TEXAS MEDICINE RESOURCES

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 Thank you very much for your assistance You were a great help! Regards, [redacted]

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 Regards, [redacted] ***

Dear Mrs***,Thank you for your response concerning your accountWe have reviewed the charges on your account and they are correctWe stand by the level we have coded and I am enclosing a copy of the coding audit which supports CPT code The charge for each CPT code is assessed based on a survey of fees charged in the Fort Worth area by an independent third party who is widely recognized within the medical industry for its compilation of physician feesOur fees are also in line with fees for this area shown on the website fairhealth.org.We are not trying to be unreasonableWe understand the frustration caused by being out of network with your insurance however we do not agree with the amount determines to be usual and customaryhas not processed this claim correctlyWe are not in-networkIn the past we have called to reprocess but they will not deal with the providerIf the insured/patient will call, will reprocess and they will often reprocess for the full balanceWe are simply asking you to contact your insurance and request that they reprocess the claimIf you choose not to appeal with your insurance, as a courtesy we can offer you a 75% discount on your remaining balance leaving you with payPlease call our office to let us know if you will be accepting the discount will be reprocessing the claim.Sincerely, [redacted] Texas Medicine ResourcesPO Box Fort Worth TX [redacted] Enclosures cc: Revdex.com (redacted)

Complaint: [redacted] I am rejecting this response because: This billing service is being unreasonableCIGNA paid them for the services renderedAttached is the explanation from the insurance company stating I do NOT owe anymore payments related to their servicesEach and every medical provider has accepted the payments made without questionCIGNA and I have tried to work with this provider AND they are not being reasonableThe physician did not provide $ worth of serviceIf they were out of network at the time service was rendered then the attached billing would show any amounts that I may oweHowever this provider is trying to over [redacted] usThey have been paid and now they are making claims about being out of network Regards, [redacted] ***

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 Regards, [redacted]

[redacted] *** EIMMRe: Account: [redacted] Dear Ms [redacted] ***,Thank you for your letter concerning your son's accountYour chart was reviewed and the charges are correct.We are not contracted with We understand the frustration caused by being out of network with your insurance however we do not agree with the amount they determine to be usual and customaryWe encourage you to appeal with your insurance.Fees for acute care are higher than in a doctor's office or an urgent care setting for many valid reasonsOur charges are assessed based on a survey of fees charged in the Dallas/ [redacted] area for each procedure code by an independent third party who is widely recognized within the medical industry for its compilation of physician feesOur fees are also in line with fees for this area shown on the website [redacted] org.If you choose not to appeal with your insurance or they will not reprocess the claim we will always work with a patient to reduce large balancesPlease call our office to discuss a discount or if you have additional questions or concerns.Sincerely, [redacted] Texas Medicine ResourcesPO Box [redacted] TX 761241-***-***-***

Thank you for the responseI did speak with someone with TMR the day the complaint was issued and the matter has been resolved.Thank you for your quick resolution

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID ***, and find that this resolution is satisfactory to meHowever I would like to say that I believe that from what I understand after reading about this company is that they act in a'collection role' for different emergency roomsIn that roll I would understand that if the hospital or emergency room were the services were preformed had a issue with payment that they would have address me directlyI was never contacted by Presby or the ER So I guess what I am not understanding is how this company interacts in its collection rollIf they can see hand written notes from the ER why would they have issues getting the full recordOh well I am glad that I no longer have to think about this issueThank you,
Regards,
*** ***

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID ***, and find that this resolution is satisfactory to me.
Regards,
*** ***

