Specialized Orthopaedic Services

I have previously responded to complaints from Mr [redacted] with Revdex.com and the Attorney General's office (for the Commonwealth of Virginia) and have encouraged him to contact us directly to reach a resolution; he has not done so I am very confused by Mr***'s rebuttal because it states our rep "would have got the payment COD" and in fact we did receive partial payment to cover the patient's deductible on the date of service In response to the claim that he can not find the brace he received on the manufacturer's website, I have attached a copy of the information about the brace from the manufacturer's website which I printed today The manufacturer is OSSUR and the part number is B-240518713, simply log in to ossur.com and search the part number to find the brace that was dispensed to Mr*** Finally, the statements were sent to his address in Baltimore because that is the address the insurance company lists as his address and claims must be submitted with the same address the carrier has on file, not to mention that address is on the check he paid with on the date of service Considering that Mr [redacted] had surgery I'm sure he had many bills that went with it and he may be confusing calls he received about those balance with the bill we sent; there are too many inconsistencies in the dollar amounts he mentioned in both this and his prior complaint that do not match our records at all We are a reputable company serving our community for over years and we are very understanding when dealing with patient's with large balances and are happy to set up payment plans IF we are contacted by the patient Our practice is to send a statement when the carrier processes the claim, a second statement with a late charge if there have been no payments and the third and final statement if there are still no payments received We DO NOT call patients regarding outstanding balances, we don't have time I one last time invite Mr [redacted] to call our office to resolve this issue as we have done everything we can without him contacting us Otherwise, I'm afraid will end up in collections for his failure to communicate with us

In response to the complaint filed by [redacted] ***, the fees being billed are valid On February 15, my co-worker received a call from our patient [redacted] ***, the call was eventually transferred to me [redacted] explained that she received a bill from us in October for services provided to her and she was upset that she believed it to be the first bill yet it showed she had a balance due in the 31-day block of the statement She also stated that she did not pay the bill at that time because she was waiting for the explanation of benefits (EOB) from her insurance company [redacted] told me she received an EOB from her insurance company in November (dated 11/11/16) and another one in December Through the course of the conversation it was realized that the November EOB was for the equipment billed to her on our October statement which was for the August date of serviceThe late portion had previously been billed to her for the July date of service As of the end of November we had not received any payment from [redacted] for our services and a Final Notice statement was sent with a letter explaining that if the account was still unpaid after days it would be turned over for collections Again, the account went unpaid, and approximately months after the final notice was sent the account was turned over for collectionsAll statements for this account were mailed to the address provided by her physician's office The first time [redacted] ever mentioned that the address we used was incorrect was in an email sent to me at 10:p.mon February 15, Despite the address on both our statements and the insurance company EOBs, the patient received them and had full knowledge of the debt I know this for a fact because the patient/her husband emailed me copies of all of these documents A payment was made to our office on 2/15/for ONLY the August date of service and only for the co-insurance assigned When [redacted] received our equipment she signed a document which states "...If this account becomes delinquent and is placed in the hands of a collections agency or attorney, I agree to pay the associated fees plus all court costs, penalties and interest..." [redacted] was given ample opportunity to pay the amount assigned by her insurance carrier but her failure to do so has resulted in the account being turned over to a collections company and the fees associated with that action For this situation to be resolved, the patient will need to pay the yet unpaid co-insurance for the July date of service as well as the collections fees I have attached a copy of the form signed by [redacted] so you may see that the patient did in fact agree to be responsible for any fees for delinquency All information regarding the patient has been redacted so as to maintain HIPAA compliance regulations, the only identifiers remaining are the patient's name and signature In addition I have attached a blank copy of our form in case the scans of [redacted] ***'s signed paperwork are difficult to read

*** *** is absolutely correct, his insurance company did pay his daughter's claim in full, there was an error in the billing office when that payment was posted and one of the contractual obligation adjustments was mistakenly applied to patient liability I sincerely apologize for the
trouble this has caused *** ***; the billing office has already contacted the collections agency to have the account corrected Today was the first time that *** *** had contacted our office directly and I immediately did as much research as I could to find out how this claim had been processed I found that *** *** had contacted the billing office on two previous occasions about the bill but I could not see any information about how the claim was processed I was awaiting a response on some follow up questions when I received this complaint I have spoken to the billing office and was informed that the claim actually was paid in full but one of the contractual obligation adjustments was mistakenly assigned as patient liability I again apologize for the billing office error and ask that *** *** contact me directly with any additional concerns he may have.Jennifer R***###-###-####-direct

