THE pt GROUP

Revdex.com: I have reviewed the response made by the business in reference to complaint ID [redacted] , and have determined that this does not resolve my complaint For your reference, details of the offer I reviewed appear below.I assure you, on each occasion listed on my original complaint, I was NOT told that The pt Group did not accept my insuarance (even though [redacted] was one of the insuarances listed on the pt group's websiteAs previously documented, the physical therapist named [redacted] quoted that it was approved that my insurance would pay for up to sessions with a 10% coinsurance fee I did not have my eyeglasses for reading, so I asked [redacted] to tell me what I was signing She said my signature was giving them permission to bill my insurance, to which I had agreed I believe an oral contract should be honored as well as one in writing When a medical facilty takes on a client, they inform that person after taking their insurance information whether or not they can accept it and inform them immediately if they do not accept it Case in point: When I had my MRI on 6/16/at [redacted] , the first thing they did was to take my insurance info to verify they could bill for services provided When I went back to this same facilty on 10/17/to get x-rays on my arm for another issue, they immediately took my insurance info Upon receiving this, they informed me that they were no longer affiliated with my insurance and did not do any x-rays This is the proper and appropriate procedure for a business to take Another case in point: When I had gone to [redacted] following my visit with the [redacted] , they orally told me that my signature was consenting permission for them to bill my insurance as they accepted my insurance and did not need to inform me otherwise Again, the appropriate action for a medical business is to inform the client prior to taking them on as a client whether or not that client's insurance is acceptedAn oral notification of this should be just as valid as one in writing I'm sure the physical therapist, [redacted] , who confirmed my signature consented permission to bill my insurance, is a very nice person But she is human, and humans make mistakes Another mistake she made, which I know was an accident, but neverthesless was inappropriate, was when she was instructing me to perform certain exercises for my therapy for my surgery rehab It was an uncomfortable movement, and I told her I hadn't done this activity before She told me I had done it at my prior session I told her nicely that I hadn't She checked the plan for my rehab and realized she had someone else's plan in her hands and apologizedAs the result of this neglect, I deserve to be reimbursedeverything I have provided is true....and my insurance consult is indeed factual on the $out of pocket fee I was quoted based on the fact that all deductibles had been met prior to my rehab Regards, [redacted]

ecember 11, 2014*** *** ***The Revdex.com*** *** *** *** ***
*** ** ***Response to Claim ID: *** *** was thoroughly explained her health insurance benefits as we dowith every patientWe do this as a courtesy for the
patient even though it isnot our responsibility but we feel it is important to try to help them understandthe increasingly confusing healthcare issuesUltimately it is the responsibilityof the patient to know what their insurance coverage consists of as it is theircontractual arrangement with the insurance company*** *** alsosigned the explanation of benefits form stating that she understood what thefinancial arrangements would be.In addition, I believe she has been misinformed as far as her costs for 27sessionsShe has a deductible, which if not met she would have had to pay infull and then she would have a 10% coinsurance which means she would have topay 10% of the billings for every visit.That being said, we did everything we could to help her with the cost of her careand in the end I believe her cost per treatment was approximately $which ismuch lower than most people’s copays in this current insurance environmentIhope this helps clear up any misunderstanding.Sincerely,*** ***Presid t/Managing Member***

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID [redacted], and have determined that this does not resolve my complaint.  For your reference, details of the offer I reviewed appear below.I assure you, on each occasion listed on my original complaint, I was NOT told that The pt Group did not accept my insuarance (even though  [redacted] was one of the insuarances listed on the pt group's website.
As previously documented, the physical therapist named [redacted] quoted that it was approved that my insurance would pay for up to 60 sessions with a 10% coinsurance fee.  I did not have my eyeglasses for reading, so I asked [redacted] to tell me what I was signing.  She said my signature was giving them permission to bill my insurance, to which I had agreed.  I believe an oral contract should be honored as well as one in writing.
  When a medical facilty takes on a client, they inform that person after taking their insurance information whether or not they can accept it and inform them immediately if they do not accept it. 
   Case in point:
        When I had my MRI on 6/16/2014 at [redacted],  the first thing they did was to take my insurance info to verify  they could bill for services provided.
        When I went back to this same facilty on 10/17/2014 to get x-rays on my arm for another issue, they immediately took my insurance info.  Upon receiving this, they informed me that they were no longer affiliated with my insurance and did not do any x-rays.  This is the proper and appropriate  procedure for a business to take.  
Another case in point:
   When I had gone to [redacted] following my visit with the [redacted],  they orally told me that my signature was consenting permission for them to bill my insurance as they accepted my insurance and did not need to inform me otherwise.   Again,  the appropriate action for a medical business is to inform the client prior to taking them on as a client whether or not that client's insurance is accepted. An oral notification of this should be just as valid as one in writing. 
  I'm sure the physical therapist,  [redacted], who confirmed my signature consented permission to bill my insurance, is a very nice person.  But she is human, and humans make mistakes.  Another mistake she made, which I know was an accident, but neverthesless was inappropriate, was when she was instructing me to perform certain exercises for my therapy for my surgery rehab.  It was an uncomfortable movement, and I told her I hadn't done this activity before.  She told me I had done it at my prior session.  I told her nicely that I hadn't.  She checked the plan for my rehab and realized she had someone else's plan in her hands and apologized.
As the result of this neglect, I deserve to be reimbursed... everything I have provided is true....and my insurance consult is indeed factual on the $76.00 out of pocket fee I was quoted based on the fact that all deductibles had been met prior to my rehab.
Regards,[redacted]

