I am deeply offended at the slanderous and libelous allegations that Ms. [redacted]has made against me while blaming me for difficulties she is having with her insurancecompany.On 1-25-16, Ms. [redacted] presented herself for a consultation and exam followedby treatments in this office from 1-26-16...
through 2-17-16 for a total often office visitsover a period of about 3 Y2 weeks. She alleges that she "was never informed that I had aco-pay for a specific service I was receiving. Had I been informed that I was incurringadditional out of pocket costs I could have made the decision of whether to receive thoseservices." This implies that: 1. We purposely or neglectfully didn't inform her that herinsurance wouldn't pay for a particular service; and 2. That she shouldn't be required topay for the services in question that she received because we didn't warn her that theinsurance wouldn't pay for all the services she needed that we provided for her.In regards to # 1 above, when a patient that has insurance comes into our office,we contact the insurance company to verify the patient's benefits with that insurancecompany out of a courtesy for our patients. When we contact the insurance carrier, thereis always a disclaimer that we must acknowledge stating that the benefits outlined for thatpatient DOES NOT GUARANTEE PAYMENT for the services rendered. For us to knowfor certain exactly what an insurance company will or won't pay for a patient before anytreatment is provided is literally impossible. All we can do is to contact the insurancecompany and get the same information that Ms. [redacted] obtained herself, which we did.After we obtained that information, we then informed Ms. [redacted] of what the insurancecompany said to us, that she has a $25.00 co-pay.In regards to #2 above, Ms. [redacted] believes (or desires) that she not be heldresponsible for services that she received at this office and that she shouldn't have to paythe balance due of$205 because we didn't warn her that there may be costs that theinsurance won't pay for. All patients are asked to read and sign a Financial Policy beforeany treatment is provided to that patient. In that financial policy there is a paragraph thatapplies to Ms. [redacted] titled "Group or Individual Insurance" which states "Yourinsurance is an agreement between you and your insurance company. If you havequestions about your insurance coverage we encourage you to call the insurance companydirectly. We cannot be certain if your insurance covers Chiropractic, although mostpolicies do provide coverage. The amount they pay varies. When possible, we willverify benefits on your insurance; HOWEVER, until the claims have been received,reviewed and processed per your plan/policy's provisions and limitations and exclusions,there is NO GUARANTEE OF PA YMEN'F. Our office will complete any necessaryinsurance forms at no additional charge, and file them with your insurance company. Itis to be understood and agreed that any services rendered are charged to you directly andyou are personally responsible for payment. This includes any services not paid byinsurance, deductibles, co-pay or co-insurance. You may choose not to use your group orindividual insurance plan/policy for any reason and participate as a patient withoutinsurance." Ms. [redacted] signed the Financial Policy with my receptionist as a witness (acopy of which is included with this letter) and we did verify her benefits, complete andfile all necessary forms with her insurance company in a timely manner, and applied theinsurance payments to her account properly.In Ms. [redacted] complaint, she also states that "The office has only offered to setup a payment plan." In the Financial Policy referred to above, the paragraph immediatelyabove Ms. [redacted] signature states "I have read and understand the payment policy(s)of The Dalles Chiropractic. I request that The Dalles Chiropractic prepare thecustomary forms at no charge to me so that I may obtain insurance benefits. I alsounderstand that if my insurance does not pay for treatments, if I suspend or terminate mycare as recommended by Dr K[redacted] that allfees will be due and payable immediately."Ms. [redacted] insurance did not pay for some of her treatments and she terminated hercare prematurely. I believe we are being more than fair in offering her an interest freepayment plan to bring her account to a zero balance.Ms. [redacted] also claims that we did not inform her in a timely manner that theinsurance wasn't paying for some of her treatment by stating that "Had I received astatement in February showing that a specific service was not going to be paid by myinsurance because it applies to my deductible, I could have avoided incurring additionalout of pocket costs." Again, it is impossible for us to know for certain what any insurancecompany will or will not pay for until we receive a notice from the insurance company(called an EOB) AFTER they process a claim and send notification to us of what they didwith the claim. It is also impossible for us to know how long an insurance company willtake to process a claim. By law an insmance company can take up to 90 days. Fortunatelymost claims are processed within 30 days. Ms. [redacted] first visit to this office was on1-25-16 and we sent the first claim to her insurance on 2-5-16 which is a 2 week timeperiod (which is well within the timely filing industry standards) and included 7 of her total 10 visits. Her last visit to this office was on 2-17-16 and we sent her a statement on2-19-16 which was before we received an EOB from her insurance company, which wereceived on 2-26-16, 3 weeks after we sent the claim to them. The next statement we sentto Ms. [redacted] was on 3-17-16 which included the processed insurance payments wereceived up to that point as well as the remainder of the balance that she is responsiblefor. We send statements to all our patients once per month as is standard in mostprofessions and businesses. Typically we send out patient statements around the 20th ofthe month which we did for Ms. [redacted].When the insurance company processes a claim and sends an EOB to us, they alsosend that same EOB to the patient as well. We received the first EOB from Ms. [redacted]'sinsurance company on 2-26-16, 3 weeks after filing the claim, meaning that Ms. [redacted]likely also received her copy of the EOB from her insurance close to that same date. IfMs. [redacted] did not understand the EOB when she received it, she could have eithercalled the insurance company or my office and we would have gladly explained what wason her EOB. Once again, it is impossible for us to know what the insurance company willor will not pay for until we receive an EOB and it is impossible for us to know when wewill receive an EOB after a claim has been filed. Ms. [redacted]'s last visit to this officeoccurred 9 days before we received the first EOB from her insurance company which was9 days before we could've known exactly what the insurance company would pay for herclaim. Ms. [redacted]'s account, insurance billing, and statements were handled in a timelymanner.Ms. [redacted] claims that I have a "lack of respect for others time". Normally, Istart treating patients at 9:00 a.m. When Ms. [redacted] first consulted me about hercondition on 1-25-16 she stated that she was unable to have appointments during ournormal patient treatment hours due to her work schedule. So I went out of my way andoffered to open my office for her an hour early at 8:00 a.m. to allow her to receive thecare she needed to recover from her condition, which she gladly accepted. This allowedher to not miss any work and to keep to as normal of a schedule as was possible for herwhile seeking care for her condition. Ms. [redacted] states that there were "a few occasions that Dr. K[redacted] was notthere" at her scheduled appointment times implying that I was careless about showing upfor her appointments. There were only 2 ap~intments that I was unable to be present forher. The frrst occasion was on February 10 when I came down with the flu (vomiting,fever, and diarrhea) at 3:00a.m. making it impossible for me to work. On that particularmorning I notified my receptionist that I was ill and unable to treat patients asking her toreschedule all my patients for that day. At 7:30a.m. my receptionist, Ashley, startedcarrying out that task and finished by 8:00a.m. Ms. [redacted] was notified that I was illand unable to make it to my office for her appointment before she had even left her housethat morning.The second time I was unable to meet her at my office for her appointment was onFebruary 15th when I had an unavoidable family emergency that morning causing me toarrive at my office later than anticipated when Ms. [redacted] appointments were scheduled. As I did not have her phone number with me at my house, I was unable tonotify her that I would not make it to her appointment on time. Ms. [redacted] came in forone more visit on February 17th at which time I apologized to her for having missed herlast visit causing her an inconvenience. It now appears that my sincere apology was notaccepted. Ms. [redacted] then failed to keep her next 4 appointments, without notification,while I waited for her at my office at 8:00 a.m. After missing those 4 appointments Ms.[redacted] contacted this office cancelling all the rest of her scheduled appointments.Regrettably, there was one day that Ms. [redacted] was seen after some otherpatients .. I did not intend for her to be seen after other patients (as they arrived before shedid) and apologized to her for not seeing her closer to her scheduled appointment time. Itseems that this apology was also not accepted. Unfortunately, I can't always control thelength of time a patient visit lasts because patients often have different needs at differentappointments and I have to adapt to that as best I can when it happens. Ms. [redacted] states that I have "poor hand hygiene" because I "do not wash (my)hands or use hand sanitizer between patients, and (my) hands come in contact with thepatients skin." 1. How does she know when my hands come into contact with a patient'sskin? There is no way for Ms. [redacted] to know when my hands do or do not come into"contact with the patients skin" as she states because she is not allowed to observe mewhen treating other patients as is standard protocol in the health care field when a doctortreats a patient, and the vast majority of my treatments are delivered over or through thepatients clothing; 2. How does she know when I do or do not clean my hands? Does Ms.[redacted] assume I do not clean my hands between patients because she hasn't personallyobserved me clean my hands in front of her? If that is the case then perhaps she shouldalways assume that no one cleans their hands (e.g.