*** *** is absolutely correct, his insurance company did pay his daughter's claim in full, there was an error in the billing office when that payment was posted and one of the contractual obligation adjustments was mistakenly applied to patient liability I sincerely apologize for the
trouble this has caused *** ***; the billing office has already contacted the collections agency to have the account corrected Today was the first time that *** *** had contacted our office directly and I immediately did as much research as I could to find out how this claim had been processed I found that *** *** had contacted the billing office on two previous occasions about the bill but I could not see any information about how the claim was processed I was awaiting a response on some follow up questions when I received this complaint I have spoken to the billing office and was informed that the claim actually was paid in full but one of the contractual obligation adjustments was mistakenly assigned as patient liability I again apologize for the billing office error and ask that *** *** contact me directly with any additional concerns he may haveJennifer R***
###-###-####-direct

[To assist us in bringing this matter to a close, you must give us a reason why you are rejecting the response. If no reason is received your complaint will be closed as Answered]
 Complaint: [redacted]
I am rejecting this response because it is becoming a he said she said argument.  I would much rather pay an attorney three times the cost than pay this company, who I feel are  nothing but crooks.:
Regards,
[redacted]

Prior to providing the knee brace to this patient our representative informed Mr. [redacted] that he would have out of pocket expenses for deductible and coinsurance, per his policy.  The patient agreed to the fee and gave our representative partial payment in the form of a check for $200.00 on...

7/24/14, the day he received the brace.  The claim was submitted to the patient's insurance on 8/21/14 and we received the explanation of payment on 9/2/14.  The patient was assigned a total cost share of $273.71, $200.00 was applied to the member's deductible and $73.71 was assigned as co-insurance.   The patient was billed twice prior to the "Final Notice" he received last month, unfortunately he never contacted us to discuss what the bill was for or to make payment arrangements.  Our office does not call patients about outstanding balances so I think Mr. [redacted] may have received a call from some other company or doctor's office.  Also, the amount mentioned, $97.00, would not make sense considering the total of the account.  With that said, the original payment made by Mr. [redacted] was not applied to the account.  I sincerely apologize for that oversight and have corrected the account;  Mr. [redacted]' balance now stands at $78.71.  This account has not yet been sent to collections so there is nothing to correct with the credit agencies.  When we send a "Final Notice" statement to our patients we include the collection fee that will be due if the accounts goes to collections.  The letter included with the final notice states that the collections fees may be waived if payment is received in a timely manner and also includes my name and direct telephone number if the patient has questions or wishes to set up a payment plan.   We would be happy to hear directly from Mr. [redacted] if he truly wishes to resolve this matter.

In response to the complaint filed by [redacted], the fees being billed are valid.  On February 15, 2017 my co-worker received a call from our patient [redacted], the call was eventually transferred to me.  [redacted] explained that she received a bill from us in October for services...

provided to her and she was upset that she believed it to be the first bill yet it showed she had a balance due in the 31-60 day block of the statement.  She also stated that she did not pay the bill at that time because she was waiting for the explanation of benefits (EOB) from her insurance company.  [redacted] told me she received an EOB from her insurance company in November (dated 11/11/16) and another one in December.  Through the course of the conversation it was realized that the November EOB was for the equipment billed to her on our October statement which was for the August date of service. The late portion had previously been billed to her for the July date of service.  As of the end of November we had not received any payment from [redacted] for our services and a Final Notice statement was sent with a letter explaining that if the account was still unpaid after 7 days it would be turned over for collections.  Again, the account went unpaid, and approximately 2 months after the final notice was sent the account was turned over for collections. All statements for this account were mailed to the address provided by her physician's office.  The first time [redacted] ever mentioned that the address we used was incorrect was in an email sent to me at 10:35 p.m. on February 15, 2017. Despite the address on both our statements and the insurance company EOBs, the patient received them and had full knowledge of the debt.  I know this for a fact because the patient/her husband emailed me copies of all of these documents.  A payment was made to our office on 2/15/17 for ONLY the August date of service and only for the co-insurance assigned.  When [redacted] received our equipment she signed a document which states "...If this account becomes delinquent and is placed in the hands of a collections agency or attorney, I agree to pay the associated fees plus all court costs, penalties and interest..."  [redacted] was given ample opportunity to pay the amount assigned by her insurance carrier but her failure to do so has resulted in the account being turned over to a collections company and the fees associated with that action.  For this situation to be resolved, the patient will need to pay the yet unpaid co-insurance for the July date of service as well as the collections fees.  I have attached a copy of the form signed by [redacted] so you may see that the patient did in fact agree to be responsible for any fees for delinquency.   All information regarding the patient has been redacted so as to maintain HIPAA compliance regulations, the only identifiers remaining are the patient's name and signature.  In addition I have attached a blank copy of our form in case the scans of [redacted]'s signed paperwork are difficult to read.