Review: This is my experience with The pt Group at [redacted].On August 5th, 2014, I went to The pt Group facility located at [redacted] to schedule physical therapy for my recuperation from having had knee surgery. [redacted] took my prescription for therapy and my [redacted] insurance card. He presented me with insurance papers and instructed me to take them home, fill them out, and bring them back on my first therapy session scheduled for August 8th, 2014, which I did.He neglected to inform me that The pt Group was out of the [redacted] network plan, nor did he inform me that he was putting me on a self payment plan.I dont know the exact date, but one of the therapists named [redacted] presented me with paperwork to sign. She told me I needed to sign to allow The pt Group to bill my [redacted] insurance. She said it was approved that my insurance would pay for up to 60 sessions with a 10% coinsurance fee. She did not inform me that The pt Group was out of the [redacted] network and neglected to inform me that The pt Group was putting me on a self pay plan.I had asked [redacted] on a following occasion how much therapy I would be receiving. He responded by saying not to worry that my insurance would cover up to 60 sessions, but that I would not need that much. On Nov. 5th, 2014, I called my insurance to ask why my co insurance fees were so high. They responded by telling me that The pt Group did not go through my insurance as they are out of network with [redacted].I immediately called The pt Group to get this resolved. I spoke with a [redacted] from the [redacted] office. I told him that I was not happy with how The pt Group was dishonest with me and wanted this issue resolved. He told me he would speak with the manager and get back to me.On Nov. 6th, 2014 [redacted] called me to inform me that the manager was willing to lower my fees from $513.50 to $385. I replied that this figure was not acceptable. He said he would speak with the manager again and relay my message. On Nov. 7th, 2014, [redacted] called me to tell me that the manager would lower my fees to $300.00 if I paid the entire fee within ten days, or if I didnt, the fee would be the original price of $513.50. I told him I would speak to my husband and get back to him.I called back and left a message stating that I wanted to speak with the manager. [redacted] returned my call on Nov. 10th, 2014 and said that I had to deal with him, and refused to let me speak with the manager. He again told me that my options were to pay $300.00 in full by Nov. 17th, 2014 or to pay $513.50. He said that there was nothing more to discuss as the discussion ends there. I told him there WAS more to discuss, but was never given the opportunity to speak with the manager.My husband went to The pt Group at the [redacted] office and paid the bill in full on Nov. 11th, 2014. On Nov. 24th, 2014, I had called my [redacted] insurance and was given information on a cost estimator. I spoke with [redacted] from the Cost Estimator department and was told that for 27 sessions (which is what I had with The pt Group) at an in network facility, my out of pocket fees would have totaled $76.00.As the result of The pt Groups incompetent, deceptive practice in their taking me on as a client, and telling me that they accepted my insurance, (when they didnt) we feel we should be reimbursed $224.00, to make up the difference for what we would have paid had they truly been on our health care plan.Thank you for investigating this matter. We look forward to your reply.Sincerely,[redacted]Desired Settlement: As the result of The pt Groups incompetent, deceptive practice in their taking me on as a client, and telling me that they accepted my insurance, (when they didnt) we feel we should be reimbursed $224.00, to make up the difference for what we would have paid had they truly been on our health care plan.

Business

Response:

ecember 11, 2014[redacted]The Revdex.com[redacted]

[redacted]Response to Claim ID: [redacted] was thoroughly explained her health insurance benefits as we dowith every patient. We do this as a courtesy for the patient even though it isnot our responsibility but we feel it is important to try to help them understandthe increasingly confusing healthcare issues. Ultimately it is the responsibilityof the patient to know what their insurance coverage consists of as it is theircontractual arrangement with the insurance company. [redacted] alsosigned the explanation of benefits form stating that she understood what thefinancial arrangements would be.In addition, I believe she has been misinformed as far as her costs for 27sessions. She has a deductible, which if not met she would have had to pay infull and then she would have a 10% coinsurance which means she would have topay 10% of the billings for every visit.That being said, we did everything we could to help her with the cost of her careand in the end I believe her cost per treatment was approximately $11 which ismuch lower than most people’s copays in this current insurance environment. Ihope this helps clear up any misunderstanding.Sincerely,[redacted]Presid t/Managing Member[redacted]

Consumer

Response:

I have reviewed the response made by the business in reference to complaint ID [redacted], and have determined that this does not resolve my complaint. For your reference, details of the offer I reviewed appear below.

I assure you, on each occasion listed on my original complaint, I was NOT told that The pt Group did not accept my insuarance (even though [redacted] was one of the insuarances listed on the pt group's website.