Spinal Rehab Sports Medicine

Complaint: ***
I am rejecting this response because:Yes, I made an error regarding the doctors, but at no point during my initial conversation with *** when scheduling my initial appointment did she indicate *** was an out of network provider. I chose not to show signs of being upset out of respect for DrBob, the office employees, and the other patients that were receving treatment. My complaint is not about not working with Dr*** or feeling confused, my complaint is that *** did not indicate that *** was an out of network provider. I provided her with my insurance information at the intial point of the call. I specifically remember providing her with my policy number and group ID. Had *** indicated to me that DrBob was an out of network provider, I would not have scheduled an appointment in the first place. You make the claim that when a patient discloses they have ***, you immediately let them know you are out of network. Well that was not the case with me. I was not told till AFTER my appointment was over, AFTER I had provided her with my *** card for the second time.Also, I did not call back to explain why I was upset, I sent her an email.Due to the lack of competency, I do not feel I should have to pay any outstanding balance and should be reimbursed. I had provided *** with my insurance information during the scheduling call and because she did not tell me *** was out of network, I was under the impression I would be paying a $copay
Regards,*** ***

Unfortunately this falls into a he said, she said disputeWe have been out of network (OON) with *** for several years and we are consistent with telling our patientsIf that wasn't the case we would have several disgruntled patientsI don't want to discredit what you are feeling but with services rendered we can not reimburse you per your contract with ***However I will write-off your balance of the late cancellation fee even though you had signed our paper work stating you understood our policiesI do encourage you to contact your insurance and review your explanation of benefits (EOB)of what is due to our office in the amount of $Our office never has to deal with patients not wanting to pay for services renderedOnce again we apologize you were confused and did not notice all over our paperwork it stated Spinal Rehab & DrBob's infoAlso did or did not hear that we were out of networkI assure you we will continue to educate our patients that it is ultimately the patients responsibility to know their benefits and know if their doctor is in or out of networkWe verify our patients benefits as a courtesy to themThank you for your time and patienceBest Regards,*** ***

January 5, 2015
sans-serif; letter-spacing: 0.2pt;">Spinal Rehab, PA [redacted] 512-[redacted] 512-[redacted] Complaint ID# [redacted] Dear Revdex.com & [redacted], I am writing this letter in regards to the complaint made from [redacted] on 12/10/2014 with claim ID# [redacted]. We are disputing this claim simply because we had no idea the patient was upset with our policies or office. We are participating providers of most major medical insurance and not providers of some. It is our policy to disclose at the time of every phone conversation with a new patient if we are in or out of network with insurance carriers. When a patient discloses they have [redacted] we immediately let them know we are out of network and it is up to their discretion to schedule the appt. As a courtesy to our patients we will verify their insurance and let them know about their insurance benefits as they check out. Regarding Mr. [redacted]' appointment, [redacted] our front desk receptionist who has been with our company for 2 years now took the new patient phone call. She recalls the conversation because of the Dr. [redacted] comment. Dr. [redacted] has not been renting space from us for a year and disclosed that she was no longer with us and doesn't know where she had moved to since she had moved several times since leaving our office. We have NEVER taken any of her patients and if they choose to stay with us that is always made clear she is not here. He then continued to schedule with Dr. Robert Meyer "Dr. Bob". On 10/31/2014 [redacted] emailed him our new patient paperwork. He came to Spinal Rehab, PA. We collected his TXDL and Insurance card and after meeting Dr. Bob and having therapy we went over his benefits (see attached records) and he paid what we had as ([redacted] Out of Network allowable). After check out and not showing any emotion regarding the payment he made towards his out of network deductable, we scheduled him a follow up appointment on 12/10/2014. Mr. [redacted] did call us several times regarding his billed amount and whether it had been submitted and it had been submitted but insurance companies have 30 to 45 days to respond with a completed explanation of benefits. On 11/11/2014 we then provided him with a receipt with diagnoses; he said he would like to try to file himself. The claim was processed by our office and sent from [redacted] to us on 11/21/2014 His deductable portion he owes totaled $186.80 and what was billed was $225.00. On 12/10/2014 [redacted] did a courtesy call to check in on why he missed his appointment and let him know of our late cancellation fee of $40 for not calling us to cancel 24 hours in advance. He then said that was fine and hung up with [redacted]. Then he called back and explained why he was so upset. If we would have known about the situation before the appointment we would have handled this differently but he had filled out all of our paperwork and signed all of our policies and didn't show any signs of being upset about paying for the out of network visit with Dr. Bob and it clearly states all over our paperwork we are NOT Austin Family and Sports Chiropractic. We feel terrible he felt this way and we could have resolved this if he would have discussed this with us from the beginning. We hope that he gets the treatment he needs to feel better and will find a provider that is "In Network" with [redacted]
11/03/2014 collected $161.35 Ins EOB patient portion $186.80 12/10/2014 Late Cancellation $40.00 Patient owes $65.45 Yours in Health, [redacted]