I spoke with the patient and her husband multiple times on 2/15/17. There was no three way call with the insurance carrier as mentioned by the [redacted]'s.  I received a call from their insurance carrier asking if we would waive fees because the carrier had sent the EOB to the incorrect address. At no time during any of those conversations did the [redacted]'s or any representative from their insurance company state that our statements had been sent to the wrong address.  The first I heard of our statements being sent to the incorrect address was in [redacted]'s email to me at 10:35 pm on 2/15/17 when she wrote: "At 2038 (carrier) realized that you had been submitting our bills to (address)..."   If the [redacted]'s had received the statements long after they had been sent that would have been their first complaint however at no time did the [redacted]'s indicate there was a delay in receiving our statements, the only delay mentioned was the EOB and that was not about the delay in receiving it but the date in relation to our statement. The [redacted]'s contention now is that because the address on the statement was wrong they should not be responsible for the fees accrued due to delinquency.  It is important to note, the address error was a single digit off and was through no fault of ours.  [redacted] had the opportunity to provide her address on the paperwork she signed for each date of service but since she did not do that we had to rely on the information provided by her doctor's office.  [redacted] specifically told me during our first conversation that she received our bill in October and was upset that there was a late balance.  She also said she was waiting to make payment until she received the EOB from her insurance company.  She then told me she received the EOB in November and another in December.  Again, our final notice was sent at the end of November and included a letter explaining that the account would be sent to collections. Through the course of the conversation [redacted] stated she had been away for a few weeks beginning late December and that was why she had not paid the bills.  At no time did either **. or [redacted] state that they had not paid the bills because they did not know about the debt.  In fact, prior to receiving the brace in August [redacted] was told to expect a cost share of approximately $350.  That fact coupled with the patient's admission that she received our statement in October shows that their is no justification for the bills going unpaid for over three months.  The fees accrued on the account are the responsibility of [redacted].

[To assist us in bringing this matter to a close, you must give us a reason why you are rejecting the response. If no reason is received your complaint will be closed Administratively Resolved]
 Complaint: [redacted]
I am rejecting this response because: I wouldn't have ever got the knee brace if I knew my insurance wasn't going to cover it. I did get the price wrong saying  $97 dollars but I asked him prior to coming to my house and when he came to my house for the fitting. I asked him if it was covered by my insurance because I wasn't going to be working for a good while and I already had bills to pay and didn't need another. I would have never taken this brace with knowledge of any payment. I also only got one notice other than the phone call and she talked t my wife and had her upset talking about destroying my credit and I came into the house and took the phone and the I told the Woman the same thing and she took my insurance information again an said she would run it. I never got anything in the mail until this final notice which was $278 dollars which seemed crazy and I then looked up this company on the Revdex.com, I also noticed that I can't even find the brace they gave me on the website or on the overseas website. I honestly wouldn't have taken the brace if there was a payment and I would have gave the gentleman a check or cash right then and got a receipt for my taxes. He came to my residence in Virginia twice and not once did he advise me of any payment due. My Wife was right there and I asked him over the phone once he came to my house and before he ever took the plastic off of the brace. He assured me that it was covered and I would never go through all of this if I wasn't sure that my Wife and I didn't ask about it. I honestly think this Company takes advantage of older people and are used to pulling fast ones on consumers that just write checks because the Woman that called said we will ruin his good credit and had my Wife all afraid on the phone call that they are saying they never made.  I think they purchase outdated braces but new and then try to sale them getting as much from the insurance company as they can and then try to get the customer, that is why you won't find the brace I got on their website or the overseas website. I know for sure that he didn't state there was another cost involved, her it is June and I got this brace over a year ago and who gives out medical equipment without being paid. He would have got the payment COD. I also like to know how they sent the so called final statement to Baltimore and he came to my house in Virginia twice.  He also had both my numbers cell and home.    
Regards,
[redacted]