-like surgeons, dentists, chef's,restaurant workers, etc ... ) unless she sees it for herself. Therefore, every time she goesinto a restaurant, just to make sure every one's hands are clean before preparing food forher, perhaps Ms. [redacted] should demand that all the workers at that establishment grabsome hand cleaning agent and clean their hands immediately in front of her beforepreparing and serving food for her so that she knows for certain that their hands areclean! Her assertions are baseless, ludicrous and ridiculous! Of course I treat my patientswith clean hands! I have baby wipes at each of my ~eatment areas and a bathroom thathas soap and water, and I do use them. When Ms. [redacted] last talked to my billing specialist, Jean, Ms. [redacted] wasvery rude and would not allow Jean to talk or explain anything until Ms. [redacted] wasfinished saying what she wanted to say. Jean was so offended by Ms. [redacted] during hertirade that Jean almost hung up on Ms. [redacted]. Ms. [redacted]'s behavior over the phonewas so bad that Jean's reactions caught Ashley's attention when she was at thereceptionists desk in a separate room at the time of the phone call. Fortunately Jean wasable to maintain her composure and professionalism during the entire phone call anddidn't even raise her voice. When Ms. [redacted] finally finished her tirade, Jean wasfinally able to respectfully try to explain what was happening with Ms. [redacted]'s accountand insurance, but Ms. [redacted] would not listen to what Jean had to say and dismissed demanded that she not be charged the $205 that she owes for services she received here atthis office.In conclusion:1. I do respect other peoples time as I know time is the most valuablecommodity on the planet and no-one ever has enough of it2. Her account and billing was handled in a timely manner3. We are being very fair by offering her an interest free payment plan4. I do keep my hands clean for my patients5. I am sorry that Ms. [redacted] is not happy with the contract she has with herinsurance company and6. I am sorry that Ms. [redacted] insurance company did not pay everything thatshe expected them to pay.We went out of our way to provide Ms. [redacted] with the best services we could providewhich helped her condition improve allowing her to work and participate in her normalactivities of daily living and we expect to be compensated for the services we provided toMs. [redacted].If you have any questions please feel free to contact me.out of hand everything that Jean tried to explain. During the phone call, Ms. [redacted]
I am deeply offended at the slanderous and libelous allegations that Ms. [redacted]has made against me while blaming me for difficulties she is having with her insurancecompany.On 1-25-16, Ms. [redacted] presented herself for a consultation and exam followedby treatments in this office from 1-26-16...
through 2-17-16 for a total often office visitsover a period of about 3 Y2 weeks. She alleges that she "was never informed that I had aco-pay for a specific service I was receiving. Had I been informed that I was incurringadditional out of pocket costs I could have made the decision of whether to receive thoseservices." This implies that: 1. We purposely or neglectfully didn't inform her that herinsurance wouldn't pay for a particular service; and 2. That she shouldn't be required topay for the services in question that she received because we didn't warn her that theinsurance wouldn't pay for all the services she needed that we provided for her.In regards to # 1 above, when a patient that has insurance comes into our office,we contact the insurance company to verify the patient's benefits with that insurancecompany out of a courtesy for our patients. When we contact the insurance carrier, thereis always a disclaimer that we must acknowledge stating that the benefits outlined for thatpatient DOES NOT GUARANTEE PAYMENT for the services rendered. For us to knowfor certain exactly what an insurance company will or won't pay for a patient before anytreatment is provided is literally impossible. All we can do is to contact the insurancecompany and get the same information that Ms. [redacted] obtained herself, which we did.After we obtained that information, we then informed Ms. [redacted] of what the insurancecompany said to us, that she has a $25.00 co-pay.In regards to #2 above, Ms. [redacted] believes (or desires) that she not be heldresponsible for services that she received at this office and that she shouldn't have to paythe balance due of$205 because we didn't warn her that there may be costs that theinsurance won't pay for. All patients are asked to read and sign a Financial Policy beforeany treatment is provided to that patient. In that financial policy there is a paragraph thatapplies to Ms. [redacted] titled "Group or Individual Insurance" which states "Yourinsurance is an agreement between you and your insurance company. If you havequestions about your insurance coverage we encourage you to call the insurance companydirectly. We cannot be certain if your insurance covers Chiropractic, although mostpolicies do provide coverage. The amount they pay varies. When possible, we willverify benefits on your insurance; HOWEVER, until the claims have