The Kor

To Whom It May Concern:I have had the opportunity to review the billing complaint for Ms [redacted] 's daughter( [redacted] )While we agree that she has been receiving physical therapy from ourproviders and that she has dual coverage, we disagree about the amount owing.Ms [redacted] has insurance coverage through United Healthcare (her primary insurance)and Providence (her secondary insurance)She has a $deductible with herprimary insurance, then a coinsurance of 20%The secondary insurance (whom we arenot contracted with), has a $deductible and then a 40% coinsurance.The primary claims processed correctly with the deductible and coinsurance and thesecondary insurance was billedBoth insurances applied the balances toward thedeductible and coinsuranceWhile she doesn't have a balance owing from date ofservice 2/9/2016-4/19/(her Providence deductible was met as of 2/9/16), the balanceis coming from dates of service 1/12/2016-2/4/2016, due to the $deductibleI'mnot sure why her insurances would tell her she doesn't owe anything; we do haveexplanations of benefits from both carriers showing that there is a patient responsibilityfor the dates of service we are billing her for.There was a problem with the secondary insurance starting with date of service 2/18/2016as we didn't have the correct address for the policy holderThe policy holder ( [redacted] ) is not a signer on the account; we have had no contact with him or any means tocontact him, and had to rely on the patient to give us this information, which we didn'tget until 4/29/We corrected the claims and they have since processed correctlyAllclaims prior to 2/processed and paid correctly and the dates of service that weredenied in error due to the incorrect address were never billed to the patient.We don't send statements out until the primary and secondary insurances have both paid.That didn't happen until March We received the March statement back in ourreturn mail on 4/8/and attempted to contact the patient for an updated addressWedidn't hear back, so we asked our front desk to ask the patient at her next appointment( 4/ 19)We got a message from the front desk that the patient's mom ( [redacted] )asked us to call herWhen we got in touch with her on 4119/16, she claimed that nobodyhad contacted her daughter asking for an updated address, despite our front desk staffasking for it when the patient came in, which generated the phone callThis was only the first statement that was sent out and we stand by our efforts to correct the address as soonas we found out that it was an issue[redacted] also stated that her calls were not being returnedWe spoke to her twice onand talked to [redacted] on 4/On 5/we received a call from [redacted] at12:pm asking ifthe address with providence had been correctedWe told her that wewould follow up with providence to double checkThe patient called back twice thatsame day ( 4:pm) and again at 4: pmIn the call on 4: pm, she informed us thatProvidence was saying that they didn't get our corrected claimsWe called and spoke to [redacted] at Providence (call ref# [redacted] ) who stated that the claims were receivedon 5/and were being reprocessed.On 5/24/16, [redacted] called wondering why she got a statement when she has 2insurancesWe told her we would double check and call her back; she stated we shouldjust call [redacted] , not herWe verified that the claims had processed correctly and wereapplied to the deductibleWe called [redacted] back and explained this to her and also lether know that the balance was correctShe said okayOn 5/this complaint was fileddue to us not calling her back, when in fact, we spoke to her days prior to the complaintand she asked us not to call her back.The balance due is correct at $and there is no refund due to her for the paymentmade for $158.00.If you have any questions, I can be reached at 503-405-4260.Thank you,Carrie H [redacted] Billing Manager

Hello,
I received an email that claim #*** is being closed without a responseI wanted to let you know that I received a check from the business for the full amount owed
Thank you so much for your help!

To Whom It May Concern:I have had the opportunity to review the billing complaint for Ms. [redacted]'s daughter([redacted]). While we agree that she has been receiving physical therapy from ourproviders and that she has dual coverage, we disagree about the amount owing.Ms. [redacted] has insurance...

coverage through United Healthcare (her primary insurance)and Providence (her secondary insurance). She has a $400.00 deductible with herprimary insurance, then a coinsurance of 20%. The secondary insurance (whom we arenot contracted with), has a $1250.00 deductible and then a 40% coinsurance.The primary claims processed correctly with the deductible and coinsurance and thesecondary insurance was billed. Both insurances applied the balances toward thedeductible and coinsurance. While she doesn't have a balance owing from date ofservice 2/9/2016-4/19/2016 (her Providence deductible was met as of 2/9/16), the balanceis coming from dates of service 1/12/2016-2/4/2016, due to the $1250 deductible. I'mnot sure why her insurances would tell her she doesn't owe anything; we do haveexplanations of benefits from both carriers showing that there is a patient responsibilityfor the dates of service we are billing her for.There was a problem with the secondary insurance starting with date of service 2/18/2016as we didn't have the correct address for the policy holder. The policy holder ([redacted]) is not a signer on the account; we have had no contact with him or any means tocontact him, and had to rely on the patient to give us this information, which we didn'tget until 4/29/2016. We corrected the claims and they have since processed correctly. Allclaims prior to 2/18 processed and paid correctly and the dates of service that weredenied in error due to the incorrect address were never billed to the patient.We don't send statements out until the primary and secondary insurances have both paid.That didn't happen until March 2016. We received the March statement back in ourreturn mail on 4/8/2016 and attempted to contact the patient for an updated address. Wedidn't hear back, so we asked our front desk to ask the patient at her next appointment( 4/ 19). We got a message from the front desk that the patient's mom ([redacted])asked us to call her. When we got in touch with her on 4119/16, she claimed that nobodyhad contacted her daughter asking for an updated address, despite our front desk staffasking for it when the patient came in, which generated the phone call. This was only the
first statement that was sent out and we stand by our efforts to correct the address as soonas we found out that it was an issue.[redacted] also stated that her calls were not being returned. We spoke to her twice on411912016 and talked to [redacted] on 4/29. On 5/23 we received a call from [redacted] at12:42 pm asking ifthe address with providence had been corrected. We told her that wewould follow up with providence to double check. The patient called back twice thatsame day ( 4:03 pm) and again at 4: 19 pm. In the call on 4: 19 pm, she informed us thatProvidence was saying that they didn't get our corrected claims. We called and spoke to[redacted] at Providence (call ref# [redacted]) who stated that the claims were receivedon 5/12 and were being reprocessed.On 5/24/16, [redacted] called wondering why she got a statement when she has 2insurances. We told her we would double check and call her back; she stated we shouldjust call [redacted], not her. We verified that the claims had processed correctly and wereapplied to the deductible. We called [redacted] back and explained this to her and also lether know that the balance was correct. She said okay. On 5/27 this complaint was fileddue to us not calling her back, when in fact, we spoke to her 3 days prior to the complaintand she asked us not to call her back.The balance due is correct at $419 .40 and there is no refund due to her for the paymentmade for $158.00.If you have any questions, I can be reached at 503-405-4260.Thank you,Carrie H[redacted]
Billing Manager