November 7, 2014On May 8, 2014 [redacted]’s daughter was prescribed a back brace by her orthopaedic doctor. Our company, Specialized Orthopaedic Services Inc., supplies the doctor’s office with a variety of durable medical equipment devices which are commonly prescribed. We have been...

serving patients in this area for over 20 years, we are an Accredited Facility and have Certified Orthotists as practitioners on staff. We have supplies in the doctor's office for patient convenience or the patient can come to our clinical office about 10 minutes away. When the doctor's office dispenses our equipment the patient or their legal guardian is given our “Prescription and Certificate of Medical Necessity” form to read and, if they are accepting the equipment provided they sign the form and the doctor will also sign the form as the prescription. The form is a three part NCR form, one part is to be returned to our office by the doctor’s office so that the proper party may be billed, one part is for the doctor’s records should they choose to retain one, and the third part is for the patient/legal guardian. The form explains on the back who we are and how the billing will be done. It also states “You have a choice. You may:1. Receive the product now, at the time of treatment, from Specialized Orthopaedic Services, Inc.and Specialized Orthopaedic Services, Inc. will bill your insurance company. If your policy does not cover the prescribed product or does cover only a portion of the hill, you will be responsible for any remaining balance and be billed by Specialized Orthopaedic Services, Inc.
2. You may go to a local medical supply company and ask to get your prescription filled there.”In response to [redacted]’s claim (#4 on her list of complaints) that we failed to bill in a timely manner, we submit claims to insurance companies when we receive the paperwork from the doctor’s office, generally once a month. This particular claim was submitted on May 27, 2014, (3 weeks from the date of service) and well within the 365 day timely filing guidelines allowed by the insurance carrier. The claim was processed by the carrier on June 12, 2014 and was billed to [redacted] the same day. Continuing with her point #4, the form she signed and was given a copy of the day her daughter received the brace explains the return policy and where to call for questions about the bill. Had [redacted] called our office the day her daughter was given the brace we would have been happy to review her insurance coverage and let her know about any out of pocket costs she would incur. Her insurance carrier is also available to inform her of the remaining deductible and plan coverage details. However, [redacted], knowing that she had a high deductible insurance plan, did not inquire about any cost.Addressing point #2, that we charge outrageously high and unreasonable prices: We deal with many insurance companies, all of which establish the rates that they deem “allowable” for each product that is described by a hilling code. The allowed amounts can vary greatly from one carrier to the next so doctor's offices and medical supply companies bill insurance companies what is known as a “usual and customary rate” which is 15-20% above the current Medicare rate for each billable code. The Virginia Medicare reimbursement for the back brace is $944.87, our charge to the insurance company was $1,100 for the back brace which is within the usual and customary range. In theory we could have billed the insurance company $2500 for the brace but at the end of the day they will always process the claim at the allowable rate, in this case, $705.27. The charge will always be reduced to our contracted rate, no more and no less. If this patient had an insurance plan with no deductible and no cost share the insurance company would pay the amount of $705.27 directly our office; [redacted] has a plan with a high deductible and since it had not becn met the entire balance was assigned to the patient responsibility. The insurance carrier allowed the S705.27 amount and applied this to her deductible which means they must pay our company for the allowed amount of $705.27.
Point #3 that we failed to provide prior notice of our charges: As stated earlier, had [redacted] called we would have been happy to provide her with a reasonable estimate if not exactly the fee her insurance carrier would allow. For patients that we see in our clinical office we do verify insurance benefits and inform them of any out of pocket costs they may incur based on the information provided by the insurance companies. Had [redacted] taken the prescription to our office or any other provider's office she would have gotten that information up front. I cannot speak to any information the doctor's staff may or may have not have given her regarding coverage or payment for the item provided.
On June 17, 2014 [redacted] called our office to discuss the bill she received for the back brace. Our biller explained that since the deductible on her insurance policy had not yet been met, the allowed amount was applied to the deductible and was the member’s responsibility. Since the entire amount was applied to the deductible we were not able to write off any of the bill. On June 24, 2014 we received a call from the doctor’s office stating that [redacted] was there complaining about the bill for the brace and asking if there was anything we could do. We offered to allow her to return the brace if it was in new condition as she claimed it was. The brace was brought to our office that day and inspected prior to being accepted for return. Upon inspection, the brace had not only been worn significantly but had also been written on in permanent marker. Prior to being brought to our office for inspection the word that had been written on the brace had also been “scribbled” over in an attempt to conceal the damage. [redacted] was told that we could not accept the brace back since it had been worn and defaced. She became hysterical and insisted that her daughter would not have done such a thing and that she probably received it in that condition. [redacted] also expressed that she now felt that the doctor should not have prescribed the brace at all. [redacted] begged us to reduce the bill any way we could. Knowing that children sometimes do foolish things, and being sympathetic to the situation, we told [redacted] that the lowest price we could possibly get for her would be the self-pay price we charge patients without insurance which is $495.00. She again begged us to ask if even that price could be further reduced. I explained that the self-pay pricing is generally the lowest price we can accept for items we dispense but that we would at least take her question to the owner. The owner, hearing [redacted]'s story about how upset she was by the cost of the brace and her belief that the brace should not have been prescribed at all, in an attempt to eliminate her complaints at both our office and the doctor's office, we offered to accept $395.00 for the brace if immediate payment was made that day. This is by no means a common practice in our office. At this point we had been called once by [redacted], visited by [redacted] and contacted by the doctor’s office about this bill. I called [redacted] shortly after she left our office at the telephone number she provided to inform her of the very generous offer. [redacted] called our office after midnight a day or two later and left a voicemail stating that our offer was outrageous and that she needed time to confirm with her daughter that she had written on the brace. On July 1, 2014 the doctor’s office called requesting that we fax a copy of the form [redacted] had signed because she now claimed that