been received,reviewed and processed per your plan/policy's provisions and limitations and exclusions,there is NO GUARANTEE OF PA YMEN'F. Our office will complete any necessaryinsurance forms at no additional charge, and file them with your insurance company. Itis to be understood and agreed that any services rendered are charged to you directly andyou are personally responsible for payment. This includes any services not paid byinsurance, deductibles, co-pay or co-insurance. You may choose not to use your group orindividual insurance plan/policy for any reason and participate as a patient withoutinsurance." Ms. [redacted] signed the Financial Policy with my receptionist as a witness (acopy of which is included with this letter) and we did verify her benefits, complete andfile all necessary forms with her insurance company in a timely manner, and applied theinsurance payments to her account properly.In Ms. [redacted] complaint, she also states that "The office has only offered to setup a payment plan." In the Financial Policy referred to above, the paragraph immediatelyabove Ms. [redacted] signature states "I have read and understand the payment policy(s)of The Dalles Chiropractic. I request that The Dalles Chiropractic prepare thecustomary forms at no charge to me so that I may obtain insurance benefits. I alsounderstand that if my insurance does not pay for treatments, if I suspend or terminate mycare as recommended by Dr K[redacted] that allfees will be due and payable immediately."Ms. [redacted] insurance did not pay for some of her treatments and she terminated hercare prematurely. I believe we are being more than fair in offering her an interest freepayment plan to bring her account to a zero balance.Ms. [redacted] also claims that we did not inform her in a timely manner that theinsurance wasn't paying for some of her treatment by stating that "Had I received astatement in February showing that a specific service was not going to be paid by myinsurance because it applies to my deductible, I could have avoided incurring additionalout of pocket costs." Again, it is impossible for us to know for certain what any insurancecompany will or will not pay for until we receive a notice from the insurance company(called an EOB) AFTER they process a claim and send notification to us of what they didwith the claim. It is also impossible for us to know how long an insurance company willtake to process a claim. By law an insmance company can take up to 90 days. Fortunatelymost claims are processed within 30 days. Ms. [redacted] first visit to this office was on1-25-16 and we sent the first claim to her insurance on 2-5-16 which is a 2 week timeperiod (which is well within the timely filing industry standards) and included 7 of her total 10 visits. Her last visit to this office was on 2-17-16 and we sent her a statement on2-19-16 which was before we received an EOB from her insurance company, which wereceived on 2-26-16, 3 weeks after we sent the claim to them. The next statement we sentto Ms. [redacted] was on 3-17-16 which included the processed insurance payments wereceived up to that point as well as the remainder of the balance that she is responsiblefor. We send statements to all our patients once per month as is standard in mostprofessions and businesses. Typically we send out patient statements around the 20th ofthe month which we did for Ms. [redacted].When the insurance company processes a claim and sends an EOB to us, they alsosend that same EOB to the patient as well. We received the first EOB from Ms. [redacted]'sinsurance company on 2-26-16, 3 weeks after filing the claim, meaning that Ms. [redacted]likely also received her copy of the EOB from her insurance close to that same date. IfMs. [redacted] did not understand the EOB when she received it, she could have eithercalled the insurance company or my office and we would have gladly explained what wason her EOB. Once again, it is impossible for us to know what the insurance company willor will not pay for until we receive an EOB and it is impossible for us to know when wewill receive an EOB after a claim has been filed. Ms. [redacted]'s last visit to this officeoccurred 9 days before we received the first EOB from her insurance company which was9 days before we could've known exactly what the insurance company would pay for herclaim. Ms. [redacted]'s account, insurance billing, and statements were handled in a timelymanner.Ms. [redacted] claims that I have a "lack of respect for others time". Normally, Istart treating patients at 9:00 a.m. When Ms. [redacted] first consulted me about hercondition on 1-25-16 she stated that she was unable to have appointments during ournormal patient treatment hours due to her work schedule. So I went out of my way andoffered to open my office for her an hour early at 8:00 a.m. to allow her to receive thecare she needed to recover from her condition, which she gladly accepted. This allowedher to not miss any work and to keep to as normal of a schedule as was possible for herwhile seeking care for her condition. Ms. [redacted] states that there were "a few occasions that Dr. K[redacted] was notthere" at her scheduled appointment times implying that I was careless about showing upfor her appointments. There were only 2 ap~intments that I was unable to be present forher. The frrst occasion was on