The Orthopaedic & Fracture Clinic, P.A.

Initial Business Response /* (1000, 11, 2015/08/24) */
We appreciate the opportunity to respond to the patient's complaint
Our Business Office manager spoke with the physician involved and had a conversation with the patient regarding the situation
We have thoroughly read the complaint and
are undergoing ways to better communicate the day global package to the best of our ability
We verified and confirmed that the code used was correct and we stand by our charges as appropriate for the services rendered
Initial Consumer Rebuttal /* (3000, 13, 2015/08/29) */
(The consumer indicated he/she DID NOT accept the response from the business.)
I have reviewed OFC's response to my claim against them and find it totally inadequate
OFC states,"We verified and confirmed that the code used was correct," but do not indicate the means in which they "verified" correct codingThe EOB shows the service as surgical however the bill sent to me indicates "treat spine fracture." Two very separate servicesI also contend that "treatment of spine fracture" is a stretch as no treatment was rendered except suggestion of wearing a brace if I choose and work restrictions
OFC also indicate they are "undergoing ways to better communicate the day global package to the best of our ability." They are basically acknowledging I was not informed of the "global package"nor did I receive the "global care" I have been billed forYet they expect me to pay for a service I was not only informed of, but also not receivedThis is fundamentally wrong and OFC should accept the fact they screwed up by not informing the patient of a service they fully intended to charge forThey received almost $which equates to about $75/minute for the service I actually receivedThis should be more than adequate considering the mistake was OFCI have no doubt any employee of OFC would pay for a service they did not receiveAgain, because the lack of communication for services billed was the fault of OFC I don't feel I should be required to pay them more money they have already received
Final Business Response /* (4000, 15, 2015/09/01) */
We follow CCI (Correct Coding Initiative)There are two ways to bill out this type of serviceThe preferred way recommended by insurance companies is to use the conservative fracture care packageThis allows the insurance company to monitor ongoing care for days in the event there is a complicationThe second way to bill is for an office visitOur policy is to follow the payor recommended conservative care packageHowever, we understand your concern and are willing to resubmit the claim to your insurance company