she never signed anything when her daughter received the brace and refused to pay for something that she had not signed for. During the same call from the doctor's office, I was told that [redacted] insisted that the doctor should have to pay for the brace since she didn't feel her daughter ever actually needed it. On July 3, 2014 [redacted] called our office and said that she would now like to pay $395.00 for the brace. When I told her we could not accept that amount she became hysterical on the phone and threatened to file a complaint with the insurance company and contact an attorney. Since [redacted] had reminded us numerous times that she was an attorney and other family members were attorneys we felt her litigious anger could jeopardize our contracted status with her insurance carrier. As I stated earlier, reducing balances assigned by insurance carriers is not a practice this office participates in and we take very seriously any threat made against our in-network status with any insurance carrier. At this time we reviewed our responsibilities with regards to our network affiliation with the provider and requested that [redacted] supply us with written permission from both her and the carrier to bill her outside of our contractual obligation with the carrier. This was not discussed in June when the initial offer was made because that offer was made in the “heat of the moment” after being bombarded by [redacted]’s emotions regarding her bill. We were overwhelmed by her distress and made a mistake in trying to help ease her financial burden, a mistake we are still dealing with four and a half months later. To properly reduce the payment amount we would fully retract the claim for the back brace and the $705.27 would return to her deductible. To bill for the brace directly to the patient we would need written permission from the insurance carrier and the patient/guardian. The point remains that the claim was submitted properly, for a covered item and the item was not able to be returned in the current condition.
On July 15, 2014 during a phone conversation with [redacted] the owner of the company attempted to explain our position regarding her bill; it was a very one sided conversation. [redacted], during all of the conversations we have had with her regarding this issue, was much more interested in venting her frustration than actually listening to the explanations being given. This same day we received a letter and check from [redacted] in the amount of $395.00 despite being told that we could not accept that amount.
The following day I received a call from Robin, a representative from [redacted]'s insurance carrier, stating that [redacted] had called to complain that we had billed her $1100.00 for the brace her daughter received. I explained that we had actually hilled the amount we were instructed to bill her $705.27. This accusation represents a violation of our contract with the insurance carrier. We are not permitted to bill anything over the contracted amount. This accusation was false and caused the insurance carrier to contact us about the violation. We have a copy of the statement which clearly shows the $1,100 billed amount for the claim was reduced to $705.27 and the $705.27 amount was the amount on the patient statement. . Despite numerous efforts to explain the billing process to [redacted], she did not understand her benefits or billing process.
[redacted] continued to call the insurance company and our office insisting that the claim could merely be retracted. While it is true that we can retract a claim there must be a valid reason to do so. [redacted] not wanting to pay her deductible is not a valid reason. [redacted] spoke to [redacted], a representative from her insurance carrier on October 1, 2014 regarding our ability to retract the claim. [redacted] called me to explain the process because [redacted] told her we just didn’t know how to do it. I explained that [redacted] was the one who wanted the claim reversed because she did not want to pay her deductible; [redacted] confirmed that was not a valid reason to retract the claim. The day after [redacted] spoke to [redacted] she sent us a letter claiming that [redacted] had told her we could retract the claim and bill her any amount we wanted. When I called to verify that with [redacted] (I read directly from the letter [redacted] sent), she denied ever having said that. She also said that during their conversation, [redacted] proposed she simply not pay the bill and notify the carrier that she would not pay the bill so they could adjust the amount applied to her deductible accordingly. [redacted] informed [redacted] that insurance does not work that way. We have requested the transcripts from this conversation between the insurance carrier and [redacted]. The request is being processed.
[redacted] has been deceitful with us, the doctor’s office and the insurance carrier. She has tried every way she could think of to get out of paying for the item her daughter’s doctor deemed medically necessary, including having her mother (patient’s grandmother), an attorney in New York, call on her behalf in an additional attempt to intimidate us to comply with her demands or face legal repercussions. We submitted the claim on her daughter's helialfin a timely manner, it was properly processed by her insurance carrier and we billed her appropriately. Our practice is to bill the responsible party when the insurance company makes payment, approximately 30 days later we send a second notice with a late fee if the balance is unpaid, a third and final statement is sent approximately 60 days after the first statement if the balance is still owed. The final statement is sent with collections fees calculated so the responsible party is aware of what the final cost will be if the account is sent to collections. A letter is sent with the statement indicating that if payment is not received within 7 days the account will be turned over for collections, we actually allow closer to a month before turning over the account. The letter also explains that if payment is received in a timely manner the collections fees may be waived. We have spent an inordinate amount of time on the phone with [redacted], her husband and her mother explaining how the claim was paid and why we needed the documentation we requested. I am sorry that [redacted] still does not understand the process but it is certainly not for our lack of trying. We responded to all of her inquiries so I am flabbergasted to read that she thinks otherwise and am not sure why she thinks we are seeking retribution when aside from our one offer to accept $395.00 the price has not changed from the $705.27 her carrier assigned. If anyone is secking retribution in this case it surely is [redacted]. She has lodged complaints with both your office and the Revdex.com in an obvious attempt to besmirch our reputation although we merely followed the billing guidelines per our contractual obligation with the patient’s insurance
We sincerely hope that this is the last communication we have regarding this matter as we feel that we are being harassed and threatened by [redacted]. I find [redacted]’s attempts to intimidate us by throwing both her own and her mother's credentials as attorney’s suspect at best. I certainly hope it is not an accepted practice to allow attorneys in the Commonwealth of Virginia to use their status as attorneys to intimidate people and businesses in their personal dealings. We have maintained copious notes regarding this matter and would certainly welcome a phone conversation to further clarify any points you may have questions about. We sincerely appreciate your consideration of this matter.Kindest regards,Jennifer R

