Virginia Eye Institute, Inc

[A default letter is provided here which indicates your acceptance of the business's offer. If you wish, you may update it before sending it.]
Revdex.com:
I have reviewed the offer made by the business in reference to complaint ID ***, and find that this resolution would be satisfactory to meI will wait for the business to perform this action and, if it does, will consider this complaint resolvedIf the company does not perform as promised I can get back to you at: [email protected]
Regards,
*** ***

Good morning, The purpose of this letter is to discuss the complaint associated with the case number above, and attempt to resolve the issue. The underage patient was brought in by his mother, with whom all our dealings have been with. The original visit was with one of our
physicians, and the visit of concern to the patient’s mother occurred three months later with a different physician. On the first visit, the patient received an eye exam. On the second, another exam was performed and fundus photos were taken. The patient’s mother contacted the patient accounting department of Virginia Eye Institute (VEI) and spoke with multiple representatives, of whom I was one. Her complaint was that an exam was performed a second time. As the issue involved the need for a service performed, I needed to speak with the physician’s offices, and I spoke with both either the lead tech or coordinator for each physician. I was told by both that given the time between visits and the fact that it was a new physician, one that the first physician referred the patient to, then there was need for an exam. Further, the first physician’s notes indicate that he spoke with the patient’s mother about this in advance of the patient’s visit with the second physician. I relayed this information to the patient’s mother, and explained that barring any change in this decision by the second physician, the charge would remain. She said she would speak with his office, and our system notes indicate that the next week she did have a conversation with the same coordinator I did, and was told that both doctors agree that the charges were valid. I was informed this morning that while VEI in no way believes that we misrepresented our policies and processes to the patient’s mother, and in fact re-affirm that she was informed that an exam would be performed at the time of the second visit, we are willing to adjust the patient responsibility portion of the exam. The patient’s mother has begun paying on the portion of the balance from the fundus photos, and after the adjustment of *** for the exam, the patient has a remaining balance of *** for his visit on ***. I would ask that any follto this issue be sent to ***, where it will be addressed accordingly. Please let us know if additional information is needed or if we can answer any questions. Thank you.
*** ***
*** ***

Revdex.com:
I have reviewed the offer and/or response made by the business in reference to complaint ID [redacted], and have determined that this proposed action would not resolve my complaint.  For your reference, details of the offer I reviewed appear below.
[Provide details of why you are not satisfied with this resolution.]
Regards,
[redacted]
The company's reply does not resolve the issue. The reply states that" ... the refraction is not considered a covered service". This is patently untrue. My [redacted] Gold insurance provides for Supplemental Vision Benefit including inter alia one routine eye exam per calendar year including refraction. My insurance provides that there will be no charge if the exam is at an EyeMed Select Network optical provider. I am advised that the company--Virginia Eye lnstitute--is an EyeMed Select Network optical provider, and their eye exam including the refraction should have been provided for $0--not $40.

Dear Sir or Madam: The purpose of this letter is to respond to the complaint filed on Revdex.com Case #[redacted].  As your letter to us states, the patient’s complaint revolves around a $40.00 charge assessed on his visit to Virginia Eye Institute on October 25, 2016.  It is our contention...

that there is a misunderstanding involving how various services are categorized by the patient’s insurance. The source of the $40.00 fee assessed was a procedure known as a refraction.   The refraction tests an individual’s ability to see an object at a specific distance, by trying to read letters or symbols while looking through lenses of differing strengths.  Because Medicare considers refractions to be a routine service, they do not approve it and consider it a non-covered service, and therefore the patient is responsible for any non-covered service.  Consequently, the Medicare Advantage plans follow Medicare guidelines and also do not cover the service.  The patient’s insurance is [redacted], which is one of those plans that follow these Medicare guidelines.  The patient’s claim that his eye exam is covered by his insurance is completely accurate, as [redacted] adjudicated the claim and we received payment on November 1, 2016.  However, as the refraction is not considered a covered service, we received payment for the exam, but not for the refraction, which is the patient’s responsibility.  As this is our understanding of how the claims will be processed, we collect the $40.00 fee in advance of the service, and it is this action and any disagreement with our policy that must have spurred the patient’s complaint being filed with the Revdex.com.  The eye exam and refraction are considered separate services by insurances such as the patient’s, and are adjudicated accordingly.  The patient’s e-mail to our company references a discussion he had with [redacted], who seem to have told him that Eyemed vision insurance should have been billed for the refraction.  However, there is a conflict with the information he was given.  The claims could not have been processed through both his major medical insurance and his vision plan, and due to his history of cataract surgery, the diagnosis code for his exam predicated the need to file to his major medical coverage in order for the exam to be paid.  We attempted to call the patient at approximately 4:15 p.m. on October 25th in response to his e-mail, but could not reach him, and left a voicemail explaining the insurance information, with the phone number to our Patient Accounting department should he have further questions.    Additionally, since the phone call did not reach him directly, he was sent an e-mail with our explanation of the insurance information.  Unless the patient filed his complaint within several hours of being seen, he received contact through two mediums attempting to address the issue, and offering an opportunity to speak about the situation further if he chose to do so.