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID ***, and have determined that this does not resolve my dispute
The money is not the issue with the compliant. As stated earlier, we will pay the funds that are due.This is about the practice of stating funds are owed that are never supporting on any documentation. As you as see in the attachment, my account statement referred owing $250.80. There is no mention of additional funds owed to this account. There was never an invoice sent stating a payment due of $after the insurance payments. If $was owed, then it should have been reflected in the statement that we owed $not $250.80.We received a new invoice from the collection agency, which appears the account is still open. But when logging online, it states the account was created in error and closed. These documents are attached.We also received a phone call on our answering machine from *** from Texas Medicine Resources either 4/or 4/15. She stated that our account had been withdrawn from United Revenue and Texas Medicine Resources would invoice us...but it was not totally clear in the call nor have we seen any invoice.In this situation, we feel deceived practices have taken place. We just don't want this to happen to anyone else. Someone needs to address what took place and ensure there are controls within their system to generate correct invoicing to the customer
Regards,
*** * *** ***
Revdex.comMESSAGE FROM BUSINESS:We received information from the Revdex.com letting us know that myresponse did not resolve your dispute I would be happy to discuss what happened with your account If you would like to discuss it further I am enclosing my direct extension.I believe this may be resolved as we have received your payments and I am enclosing a zero balance statement for your records I personally canceled the account with our collection agency, United Revenue Corporation on 4/11/ United Revenue Corporation no longer has the account.Please contact me at the number below if you have additional questions or concerns

Dear Mrs***, We received the information *** *** provided to the Revdex.com concerning the above accountWe do not have an agreement to accept discounted ratesWe understand the frustration caused by bein out of network with your insurance however we do not agree with the
amount determines to be usual and customaryIn the past we have called to have them reprocess the claim for the balance but they will no longer reprocess the claim for the providerThe insured has to call and ask them to reprocessIf you choose not to have your insurance reprocess the claim we will gladly work with you to reduce the billPlease call our offce if you have additional or concemsSincerely, ***Texas Medicine ResourcesPO Box ***Fort Worth TX *** cc: Revdex.com (redacted)

Dear Ms***,We received the information that you provided to the Revdex.com and the separate letter detailing the care you received from DrFranksI have forwarded your letter to the physician group to review.The following information is to address the other issues you mentioned in your response to the Revdex.com.Texas Health Willow Park is a freestanding emergency room and there is signage on the emergency department indicating it is an emergency room.I apologize for the inconvenience but MEM is not giving you accurate information, Texas Medicine Resources does not have a contract withHowever, we will always work with patients to reduce large balancesOnce the physician group has reviewed your letter, if a large balance remains we can offer you a discount.Please allow days for the reviewWe will contact you with an update.Please contact our office if you have further questions.Thank You,CelesteTexas Medicine Resources** *** ***Fort Worth TX 761241-***-***-***

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID ***, and have determined that this does not resolve my dispute
Please enter your reason(s) for rejecting the business response below.This response does not resolve my dispute because the solution offered by Texas Medicine Resource is to balance bill for over three times the amount considered "fair" for the service providedIf Texas Medicine Resources feels the insurance company did not process the claim correctly, the dispute is between Aetna and Texas Medicine Resources as I do not process medical claims.
Regards,
*** ***
Revdex.comThank you for your feedback concerning your son's account We understand the frustration caused by being out of network with your insurance however we do not agree with the amount -determines to be usual and customary The rate they set is not an accepted or fair rate In the past we have called to ask them to reprocess the claim but they will no longer reprocess the claim for the provider They will send the balance back for the insured We often have to enlist the help of the insured to have the claim reprocessed and apologize if this causes an inconvenience.-is aware that many providers do not accept their rate They even include details on how to appeal on your explanation of benefits for this reason You should see a message that reads:We made a payment to a health care provider you usedThis provider is not part of our network, (This means we do not have a contract with the provider.) Because we are treating these services under your plan as if you got your care from a network provider, you do not owe the provider anything except any copayment coinsurance or deductible that applies You do not have to make any other payments to the providerWe believe our payment to the provider was fair. Theprovider may not agreeIf this provider billsyou any additional amount above the amount you are responsible for, send the bill to US at the address on your member ID cardBe sure your member ID number is on the bill.Make sure to include a copy of this explanation of benefits when you send the bill to us.We will always work with the patient if a large balance remains after insurance paysAs stated in the previous letter, if you choose not to appeal with -we have already applied a 40% discount to your account leaving you with a balance of $177.57.Please call our offices if you have any further questions