Prior to providing the knee brace to this patient our representative informed Mr. [redacted] that he would have out of pocket expenses for deductible and coinsurance, per his policy.  The patient agreed to the fee and gave our representative partial payment in the form of a check for...

$200.00 on 7/24/14, the day he received the brace.  The claim was submitted to the patient's insurance on 8/21/14 and we received the explanation of payment on 9/2/14.  The patient was assigned a total cost share of $273.71, $200.00 was applied to the member's deductible and $73.71 was assigned as co-insurance.   The patient was billed twice prior to the "Final Notice" he received last month, unfortunately he never contacted us to discuss what the bill was for or to make payment arrangements.  Our office does not call patients about outstanding balances so I think Mr. [redacted] may have received a call from some other company or doctor's office.  Also, the amount mentioned, $97.00, would not make sense considering the total of the account.  With that said, the original payment made by Mr. [redacted] was not applied to the account.  I sincerely apologize for that oversight and have corrected the account;  Mr. [redacted]' balance now stands at $78.71.  This account has not yet been sent to collections so there is nothing to correct with the credit agencies.  When we send a "Final Notice" statement to our patients we include the collection fee that will be due if the accounts goes to collections.  The letter included with the final notice states that the collections fees may be waived if payment is received in a timely manner and also includes my name and direct telephone number if the patient has questions or wishes to set up a payment plan.   We would be happy to hear directly from Mr. [redacted] if he truly wishes to resolve this matter.