February 10 when I came down with the flu (vomiting,fever, and diarrhea) at 3:00a.m. making it impossible for me to work. On that particularmorning I notified my receptionist that I was ill and unable to treat patients asking her toreschedule all my patients for that day. At 7:30a.m. my receptionist, Ashley, startedcarrying out that task and finished by 8:00a.m. Ms. [redacted] was notified that I was illand unable to make it to my office for her appointment before she had even left her housethat morning.The second time I was unable to meet her at my office for her appointment was onFebruary 15th when I had an unavoidable family emergency that morning causing me toarrive at my office later than anticipated when Ms. [redacted] appointments were scheduled. As I did not have her phone number with me at my house, I was unable tonotify her that I would not make it to her appointment on time. Ms. [redacted] came in forone more visit on February 17th at which time I apologized to her for having missed herlast visit causing her an inconvenience. It now appears that my sincere apology was notaccepted. Ms. [redacted] then failed to keep her next 4 appointments, without notification,while I waited for her at my office at 8:00 a.m. After missing those 4 appointments Ms.[redacted] contacted this office cancelling all the rest of her scheduled appointments.Regrettably, there was one day that Ms. [redacted] was seen after some otherpatients .. I did not intend for her to be seen after other patients (as they arrived before shedid) and apologized to her for not seeing her closer to her scheduled appointment time. Itseems that this apology was also not accepted. Unfortunately, I can't always control thelength of time a patient visit lasts because patients often have different needs at differentappointments and I have to adapt to that as best I can when it happens. Ms. [redacted] states that I have "poor hand hygiene" because I "do not wash (my)hands or use hand sanitizer between patients, and (my) hands come in contact with thepatients skin." 1. How does she know when my hands come into contact with a patient'sskin? There is no way for Ms. [redacted] to know when my hands do or do not come into"contact with the patients skin" as she states because she is not allowed to observe mewhen treating other patients as is standard protocol in the health care field when a doctortreats a patient, and the vast majority of my treatments are delivered over or through thepatients clothing; 2. How does she know when I do or do not clean my hands? Does Ms.[redacted] assume I do not clean my hands between patients because she hasn't personallyobserved me clean my hands in front of her? If that is the case then perhaps she shouldalways assume that no one cleans their hands (e.g.-like surgeons, dentists, chef's,restaurant workers, etc ... ) unless she sees it for herself. Therefore, every time she goesinto a restaurant, just to make sure every one's hands are clean before preparing food forher, perhaps Ms. [redacted] should demand that all the workers at that establishment grabsome hand cleaning agent and clean their hands immediately in front of her beforepreparing and serving food for her so that she knows for certain that their hands areclean! Her assertions are baseless, ludicrous and ridiculous! Of course I treat my patientswith clean hands! I have baby wipes at each of my ~eatment areas and a bathroom thathas soap and water, and I do use them. When Ms. [redacted] last talked to my billing specialist, Jean, Ms. [redacted] wasvery rude and would not allow Jean to talk or explain anything until Ms. [redacted] wasfinished saying what she wanted to say. Jean was so offended by Ms. [redacted] during hertirade that Jean almost hung up on Ms. [redacted]. Ms. [redacted]'s behavior over the phonewas so bad that Jean's reactions caught Ashley's attention when she was at thereceptionists desk in a separate room at the time of the phone call. Fortunately Jean wasable to maintain her composure and professionalism during the entire phone call anddidn't even raise her voice. When Ms. [redacted] finally finished her tirade, Jean wasfinally able to respectfully try to explain what was happening with Ms. [redacted]'s accountand insurance, but Ms. [redacted] would not listen to what Jean had to say and dismissed demanded that she not be charged the $205 that she owes for services she received here atthis office.In conclusion:1. I do respect other peoples time as I know time is the most valuablecommodity on the planet and no-one ever has enough of it2. Her account and billing was handled in a timely manner3. We are being very fair by offering her an interest free payment plan4. I do keep my hands clean for my patients5. I am sorry that Ms. [redacted] is not happy with the contract she has with herinsurance company and6. I am sorry that Ms. [redacted] insurance company did not pay everything thatshe expected them to pay.We went out of our way to provide Ms. [redacted] with the best services we could providewhich helped her condition improve allowing her to work and participate in her normalactivities of daily living and we expect to be compensated for the services we provided toMs. [redacted].If you have any questions please feel free to contact me.out of hand everything that Jean tried to explain. During the phone call, Ms. [redacted]