Sky Facial Plastic Surgery

We are deeply troubled that the patient feels misleadOur office and our biller's office have attempted to reach her at least three times to try resolve the matter with her directly, but our communication was ignored We pride ourselves on being transparent with our patientsThe Financial Policy that is in our new patient paperwork (which the patient signed) and the "Working with Your Insurance" part of the ppacket (which the patient received prior to the surgery) are all designed with that in mind The patient had two procedures done by our surgeonThe two procedures are completely separate in terms of billing and that is where the source of the confusion lies (1) FUNCTIONAL procedure- improves difficulty breathing, which the patient reported.as being severe, and insurance usually pays a portionThis is why on the initial visit we gave her hope that her insurance would pay a portion of the surgery, and they didAs explained in the Financial Policy and ppacket, our office, the surgery center, and the anesthesiologists separately bill the patient's insurance carrier after the surgeryAfter the insurance company pays their portion, the patient then receives the final bills with the amount that the patient is responsible for payingThese are the bills the patient is currently concerned about (2) COSMETIC procedure - addresses the appearance of the nose and insurance does NOT help pay for this When patients need surgery to improve breathing, they often elect, like this patient did, to get the Cosmetic procedure done at the same time as the Functional procedure because this makes the Cosmetic procedure much more affordable (about half the usual price)It costs us less to perform an "add-on'' Cosmetic procedure and we pass that savings on to the patientCosmetic procedures are paid in full prior to surgery.The patient has paid in full and is not receiving any bills for this procedure Our records show that we saw the patient on 6/for a consultation, 11/27/to go over the p packet, 12/12/for surgery.and 12/18/13,1/20/and 4/21/for pofollow up visits The patient was originally referred to us by a colleague who was performing a functional septoplasty and turbinate reduction on this patientHe wanted us to perform an adjunct functional rhinoplasty to improve the patient's breathingThe colleague does not perform this surgeryDuring the initial consultation on 6/14/13, the records state that the patient requested cosmetic changes to her nose and was interested in what could be done to make her nose "more appealing." Based on the patient's consultations with both physician offices, the Surgery Plan was for the referring physician and our surgeon to jointly perform the Functional procedures required to address the patient's medical problems and for our surgeon to perform an "add-on'' Cosmetic procedure to address the patient's requested cosmetic changes On 9/11/13, the Medical Assistant documented in the patient's chart that the patient gave verbal authorization to proceed with the Surgery Planbut was confused about which part of our surgeon's billing would be covered by insuranceThe chart notes clearly state that we told the patient that "the functional part would be covered by insurance, but the cosmetic portion would notThe conversation concluded with the patient saying that she understood On 9/16/13, we called her insurance company for the Functional procedure to be perfonned by our surgeon, and they told us that the patient would be responsible for 15% of the feesThe chart notes indicate that on 9/17/our Medical Assistant called and explained the patient's insurance benefits to herDuring that conversation, the patient expressed confusion and the Medical Assistant again clearly stated that there were two parts being performed by our surgeon: a "cosmetic portion and functional portion." Once again, the patient verbalized understanding On 11/27/13, at the pappointment we reviewed again the estimate for the acosmetic procedure in addition to bow we would work with her insurance for the functional procedureThis information was also included in her ppacket, which she took home On 12/11/13, the day before surgery, the patient called expressing further concern over the financialsThe chart notes indicate that the patient "was under the impression that [our surgeon] was strictly cosmetic" and we again explained that our surgeon would be doing a functional portion to improve her breathing in addition to the "strictly cosmetic" portion of "making her nose look pretty." We also explained that we could certainly do just the Cosmetic procedure, but that without the functional component, the price for the Cosmetic procedure would doubleAfter two additional lengthy conversations that day, the patient again gave verbal authorization to proceed with the Surgery Plan already in place The insurance and billing process can be confusing, and we always take ample time to explain to patients what costs they may be responsible for and can expectThe procedures performed for this patient are common for our office and usually require three routine discussions about the financialsIn this case, we went beyond what is customary to try to make sure that the patient had a clear understanding of the financialsThe chart documentation shows that we explained the financial responsibilities a total of times As indicated above, most of the conversations revolved around explaining the difference between the Functional and Cosmetic billingThe verbal discussions were further supported by the written material that the patient received and signed, including the Financial Policy, the Estimate for the Cosmetic procedure, and the ppacket that explained how we would work with her insurance company for the Functional procedureThe patient verbalized understanding of the fmancial process and elected to proceed with the Surgery Plan On 5/23/14, the patient emailed our office about her current concernsAfter reviewing her chart, I responded the same day with a very clear explanation that the bills she is now receiving are for the Functional procedure and have nothing to do with the $4,payment the patient made prior to surgeryI explained that the $4,payment she made prior to surgery was for the aCosmetic procedure, which insurance does not coverSince the patient seemed especially concerned about the bill from the surgery center, I took particular care to explain that the bill she is receiving from the surgery center is for the Functional procedure Our office already paid the surgery center for the Cosmetic procedure, and the surgery center confirmed this fact directly with the patientI closed the email by saying that I would have our biller call the patient directly to resolve her concernsThe patient did not respond to my email or to the phone message left by our biller On 6/2/14, the patient's insurance company called our office to try to understand the patient's concernsI explained what had transpiredThe insurance company confirmed that our billing was above boardThe representative said that she was going to call the patient back and explain everythingI told the representative that we had reached out to the patient to resolve the matter directly, but that she hadn't respondedI emphatically urged the representative to tell the patient that we are happy to work with her, but she needs to call our biller to notify him of her concernsI gave the representative the biller's contact information to give to the patientThe patient did not follow up with our biller The bottom line is that the patient's breathing has significantly improved due to the Functional procedures that were performed by both our surgeon and the referring physicianAs is customary, the two surgeons billed the insurance company individually for the Functional procedures (they each performed different operations on the nose; there was no duplicate billing) and now the patient is being billed for the amount that she is responsible for, per her contract with her insurance carrierThe patient also elected to have an a Cosmetic procedure done in conjunction with the Functional procedureAs is customary, the patient paid up front and in full and is not receiving any bills for the Cosmetic procedureAgain, if the patient had elected for our surgeon to perform only the Cosmetic procedure without the functional componentas she states in her letterthen the Cosmetic fee would have doubledShe is paying considerably less since she elected to have the Cosmetic procedure as an "add-on," done in conjunction with the Functional portion Our excellent reputation in the community is extremely imporrant to us, and we take all complaints seriously Again, we regret that this patient was not satisfied, but the records clearly support our diligence in trying to resolve this matterI hope that the patient elects to call our biller Sincerely, [redacted] N***, MBA Vice President