The Center for Advanced Pediatrics P.C.

Good Evening, As stated earlier, being in this practice for years and having experience with other pediatric offices, vision and hearing SCREENINGS were always included as these screening are done by medical assistants who are not certified in hearing/vision and this is the reason insurance does NOT allow for them to bill these screenings as extrasThese were ALWAYS covered for all the years I was there, and the only time I was asked if my child wanted these services was when he had [redacted] as secondary insurance and the practice was not allowed to bill me for ANYTHING by law, so they asked me hoping I would opt outNever did they say that they now charge for this screening that has been part of a physical for as long as I have been aliveI understand when I signed the financial policy as with all doctors, that blood and urine samples sent out may not be coveredThe practice should thoroughly explain to patients about the vision and hearing not being covered under ANY plans so patients can opt out especially for those having vision/hearing coverage with NO copaysThose that want to pay for a service such as a "screening" only to be referred to a specialist can do soI find it odd that they asked me to get my consent for this service while on [redacted] and the first year I have only private insurance they preform these tests without my written or verbal consentMy son is and is not old enough to consent for these testsThe financial for did not consent for "screenings" for specialty servicesWhen schools provide these screenings, free of charge, they need the parents written permissionAgain, I would like these charges removed from my account Complaint: [redacted] I am rejecting this response because: Sincerely, [redacted]

Good Evening,
As stated earlier, being in this practice for 15 years and having experience with other pediatric offices, vision and hearing SCREENINGS were always included as these screening are done by medical assistants who are not certified in hearing/vision and this is the reason insurance does NOT allow for them to bill these screenings as extras. These were ALWAYS covered for all the years I was there, and the only time I was asked if my child wanted these services was when he had [redacted] as secondary insurance and the practice was not allowed to bill me for ANYTHING by law, so they asked me hoping I would opt out. Never did they say that they now charge for this screening that has been part of a physical for as long as I have been alive. I understand when I signed the financial policy as with all doctors, that blood and urine samples sent out may not be covered. The practice should thoroughly explain to patients about the vision and hearing not being covered under ANY plans so patients can opt out especially for those having vision/hearing coverage with NO copays. Those that want to pay for a service such as a "screening" only to be referred to a specialist can do so. I find it odd that they asked me to get my consent for this service while on [redacted] and the first year I have only private insurance they preform these tests without my written or verbal consent. My son is 15 and is not old enough to consent for these tests. The financial for did not consent for "screenings" for specialty services. When schools provide these screenings, free of charge, they need the parents written permission. Again, I would like these charges removed from my account.
Complaint: [redacted]
I am rejecting this response because:
Sincerely,
[redacted]

Dear Ms. [redacted],      While we totally understand Ms. [redacted]'s frustration that her insurance did not cover all the vision test, she needs to understand that it is her responsibility to know if services are covered under her son’s specific insurance plan.   If she would review her EOB (we would be happy to walk her through it), she would see that her insurance did cover part of the vision test ($20.85) and billed $25 as her co-pay.  The tests we perform are totally different than those done in school as we use the most advanced technology in our screening.  We do not know which of our patients’ insurances cover vision but we want to make sure all our patients are screened properly for both vision and hearing.  We do inform all our patients of the services and tell them to check their insurance.  We don’t discriminate between [redacted] and Private Insurance, it is our policy to tell everyone, especially the private, so that they are aware of this and we can avoid this type of backlash.  Actually, the [redacted] patients are the ones we don’t worry about because we know they are all covered, but we still inform them.  Ms. [redacted]’s insinuation of our trying to manipulate the system is totally not founded.  As a matter of fact, she acknowledges she knew we always conduct these tests, but that now we are charging for them, which is not true.  We have always charged for them, now that she has new insurance, it is her responsibility to know if they are covered.  Her reasoning is contradictory: “These were ALWAYS covered for all the years I was there, and the only time I was asked if my child wanted these services was when he had [redacted] as secondary insurance and the practice was not allowed to bill me for ANYTHING by law, so they asked me hoping I would opt out. Never did they say that they now charge for this screening that has been part of a physical for as long as I have been alive.” Again, we can understand her frustration, but she is responsible for this charge and has signed a financial policy acknowledging it is her responsibility.  With all the changes happening with medical insurance, it is important for families to understand their policies.  Ms. [redacted] is responsible for her $40 balance, and as stated in our previous email, she needs to let the scheduler know that she does not want these tests in the future and her son’s account will be noted as such. Sincerely, Mary S[redacted] The Center for Advanced Pediatrics [redacted]
[redacted] [redacted]
[redacted]

I am writing in response to a "final notice" we received regarding the complaint # [redacted].  We had not received any prior notices for this complaint, so we apologize if it appears we were not responding.      Our practice follows the Bright Futures standard...

of care and an annual vision and hearing test is a part of that care. We don't ask if patients want the tests, they are always included in an annual check up.   Ms. [redacted] did sign our financial policy which states she needs to check with her insurance for specific services covered.      Her son is 15 years old and as she stated in her letter, they have been coming to our practice for years and she knows that these tests are a part of every annual check up. We had lowered the bill because we were sensitive to her having changed insurances and understood this was a one time happening.  Ms. [redacted] should make our office aware that she does not want these services included in her son's annual visit since they are covered with specialists and it will be noted in his chart.      We hope you can understand that we can not be responsible for knowing every patients insurance plan, but our patients do know what to expect at each annual physical. If you have any questions please don't hesitate to let me know. Best regards, Mary S[redacted] Patient Relations The Center for Advanced Pediatrics [redacted] ###-###-#### [redacted]