[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 ***, and find that this resolution would be satisfactory to me. I will wait until for the business to perform this action and, if it does, will consider this complaint resolved
Regards,
*** ***
For the last nine years it has been office policy that patients present for a consultation with Dr. Rusiecki and develop a treatment plan. Once the development of the treatment plan is completed, the patient is then guided to the front desk where a member of the staff reviews all the financial...
aspects associated with the treatment plan. This includes the total cost before any insurance is filed and the office financial policy of collecting 25% of the total cost of the surgery up front. We then explain to them we will call both their medical and dental insurance, if applicable, to clarify coverage, deductible and any other out of pocket expenses. This office policy as we have found with experience that quotes over the phone, Internet and fax are not always accurate. The patient is then asked to review, agree and sign the office financial policy. They are then given the original copy after it is scanned into our system. This 25% is broken down by placing a $100 deposit for the surgery appointment and the remaining balance of the 25% is due at the time of service/ the surgery date. In the mean time, the patient's medical and dental benefits are verified, if applicable. This can be completed by phone, internet, or fax. If it is found that the remaining balance of the 25% needs to increase due to a patient's deductible not being: met, or lack of benefits, the patient is then called at the earliest possible time so that the patient is educated and is able to gather any financial resources they may need. On the day of the procedure the patient is checked in and payment is collected, any necessary follow up appointments are made, and post op instructions are given to the patient. After the patient's procedure is completed the patient's claim is processed that same day and sent out to the appropriate medical or dental insurance. It is standard practice that if a patient has medical insurance to bill the medical insurance first because the dental insurance will not process any claims without the Explanation of Benefits(EOB) from the primary insurance. Receiving the EOB from the primary insurance will take anywhere from 6-8 weeks which is standard time of processing as long as the insurance does not require any additional information to support the claim. Once our office receives the primary insurance's EOB then it is attached the dental insurance or secondary insurance's claim and mailed out. The standard practice again to have the EOB from the dental or secondary insurance EOB received back in our office is 6-8 weeks. After we hear back from all the insurances we then will process the account and make any refunds due back to the patient if necessary. The EOB breaks down all payments and adjustments made by that insurance company. In regards to the complaint filed by the above party the "non billable to the member so therefore we owe nothing" is incorrect. It clearly states on the patients primary [redacted] EOB that the services for the anesthesia were denied under code H1- a rejected billable service non-covered 'service, nowhere on the EOB does it state that we couldn't bill patient or patient's secondary insurance. It is our standard protocol to bill secondary insurance for any remaining balance due on the procedure after processed by primary insurance or if there is no secondary insurance the remaining balance goes to patient responsibility. Patient, [redacted]'s claim was submitted by mail the day of her procedure. We received the EOB back from her primary insurance six weeks later where we then submitted a claim to the secondary insurance for the remaining balance for the non covered services. We are now waiting for the secondary insurance to process the claim which can take up to 6 to 8 weeks. All of which is the standard of processing and all fails within the timely filing guidelines. After receiving all EOB from all insurances billed we will then process refund check to patient if refund is applicable. This is our office financial policy and is explained to patient at time of the consultation, which as stated in the earlier part of the letter is understood and signed by the patient, scanned into their electronic medical records, and the original is given to them for their records. If you have any further questions or concerns please feel free to contact me at my office at [redacted].
[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 ***, and find that this resolution would be satisfactory to me. I will wait until for the business to perform this action and, if it does, will consider this complaint resolved
Regards,
*** ***
For the last nine years it has been office policy that patients present for a consultation with Dr. Rusiecki and develop a treatment plan. Once the development of the treatment plan is completed, the patient is then guided to the front desk where a member of the staff reviews all the financial...
aspects associated with the treatment plan. This includes the total cost before any insurance is filed and the office financial policy of collecting 25% of the total cost of the surgery up front. We then explain to them we will call both their medical and dental insurance, if applicable, to clarify coverage, deductible and any other out of pocket expenses. This office policy as we have found with experience that quotes over the phone, Internet and fax are not always accurate. The patient is then asked to review, agree and sign the office financial policy. They are then given the original copy after it is scanned into our system. This 25% is broken down by placing a $100 deposit for the surgery appointment and the remaining balance of the 25% is due at the time of service/ the surgery date. In the mean time, the patient's medical and dental benefits are verified, if applicable. This can be completed by phone, internet, or fax. If it is found that the remaining balance of the 25% needs to increase due to a patient's deductible not being: met, or lack of benefits, the patient is then called at the earliest possible time so that the patient is educated and is able to gather any financial resources they may need. On the day of the procedure the patient is checked in and payment is collected, any necessary follow up appointments are made, and post op instructions are given to the patient. After the patient's procedure is completed the patient's claim is processed that same day and sent out to the appropriate medical or dental insurance. It is standard practice that if a patient has medical insurance to bill the medical insurance first because the dental insurance will not process any claims without the Explanation of Benefits(EOB) from the primary insurance. Receiving the EOB from the primary insurance will take anywhere from 6-8 weeks which is standard time of processing as long as the insurance does not require any additional information to support the claim. Once our office receives the primary insurance's EOB then it is attached the dental insurance or secondary insurance's claim and mailed out. The standard practice again to have the EOB from the dental or secondary insurance EOB received back in our office is 6-8 weeks. After we hear back from all the insurances we then will process the account and make any refunds due back to the patient if necessary. The EOB breaks down all payments and adjustments made by that insurance company. In regards to the complaint filed by the above party the "non billable to the member so therefore we owe nothing" is incorrect. It clearly states on the patients primary [redacted] EOB that the services for the anesthesia were denied under code H1- a rejected billable service non-covered 'service, nowhere on the EOB does it state that we couldn't bill patient or patient's secondary insurance. It is our standard protocol to bill secondary insurance for any remaining balance due on the procedure after processed by primary insurance or if there is no secondary insurance the remaining balance goes to patient responsibility. Patient, [redacted]'s claim was submitted by mail the day of her procedure. We received the EOB back from her primary insurance six weeks later where we then submitted a claim to the secondary insurance for the remaining balance for the non covered services. We are now waiting for the secondary insurance to process the claim which can take up to 6 to 8 weeks. All of which is the standard of processing and all fails within the timely filing guidelines. After receiving all EOB from all insurances billed we will then process refund check to patient if refund is applicable. This is our office financial policy and is explained to patient at time of the consultation, which as stated in the earlier part of the letter is understood and signed by the patient, scanned into their electronic medical records, and the original is given to them for their records. If you have any further questions or concerns please feel free to contact me at my office at [redacted].