Zen Acupuncture & Herbs

Initial Business Response / [redacted] (1000, 5, 2015/08/10) */ [redacted] was provided three acupuncture treatments on the following dates: 06/19/2015, 06/25/2015, and 07/06/Prior to rendering these treatments, I informed him of our billing practicesSome meaning may have been lost in translation as English is not my first language, but I explained that my billing company was going to claim his insurance and that the $amount was not actually a payment for services in kind, but a depositThe deposit functions as a retainer in the case that the insurance denies the claim for medical necessity or the patient having exceeded his acupuncture benefitsOtherwise, if the claim has actually been paid, the $deposit would have been reimbursed to the patient The date of service 06/19/was billed at $600.00, and 06/25/and 07/06/were billed at $eachThe discrepancy between the first and other dates of service is that the first date of service includes an office visit feeThese amounts are billed as an opening offer to the insurance company since it is the insurance company's prerogative to allow whatever amount they so wish for out-of-network claimsOnce the claims have been paid and the patient has received the Explanation of Benefits ("EOB"), then a dialogue between patient and provider could be opened up if the amount owed by the patient is too highThis is similar to how the hospital chargemaster sets rates and payment could be lowered upon negotiating with the patientFurthermore, this is standard billing practiceThis is how fee-for-service works in the United States It just so happens that the patient has yet to meet his out-of-network deductible, so the claims were applied to his deductibleWhen amounts are applied to his deductible, the EOB will state that whatever deductible amount is the "patient's responsibility." This is most likely where the misconception arose, as the patient most likely thought that the deductible amount was the outstanding amount owed to us and may have deemed the amount exorbitant, however it is owed to the insurance as he has yet to meet his deductibleUpon receiving the EOBs, the patient contacted me regarding the allegedly high billing amountsI attempted console him and to explain basic insurance principles and our billing practices to himHowever, seeing that Chinese is my primary language, the explanation may not have come across clearly enough or the patient may have misconstrued what was said To reiterate, this complaint has no merit as the $amount was agreed upon to be a deposit that was to be returned upon the insurance company paying the claimsFurthermore, these charged amounts are not "outrageous" as the patient has alleged, but standard billing practiceIn any case, I contacted the insurance company to have the claims cancelled, and the amount that was applied to his deductible will be voidedNevertheless, the remaining deductible amount will still need to be paid by the patient for any future services claimed by any future provider Initial Consumer Rebuttal / [redacted] (3000, 7, 2015/08/19) */ (The consumer indicated he/she DID NOT accept the response from the business.) I have communicated with my insurance as of X-XX-XXXX none of these claims have been "cancelled"I would like to further point out a few thingsI was well aware that this person was out of my insurance network when I engaged her for servicesWith this said, if I was presented with these cost for serves I would not have agreed to the treatmentsI would like to point out that if I was presented with the outlandish price of $up to $for a one hour massage from someone, who as far as I know, does not even have a certificate from any accredited US massage therapy school I would never ever agreed to this serviceI have since received two text messages from this person in which she clearly mentions that there was a lack of communication on her part and she claims it is due to her poor EnglishShe goes on to state that if I come back I would just have to pay the $that was originally discussedAgain, there is no mention of this being a depositIt seems to me, based on the above communication, that this individual is able to communicate in English very wellHer falling back on lack of speaking English is an excuse and not does not justify how she practices her business regarding billing for servicesIn any case I am confident that my insurance agency is investigating her questionable practice in great detailI am sure that I will be exempt of having to pay any of these bills whether she retracts these claims or not

Initial Business Response /* (1000, 5, 2015/08/10) */
[redacted] was provided three acupuncture treatments on the following dates: 06/19/2015, 06/25/2015, and 07/06/2015. Prior to rendering these treatments, I informed him of our billing practices. Some meaning may have been lost in translation...

as English is not my first language, but I explained that my billing company was going to claim his insurance and that the $70.00 amount was not actually a payment for services in kind, but a deposit. The deposit functions as a retainer in the case that the insurance denies the claim for medical necessity or the patient having exceeded his acupuncture benefits. Otherwise, if the claim has actually been paid, the $70.00 deposit would have been reimbursed to the patient.
The date of service 06/19/2015 was billed at $600.00, and 06/25/2015 and 07/06/2015 were billed at $450.00 each. The discrepancy between the first and other dates of service is that the first date of service includes an office visit fee. These amounts are billed as an opening offer to the insurance company since it is the insurance company's prerogative to allow whatever amount they so wish for out-of-network claims. Once the claims have been paid and the patient has received the Explanation of Benefits ("EOB"), then a dialogue between patient and provider could be opened up if the amount owed by the patient is too high. This is similar to how the hospital chargemaster sets rates and payment could be lowered upon negotiating with the patient. Furthermore, this is standard billing practice. This is how fee-for-service works in the United States.
It just so happens that the patient has yet to meet his out-of-network deductible, so the claims were applied to his deductible. When amounts are applied to his deductible, the EOB will state that whatever deductible amount is the "patient's responsibility." This is most likely where the misconception arose, as the patient most likely thought that the deductible amount was the outstanding amount owed to us and may have deemed the amount exorbitant, however it is owed to the insurance as he has yet to meet his deductible. Upon receiving the EOBs, the patient contacted me regarding the allegedly high billing amounts. I attempted console him and to explain basic insurance principles and our billing practices to him. However, seeing that Chinese is my primary language, the explanation may not have come across clearly enough or the patient may have misconstrued what was said.
To reiterate, this complaint has no merit as the $70.00 amount was agreed upon to be a deposit that was to be returned upon the insurance company paying the claims. Furthermore, these charged amounts are not "outrageous" as the patient has alleged, but standard billing practice. In any case, I contacted the insurance company to have the claims cancelled, and the amount that was applied to his deductible will be voided. Nevertheless, the remaining deductible amount will still need to be paid by the patient for any future services claimed by any future provider.
Initial Consumer Rebuttal /* (3000, 7, 2015/08/19) */
(The consumer indicated he/she DID NOT accept the response from the business.)
I have communicated with my insurance as of X-XX-XXXX none of these claims have been "cancelled". I would like to further point out a few things. I was well aware that this person was out of my insurance network when I engaged her for services. With this said, if I was presented with these cost for serves I would not have agreed to the treatments. I would like to point out that if I was presented with the outlandish price of $275.00 up to $300.00 for a one hour massage from someone, who as far as I know, does not even have a certificate from any accredited US massage therapy school I would never ever agreed to this service. I have since received two text messages from this person in which she clearly mentions that there was a lack of communication on her part and she claims it is due to her poor English. She goes on to state that if I come back I would just have to pay the $70.00 that was originally discussed. Again, there is no mention of this being a deposit. It seems to me, based on the above communication, that this individual is able to communicate in English very well. Her falling back on lack of speaking English is an excuse and not does not justify how she practices her business regarding billing for services. In any case I am confident that my insurance agency is investigating her questionable practice in great detail. I am sure that I will be exempt of having to pay any of these bills whether she retracts these claims or not.