Complaint: ***
I am rejecting this response because: the billing service is being unreasonable in their demandsI met my deductible for the year in questionThis means I should NOT pay one more penny out of pocketHowever I will contact the insurance company and ask them to pay the discounted offer of 75% that the billing service tenderedThey are asking me to refile the claim even though I did that and CIGNA would not pay the $ amountMaybe CIGNA will pay the discounted amount of $ that has been proposed? I am really disappointed that it took involving the Revdex.com to get the billing department at this physician's office to do anything other than demand the outrageous payment of $ 774.94, in addition to what the insurance paidEvery other physician and medical facility accepted the amount paid by CIGNA for this medical issueI did involve CIGNA, even had a conference call among CIGNA Claims, myself and this billing departmentThey would NOT budge on the full payment demandsCIGNA attempted to explain the reasoning and that the payment made was fair and reasonableIf the billing department would have made the discount offer during that conversation, this could have been avoided
Regards,
*** ***

To Whom It May Concern;We received the information you sent concerning the above case.  We have responded directly to Mr. [redacted] concerning his account. Hopefuly our response to Mr. [redacted] has answered his questions and concerns. If you need additional information please let me...

know. Sincerely, [redacted] Director of Reimbursement Texas Medicine Resources

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.
Regards,
[redacted]

Complaint: [redacted]
I am rejecting this response because: This billing service is being unreasonable. CIGNA paid them for the services rendered. Attached is the explanation from the insurance company stating I do NOT owe anymore payments related to their services. Each and every medical provider has accepted the payments made without question. CIGNA and I have tried to work with this provider AND they are not being reasonable. The physician did not provide $ 1254.00 worth of service. If they were out of network at the time service was rendered then the attached billing would show any amounts that I may owe. However this provider is trying to over[redacted] us. They have been paid and now they are making false claims about being out of network.
Regards,
[redacted]

[redacted] EIMMRe: Account: [redacted]Dear Ms[redacted],Thank you for your letter concerning your son's account. Your chart was reviewed and the charges are correct.We are not contracted with We understand the frustration caused by being out of network with your insurance however we do not agree...

with the amount they determine to be usual and customary. We encourage you to appeal with your insurance.Fees for acute care are higher than in a doctor's office or an urgent care setting for many valid reasons. Our charges are assessed based on a survey of fees charged in the Dallas/[redacted] area for each procedure code by an independent third party who is widely recognized within the medical industry for its compilation of physician fees. Our fees are also in line with fees for this area shown on the website [redacted]org.If you choose not to appeal with your insurance or they will not reprocess the claim we will always work with a patient to reduce large balances. Please call our office to discuss a discount or if you have additional questions or concerns.Sincerely,[redacted]Texas Medicine ResourcesPO Box [redacted] TX 761241-[redacted]

We received the information you sent to the Revdex.com concerning the above account.  Our demographic information is forwarded to us from the hospital but we.often do not receive complete information.  Due to the volume of accounts we cannot contact the hospital on...

every account with a bad address.  We do have an automated system that calls patients for a month when we have been notified of a bad address. If we do not receive a response from the patient we send those accounts to a collection agency to do further research.United Revenue Corporation has not reported this account to the credit bureaus. Per United Revenue they received the first call from you on and sent an itemized statement to you the same day.Your insurance reprocessed the claim and paid in full on 10/31116. We are requesting a refund to United Revenue which can take 4 6 weeks. They have placed your account on an indefinite hold pending the payment.  You should not receive any further communication from them.If you have additional concerns or questions please call our office.

Re: Account TMR Dear Mr. [redacted],We received the information you sent to the Revdex.com concerning yourson's account. We are not in-network with but they still took a discount they should not have taken. They applied this discount to over 400 of our claims. We made them aware of...

the issue and they chose not to reprocess the claims.We understand the frustration caused by being out of network with your insurance however we do not agree with the amount determines to be usual and customary.Texas Medicine Resources has made an effort to reach a mutually agreeable contract with has been unwilling to present the physician group with satisfactory terms,In the past we have called to ask them to reprocess claims but they usually will not reprocess the claim for the provider. They will send the balance back for the insured [redacted] have to enlist the help of the patient to get the claim re repocessed. I called on your son's claim on 4/12/17, reference number: , The representative statedthat he would send the claim back for reprocessing. However, the often state that they processed it correctly. I would encourage you also to reach out to ME to make sure they are reprocessing the claim,If does not reprocess the claim for additional payment or leaves a large balance please call our office to discuss a discount. We will always work with the patient if a large balance remains after insurance pays.Sincerely,CelesteTexas Medicine Resources[redacted]cc: Revdex.com (redacted)