Syracuse Physical Therapy

I am writing in response  to a letter we received from the Revdex.com.  ID # [redacted]. The letter is in regards to a complaint from a patient who was seen in our office, patient [redacted].  Mr. [redacted] scheduled an appointment with us on March 10, 2015 for a physical...

therapy initial evaluation.  He was told to come in with his prescription and his insurance card.  He brought both the script and an insurance card to the appointment and filled out and signed all appropriate paperwork.  It is the patient's responsibility to check and or know his or her  benefits before an  appointment.  As a courtesy we do check the patient's benefits.  Mr. [redacted] brought to me a Medicare card on the day of his first appointment.  I called the Medicare automated system and was told by their computer system that his insurance effective date was 3/1/2012 and his deductible had been met for the year.  I began billing Medicare on 3/11/2015.  The patient was seen a total of 7 times.  Approximately 2 weeks later we started to get denials from Medicare stating that this patient was no longer covered under this plan.  I asked the patient if he had recently changed insurances and said yes.  He had never given me his new insurance card until that day.  I then checked his benefits for his new insurance company - [redacted] Plan Medicare Managed Care - we are not a participating provider with this plan.  I let the patient know over the phone the next day that we were not participating and unfortunately he would then be responsible for payment.  He yelled at me and then hung up the phone.  The next day I received a phone call from his insurance representative.  I explained to her what happened, and she and I both agreed that he was responsible to let us know of any insurance changes, and unfortunately he did not until it was too late.  I told her that that we would accept monthly payments because he is on a limited/ fixed income.  She was going to call him and let him know about our conversation.  I even went as far as to change his amount owed to our "self pay" billing, which is significantly less than what the insurance company would pay us.  Self pay is as follows:  $75 for the patient's initial visit and $35/visit for each individual appointment.  Mr. [redacted] did pay us for his initial visit, but there is no reason he should not be responsible for the other 6 times he was here and treated for an hour by a licensed physical therapist.  Mr. [redacted] did sign all of our financial paperwork that states he is responsible for payment if his insurance company denies treatment.  Please let me know if there is any additional information you would like from me, or feel free to call me anytime.