[To assist us in bringing this matter to a close, you must give us a reason why you are rejecting the response. If no reason is received your complaint will be closed Administratively Resolved]
 Complaint: [redacted]
Specialized
Orthopaedic Service’s response contains several factual misstatements and false personal accusations.  I have written many letters to
this company and the written record is clear.  I am happy to provide all
of the correspondence to the Revdex.com to set the record straight.
The most
relevant facts are not disputed:
 
·        
I
received a bill in the amount of $1100, of which I was responsible for $705.27
(which is the permissible amount under my insurance)
·        
I
contacted the insurance company, the doctor’s office and the provider about
this charge (for a product that was available at retail for less than $200)
·        
The
provider left me a voice mail offering to allow me to self pay in the amount of
$395 if paid “that day” and if not that day, then the  amount would be
$495.
The provider then reversed their position, retracting the offer to pay the reduced amount
·        
The
provider then sent me a bill with a total balance owing in the amount of
$1060.10, which reflected the $705.27 charge plus a collection fee of $349.83
which they stated they “may” waive. The letter also threatened to send the
matter to collections. 
 
Even if it’s
legally permissible, the public should be aware of the enormous price
differential charged by this business for the same product.  Their price appears to range between $395-$1100.
Consumers
should not be penalized if they make reasonable inquiries regarding
charges.  In this case, I made such inquiries and believe I was penalized
for doing so as that apparently prompted the provider to retract their offer to
allow me to pay the self-pay amount. 
Finally,
consumers should not be charged collection fees when the matter is still
processing and has not even been sent to collections.  Specialized
Orthopaedic Services’s response to the Revdex.com states that the $349.83
 “collection fee” was  a notice of what the fee would be if it is
sent to collections.   The bill that was sent to me provided no such
clarification or notice that this was a future fee that may be imposed, but
rather incorporated this fee into the final amount owed (thereby resulting in a bill
for $1060.10) and suggested paying this full amount immediately to avoid
“further” collection costs.  If there is any dispute concerning the language of this bill, I am happy to provide it to the Revdex.com.
[redacted]

I have previously responded to complaints from Mr. [redacted] with Revdex.com and the Attorney General's office (for the Commonwealth of Virginia) and have encouraged him to contact us directly to reach a resolution; he has not done so.  I am very confused by Mr. [redacted]'s rebuttal because it states our rep "... would have got the payment COD" and in fact we did receive partial payment to cover the patient's deductible on the date of service.  In response to the claim that  he can not find the brace he received on the manufacturer's website, I have attached a copy of the information about the brace from the manufacturer's website which I printed today.  The manufacturer is OSSUR and the part number is B-240518713, simply log in to ossur.com and search the part number to find the brace that was dispensed to Mr. [redacted].  Finally,  the statements were sent to his address in Baltimore because that is the address the insurance company lists as his address and claims must be submitted with the same address the carrier has on file, not to mention that address is on the check he paid with on the date of service.  Considering that Mr. [redacted] had surgery I'm sure he had many bills that went with it and he may be confusing calls he received about those balance with the bill we sent; there are too many inconsistencies in the dollar amounts he mentioned in both this and his prior complaint that do not match our records at all.  We are a reputable company serving our community for over 20 years and we are very understanding when dealing with patient's with large balances and are happy to set up payment plans IF we are contacted by the patient.  Our practice is to send a statement when the carrier processes the claim, a second statement with a late charge if there have been no payments and the third and final statement if there are still no payments received.  We DO NOT call patients regarding outstanding balances, we don't have time.  I one last time invite Mr. [redacted] to call our office to resolve this issue as we have done everything we can without him contacting us.  Otherwise, I'm afraid will end up in collections for his failure to communicate with us.