The Eye Institute of Utah, Inc.

Complaint: ***
I am rejecting this response because: The Eye Institute was not truthful in their response They claim I did not contact them before September In fact I called them in April, June and AugustI repeatedlyspoke with their billing department and Tricare I asked their representative to call Tricare directly, since there was some confusion It was only after they sent my bill to a collection agency and I found out they had correctly processed my wife's claim, and their office manager wouldn't return my calls, that I filed this complaint Their statement that I didn't contact them is either willful deceit or anot indication of poor documentation of customer communication.
Sincerely,
*** ***

We are sorry if there was any confusion about participation in our research studies. Patients do not have to have insurance in order to participate in any of our research studies. If they have no insurance they would be responsible for the cost of the exams and surgery. The
advertisement for these studies clearly states that “Compensation for time, travel and surgical medications may be available.” There is no mention that the cost of the procedure would be waived or providedTypically, insurance would cover the cost of this procedure but without coverage, the patient is responsible for the surgical costsThis is also explained to patients when they call inquiring about participating in clinical studies. We do not feel that this advertisement is misleading. Attached is a copy of the advertisement

We have investigated this case and have the following observations and recommendations. The patient and his wife were seen last week (10/24/17) and were told at the time of scheduling their appointment that we bill medical insurance for our services. We always verify this with all
patients, especially new patients. We are not able to participate with vision plans like VSP because we do not sell glassesWe discussed and verified specifically with themBoth patients have United Healthcare which we accept and are participating providersIt is not clear why the patient believes he will owe $550. We have not issued any billing statements to him or his family We have submitted the claims to United Healthcare (UHC), which normally takes a few weeks to process. Once processed, UHC will assign an allowable for covered services (which is less than our billed amount) they then inform us what is to be collected from the patient, if anything. If the patient is found to have a medical problem that is covered, normally the coverage is 80/20. The patients’ plan does not have a deductible, so it is likely that the claim will process and with a 20% coinsurance which is the patients’ responsibilityIf the claim(s) is denied, for whatever reason, we always work with our patients to find a financially feasible solution for both parties. Many vision services, such as VSP, will provide some level of coverage if the patient submits paperwork for reimbursement. On October 30th, our billing manager documented a call with the patient explaining that we would be willing to provide statements and explanation of benefits from the insurance company, if necessaryWe are somewhat confused why the patient has already issued a complaint when the claims have not been processed and no billing statement has been issued. We respectfully ask that the patient retract his complaint until such time that the claim has processed

The patient was seen February of this year for an annual eye exam, and we billed his visit as a medical eye exam, which went towards his deductible, leaving him responsible for a payment of $[redacted]. The patient called our office in May asking why he was receiving a bill, and he was informed that per...

his EOB with Tricare, his payment would go towards his deductible. After he called, we re-billed his visit as a preventative eye exam, however, it was denied by Tricare as a duplicate claim. When this happens, our billing software automatically triggers the balance to be billed to the patient. Since that time, he was sent two delinquent letters, (1st letter on 8/18/2015 and 2nd and final delinquent letter on 9/11/2015). We did not receive a call, payment or any communication from Mr. [redacted] until 9/29. After his call, a member of our billing and claims department researched his claim and spoke with Tricare about correcting his claim, which they said could take between 5-7 business days. We left the patient a detailed voicemail message with this information on 9/30, and hope to have the situation resolved within the next 5-7 business days. Our billing representative also left her direct contact information on the patient's voicemail so he could contact her directly with any further questions or requests. It's our standard operating procedure to immediately address and research patient complaints as soon as they arise so that we can reach a quick resolution. We believe this issue will be resolved to the patient's satisfaction in a timely manner.

We understand your frustrations and have contacted Tricare several times to resolve this issue as quickly as possible. We have submitted another corrected claim and have been told by a Tricare representative that it may take up to 30 days to re-process. Your account will not be sent to collections as we work to resolve this matter. We will make sure to contact you as soon as we find out more information on the status of your claim. We assure you that we are diligently working to resolve this issue, and if you have any additional questions or concerns, please call our billing office at ###-###-####.

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.
Sincerely,
[redacted]