decision. She was informed of an option to bring the appointment cost down to the company’s private pay rates with an additional 30% discount off of those rates in an effort to help resolve the situation and ease the financial burden of the services we provided her. [redacted] refused this offer and said she would not move forward with resolving this issue unless we removed the charges completely. She told the Director of Quality Improvement she planned to sue the company and take the situation to the “media”.Since that conversation Skill Sprout staff have had no further communication with this family and this account has been turned over to collections with an outside collection agency.
This is our second response to this family in order to try to clarify [redacted]’s concerns. The additional concerns [redacted] has were not answered in our previous response as Skill Sprout feels they do not have merit in terms of this complaint. The Intake Specialist who quoted the family their benefits gave the family a quote. We have stipulations stating any information we give families about insurance is not a guarantee of payment. When the family signed the contract they agreed to this term. A copy of the signed contract was sent over to the family on December 13th, 2017 at the request of [redacted]. Also, I cannot find any evidence on this account that shows one of our previous staff members caused this issue. Insurance denied payment for a reason outside of Skill Sprout’s control, therefore, our staff cannot be the cause of this particular issue. At this time Skill Sprout does not see any further action we can take in order to solve the complaint with this family as they agreed to the terms of Skill Sprout’s involvement with their insurance when they signed up for services.