Winchester Open MRI

In follow up to our conversation yesterday…we had talked about contacting the employer to see if they have adequately explained the benefits to the patient or whether they could intervene to provide them with information about their benefit plan structure. Rhonda at the
employer (###-###-####) was helpful. She indicated that she has personally explained the benefit plan to the family and employee She has also had their insurance broker explain this to the employee and family. She has pulled the employee aside to explain it to him so that he could try to help his spouse accept the plan structure. She said that their plan is different because they are partially self funded. This year, the plan is structured the same but the payer has changed to United. I never told her the family name and she named the employee, spouse, and daughter immediately. She said that the spouse has written the insurance commissioner about different providers (physicians, offices, etc) in the area when she receives a bill from them. She said that the way the EOB is formatted, it does confuse several of their employees but once explained, all employees (and families) accept what is and is not owed by them except for this family. Rhonda indicated that the spouse of her employee (mother of patient) is the person creating the dispute with area providers. Based on this information, I don’t know that additional follow up with the patient or her mother will be helpful to persuade a change of heart. I don’t know how they will respond to being in collections but most collection agencies are well versed in how to handle a combative party. The collection agency currently has a quick review of the account so that they know they will likely be met with hostility. I think we have researched all that we can on this account to have assurance that the bill is owed and to give the patient every benefit of the doubt. Please let us know if there is anything further we can do to help. Thanks, Megan Megan R*** Director of Operations

In follow up to our conversation
yesterday…we had talked about contacting the employer to see if they have adequately explained the benefits to the patient or whether they could intervene to provide them with information about their benefit plan structure
Rhonda at the employer (###-###-####) was helpful. She indicated that she has personally explained the benefit plan to the family and employee She has also had their insurance broker explain this to the employee and family. She has pulled the employee aside to explain it to him so that he could try to help his spouse accept the plan structure.
She said that their plan is different because they are partially self funded. This year, the plan is structured the same but the payer has changed to United
I never told her the family name and she named the employee, spouse, and daughter immediately. She said that the spouse has written the insurance commissioner about different providers (physicians, offices, etc) in the area when she receives a bill from them. She said that the way the EOB is formatted, it does confuse several of their employees but once explained, all employees (and families) accept what is and is not owed by them except for this family. Rhonda indicated that the spouse of her employee (mother of patient) is the person creating the dispute with area providers.
Based on this information, I don’t know that additional follow up with the patient or her mother will be helpful to persuade a change of heart. I don’t know how they will respond to being in collections but most collection agencies are well versed in how to handle a combative party. The collection agency currently has a quick review of the account so that they know they will likely be met with hostility.
I think we have researched all that we can on this account to have assurance that the bill is owed and to give the patient every benefit of the doubt
Please let us know if there is anything further we can do to help
Thanks, Megan
Megan R*** Director of Operations

December 19, 2014
Dear [redacted],
This letter is in response to the complaint filed by [redacted] (Revdex.com ID [redacted], WIM ID [redacted]). The account balance of $170.56 has been written off per the patient's request as the desired outcome to resolve this complaint.
On...

5/28/2014 [redacted] called our office to advise us she called the ordering doctor's office who confirmed the two separate procedures were ordered and agreed to try to make monthly payments of $17.00 on the account. Statements were mailed to the patient on 5/21/2014, 6/18/2014 and 7/16/2014; however, no payments were received.On 8/12/2014 we called [redacted] to discuss her concerns in the letter (dated 7/28/2014) that we received. We advised her that our office confirmed with the ordering doctor's office that two separate procedures had been ordered by them. Our coding of the procedures was reviewed by a Radiology Certified Coder who verified that according to CPT guidelines our coding was correct. Both the ordering doctor's office and our office explained this to [redacted] on 8/12.
[redacted] expressed her concern regarding their ability to pay the account balance of $170.56 on the two calls that occurred with our office on 5/28/2014 and 5/12/2014.
Sincerely,Lois W

[To assist us in bringing this matter to a close, you must give us a reason why you are rejecting the response. If no reason is received your complaint will be closed Administratively Resolved]
 Complaint: [redacted]
I am rejecting this response because: We have spoken to insurance and they stated we do not owe.  However have made several payments and still not credited to account.  Have all records of payments and they are sent with other bills so we know they are received since other bills are credited for these bills on the 25th of each month. 
Regards,
[redacted]