Smart Choice MRI, LLC

We received your letter dated November 28th regarding ID# ***The nature of the relationship between Smart Choice MRI and US Imaging is misconstrued in the customer’s statementUS Imaging Network is not a 3rd party billing organization for Smart ChoiceUS Imaging offers programs to
self-insured organizations to help lower the high cost of imaging such as MRI’s (typically $2,or more in a hospital setting)They negotiate with those employers and, as part of that program, they refer patients to free standing imaging centers across the U.SIn this case, US Imaging appears to have a negotiated program with GEHA (a large health plan that serves federal employees, retirees and their families)The customer’s insurance has negotiated this program to help reduce the out of pocket costs of their participantsIt appears that US Imaging then referred the customer to one of our centers to perform the MRIIn these specific cases, we have a standard price that we receive from US Imaging and have a portion that is the customer’s responsibilityUnfortunately, we have no control over what US Imaging has negotiated with GEHA which appears to be the $amount (less any negotiated discounts)We received $from US Imaging and $from the patient for a total of $We researched our call logs and customer tracking system and have no record of Mr*** calling into our center regarding the issue but we would be happy to discuss the above with himI have copied him on this message as well for full transparencyUnfortunately, I can’t speak to what GEHA and US Imaging represented to Mr*** about the cost of the servicesSince neither of those companies have any duty to respond to me, I don’t have any sway in resolving that side of the issue The genesis of our business was and continues to be to try to transform healthcare in a way that not only lowers the overall cost of healthcare significantly ($2,down to $600) but also to provide our MRI services in clinics dedicated to providing a warm and pleasant environment to our patientsIt is unfortunate that our healthcare system is putting families like Mr***’s in an untenable situation for out of pocket costs and we certainly appreciate that given our missionPlease let me know if I can be of any further service to you. Kindest regards, ***
*** ***Chief Financial OfficerP: (312) 888-0280M: (949) 701-3744smartchoiceMRI.com

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID [redacted], and have determined that this does not resolve my complaint.  For your reference, details of the offer I reviewed appear below.
While we appreciate Smart Choice making the industry more competitive, we differ with Mr. [redacted] on several points regarding.  First, to be clear, the starting point for us was a call directly to Smart Choice.  We were not referred to Smart Choice by US Imaging. In fact, we had to get the phone number for US Imaging when we received the first bill since the bill came from “Smart Choice MRI” with no mention of US Imaging anywhere on the bill, and the instruction on the bill is to “PLEASE MAKE CHECK PAYABLE TO: Smart Choice MRI”. Furthermore, we checked our insurance company’s (GEHA’s) website for providers that we could use, and Smart Chose MRI came up as an “in network” provider. Consequently, we had no reason to question that another entity would be involved.  In fact, I just re-verified that Smart Choice MRI is still listed as an “in network” provider with the Silvernail facility in Pewaukee as one of the listed locations.Second, we did in fact make at least two calls each to Smart Choice, US Imaging, and GEHA.  One series of calls to Smart Choice, US Imaging, and GEHA was in late September 2017 after we received the first bill from Smart Choice. We explained the situation and were told by either Smart Choice or US Imaging that someone would get back to us, which never happened.  When we received the second bill on October 28, 2017 we again called all three parties.  The call to Smart Choice was made to phone number (414) 431-0309 on October 31 at 10:57 a.m. and was 15 minutes long per our phone log.  Unfortunately, we did not write down the name of the person we spoke to. (On that same day we also spoke to US Imaging and spoke to a [redacted] (a supervisor / manager) when we called them at [redacted].)   I don’t understand why Smart Choice could not find a record of any of the calls, but I don’t know whether or not their policy requires a notation on every customer calls received.  In checking the notes we made on our bill, the account number is circled implying that we probably identified ourselves based on that number.In summary, we strongly feel that the business practice employed by Smart Choice is very misleading and should be changed to be transparent to unsuspecting clients.  The current practice by Smart Choice of making a claim on their website to charge no more than $600 appears to us to be clearly misleading since there is no mention of any type of qualifiers.  We suspect that others have experienced the same problem but just don’t bother to complain, and if they do complain are given the same runaround that we experienced, causing us to turn to the Revdex.com for resolution.  Finally, we still believe that we ought to be refunded the $111 amount that we paid directly to Smart Choice.
Regards,
[redacted]

Based on [redacted] most recent letter, we spent time with US Imaging to determine how they would have gotten involved in the middle of this situation. Essentially, their process was to grab all GEHA MRI claims and process them as the third party administrator for GEHA at their negotiated contract rates (higher than what Smart Choice charges our patients). US Imaging has agreed to discontinue this practice when a patient elects to go directly through Smart Choice as a GEHA member. For this particular situation, we have asked US Imaging to unwind the transaction and Smart Choice will directly send a claim to GEHA for processing. I don’t know how long it will take the various parties to adjust in their respective systems but our billing team will continue to track it. Based on the conversation that I had with US Imaging, there will still be a 15% patient co-pay as part of the GEHA plan but my estimate is that it will result in a small refund back to Henry for this service. Once GEHA processed the claim, we will be notified what that amount will be. I have also researched the telephone call logs to try to trace the call placed into Smart Choice on Halloween. There is a call that appears to match the patients stated timeframe so I have to presume that is the call mentioned in the letter. It went into a temporary resource that had just started on our team and we have discussed placing notes in the system for every call to avoid this type of confusion and lack of notes going forward.   I appreciate the opportunity to respond to the issue but please feel free to contact me if you need anything further. Kindest regards, [redacted]
 
[redacted]Chief Financial OfficerP: (312) 888-0280M: (949) 701-3744smartchoiceMRI.com

[A default letter is provided here which indicates your acceptance of the business's response.  If you wish, you may update it before sending it.]
Revdex.com:
I have reviewed the response made by the business in reference to complaint ID [redacted], and find that this resolution is satisfactory to me.  We expect that Smart Choice will follow through and that their "billing team will continue to track it" until full resolution, and that will occur in a reasonable time frame.
Regards,
[redacted]