Tony's BP Service Center

Dear Ms*** Thank you for forwarding complaint ID#*** I apologize for the delay in response*** *** is no longer with our practice*** *** is our practice administrator as of last October I am copying our Aetna contract representative, ***
***, as she may be able to further assist us in resolving Miss *** complaintOur practice has been a part of the Aetna network since our inception in When Miss *** called to schedule her appointment she told our office that her insurance was through her employer with AetnaAs a courtesy, our practice does a request for eligibility and benefits with insurance carriers in anticipation of services and patient financial responsibility, however, we also tell patients that the insurance carriers will not guarantee payments until claims are submittedWe do not possess individual/employer contracts with the carriers, and thus we rely on the carriers for terms of the client’s policyOur office did a courtesy eligibility check prior to Miss *** appointment and we were told she was eligible and what her anticipated responsibility would be Miss *** presented for her appointmentShe was presented our financial policy as well as the information we had received from Aetna which she signed prior to receipt of careThe requested services were rendered and the claim was timely filedAetna subsequently declined payment of services stating that Miss *** plan is part of a new narrow networkWe were never updated about these narrow networks by Aetna when they were established and we were not told by Aetna when we checked her eligibility that she was limited to that network for coverage of these services When Miss *** received her statement from our practice, she called to discuss the matter*** called Aetna to learn that the claim had denied because she is in this narrow network*** has tried multiple times to escalate the issue, however, Aetna’s position has been that it is the member’s responsibility to understand their benefits and that our practice would not have known about her limited discounted network*** and I spoke to Miss *** to explain our knowledge of the situationWe recommended that Miss *** as the member, contact her HR department and Aetna for further assistanceWe further offered to write-off the physician fees entirely and requested that Miss *** only be accountable for the cost of the birth control device in the event that we could not get resolution through AetnaMiss *** thanked us for our help and verbally agreed to this planWe do not know if Miss *** has followed up with her HR department or Aetna We believe that our office was honest and acted with integrityWe delivered good medical care to Miss ***She is currently enjoying the benefits of her birth control deviceWe sincerely apologize for Miss *** situation, however, we have been hurt by this financially as well, our services and the cost of the birth control device have not been paidWe would request that the Revdex.com assist us in recovering our losses from Miss *** per her agreement with us in which I offered to waive my professional fees, unfortunately we cannot cover the cost of her device Thank you very much for your consideration, *** *** ** *** *** *** *** *** *** ** *** *** ***