Weather or Not

Ms*** presented for her appointment and was told that we were not providers for her routine eye care plan (EyeMed). Our front desk staff did inform her that we are providers for her medical insurance (BCBS) and that we could bill the exam as medical to the medical insurance. At no
time did the front desk employee say to her that when we bill it to medical, it will be 100% covered as that is not something that we can promise to anyone due to the co-insurances and deductibles that vary immensely from one insurance plan to another So, unfortunately, the exam went to the patients deductible and she therefore got a bill for the exam. While we understand her position in that had she gone to another provider that was contracted with EyeMed, what we told her wasn’t wrong, wasn’t being sneaky and wasn’t trying to manipulate her into staying. We were simply attempting to give her the best service possible by letting her know her options. We are providers for BCBS and the exam was “covered.” What we didn’t know and what she didn’t know is that the exam would go toward her deductible Because I recognize that our front desk employee might have made it seem like the exam would be covered and because Ms*** wasn’t aware of what that she had an unmet deductible, I recommended that the patient and the practice split the charges on the exam and that we discount 50% of the charges and she pay 50% of the charges. Her response to this was that she felt she was talked into the exam. I don’t believe that our front desk staff was trying to do anything but help the patient. Our front desk staff are not responsible to know, nor are they able to be aware, if the patient met her deductible. What they told her was true, her exam could and was be billed to medical insurance. The patient ultimately decided that she would stay and have the exam done. Ms*** does still have a balance left on her account for 50% of the charges which we believe is a very fair compromise being the work was done