ComplaintsforLearning to Achieve Wellness Inc.

• Initial Complaint

  05/03/2024

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  I've been going to psychiatrist here for the better part of 10 months and I've never seen psychiatrist more unempathetic and rude in my entire life. They literally rush you off like your time doesn't matter. They don't listen. They Speak AT you not to you. They don't care what I have to mentally go through on a daily basis that I ended up in the hospital and they gave me a telehealth appointment on the same day just for them to patronize me one last time and drop me as a patient while I was at my biggest crisis. I've cried every single night because I have to deal with suffering or then not doing anything about it. They just say next week, just for the following week to turn out the same. They don't listen to any of your concerns or ideas and this has really mentally shot me and I don't even know what to say because the third and final psychiatrist I was kicked to victim blamed me for the time loss (which I was venting my traumatization and experience with the last psychiatrist) and didn't solve the main concern I've been crying about for months now. Aside from mentioning one antipsychotic that has nothing to do with my problem. They just wanna feed you nothing but schizophrenia medicine and be done with you all in a span of 10 minutes so they wasted so much of my money and time that I couldn't afford to treat me like a complete jerk. So not only am I going through a bad episode she hung up the call in my face mid talk while I was talking. This establishment has traumatized me and put me in the worst place in my entire life. And they don't even care. Please don't go here if you actually want to be treated like a human being. Even the manager I've tried expressing my concern with and I get playing the devil's advocate but someone's mental health is worth more than believing a psychiatrists intentions over a patient. When I called back they just said they can't do anything besides me making another appointment. I'm disabled and depressed and I can't do it anymore.

  

  Business response

  05/04/2024

  Thank you for your report.  We take every report seriously and complete a full and complete review of all complaints.   We have fully investigated these claims and have found each of the claimants ***************** (Patient) claims about the practice and stated providers to be unfounded, inaccurate, and untruthful. 

  Please see the attached documents for a better layout of the below information. 

  
  Patient claims to have been part of practice and being seen for 10 months.
  This is not true:  Patient has been under care and treatment of this practice since 11-5-2023 (6 months).  We have found this to be a false report.
  Patient claims that he has been treated without empathy and rudely.
  This is not true:  please see the summary of visits reviewed with each of his visits below during which providers saw him for longer than required and despite education and recommendations and his declining their treatments continued to work with him and agree to his most comfortable plan of care. We have found this to be a false report.
  Patient reports that he has been tearful every night and is suffering and no one is doing anything about it.
  -This is not true: 3/3 of the Psychiatric Mental Health Nurse Practitioner (PMHNP) and 1/1 of the Licensed Clinical Social Worker (LSCW) has noted that he did appear depressed and offered him assistance and treatment per guidelines for this and even requested to work together to help him and also review his past treatment and get genetic gene ***** testing and he refused their recommendations each time, at times stating he did not need any depression treatments.  See summary below. We have found this to be a false report.
  Patent claims that he was only offered one antipsychotic as an alternative to treatment.
  This is not true: he has been offered several sedatives for sleeping, he has been offered different benzodiazepines, he has been offered increase in his stimulant ADD med, he has been offered antidepressants, he has been offered antipsychotics all to be used within treatment guidelines and recommendations, he only agreed to take those medication that fall under the controlled substances see summary below.  We have found this to be a false report.
  Patient claims he has been only seen for 10 minutes.
  -This is not true, he has never had an appointment that lasted less than 18 minutes, please see all timing below.  He was offered additional time for a majority of the visits.  He was also offered therapy appointments with the therapist which are a full 60 min which he stopped attending.  We have found this to be a false report.
  Patient claims that the establishment has traumatized him and dont care about him.      
   - This is not true, everyone has done everything they can to help this patient,offering him extra frequent appointments, offering him therapy and medication mgt, offering multiple different options, staying with him as time allowed for longer visits then for which he was scheduled just to help him.  We have found this to be a false report.
  Patient claims he is disabled. 
  -This is not true, the patient has just requested his Paperwork to file his disability claims.  We have found this to be a false report.
  Billing- Patient claims to have spent $10,000 on his care.  Please see information as noted by billing.  He has held 3 different insurers during his 6 months of care.   He initially provided an **************** then in 1-2024 he provided a Cigna policy, and then in 3-2024 he provided a FL Blue Shield Policy, despite requests he has only provided us a copy of one insurance card, for ****************** which he is listed as a dependent.
  
  
  
  Account Summary: Please see that the patient has paid a total of $241 over his duration of care and his insurances.  He owes $454.12 and is continued to be treated as we never decline patients for their inability to pay and always work with them to meet their needs even offering severely discounted sliding scale visits for those without insurance.  His insurance has paid a total of $854.82 so over the course of 6 months, 17 visits and 3 cancelled visits.    Please see full summary of charges below.
  
  Charges
  Payments
  Adjustments
  Balance
  
  
  Patient
  995.78
  241.84
  299.82
  454.12
  Insurance
  6,869.22
  864.82
  3,169.40
  2,835.00
  Total
  7,865.00
  1,106.66
  3,469.22
  3,289.12
  
  
  Please find summary of care:
   -Patient visits have been reviewed. 
  - on 11-5-23 Patient has been seen for a period of 60 min for reasons of he wanted a new psychiatrist.   During which he reported to his new provider ****************, PMHNP that he was coming to H3336373236363**63530H because he was upset that his prior Psychiatrist who was seeing him weekly was blackmailing him and being rude to him and not getting his disability papers done.  New patient screenings, automatic billing, now show policy and standard forms were also collected.  A standard two week follow up appointment was scheduled for the patient.
  - on 11-13-2023 Patient was also scheduled a new patient appointment with E Ferro, Therapist, for 60 min he cancelled appointment.
  - on 11-20-24 Patient was seen for a standard 20 min follow up appointment with **************, PMHNP and complained that his medication for ADD  was not working for him and demanding paper script, which is not allowed for controlled substances.  The provider increased his medication per his request.
  - on 12-4-24 Patient was seen for a standard 20 min follow up appointment due to his reporting his medication for ADD that had been increased was not working he was seen by **************, PMHNP he was offered therapy and also ************** testing to better help him with his medication that was not working, and he declined.  The provider changed his medication per his request.
  - on 12-18-24 Patient requested to be seen for medication not working for sleeping on he was seen for a standard 20 min follow up appointment with **************, PMHNP. He complained that his controlled substance for sleeping was not working and he wanted a different controlled substance, education provided on controlled substances and use of non-controlled substances for sleeping, he declined the providers recommendation and the provider educated on his risk of taking controlled medication for sleeping and ordered him the medication he requested.
  - on 1-4-24 Patient came to appointment for standard 20 min appointment time and complained that now his ADD medication was not working again- He saw **************, PMHNP, he declined recommendation for Gene ***** testing to help with better medication mgt, he declined a request by the provider to obtain prior providers office visits in order to better help him.  The provider educated him on risk of increased ADD controlled substance medication and increased his medication per his request.
  -The patient then sent an email to ************************************************ in a name that was not his own asking how to change to another provider in the practice stating that he was not comfortable seeing **************, although as noted above each of his requests had been followed though on after he was educated on the risk of his choices and even after he had declined **************, PMHNP recommendations such as gene *****, other non-controlled medication, and review of prior records.  His appointment on 1-18-24 with ************** was cancelled on 1-15-24.
  -The office manager, ************** was able to decipher who the patient emailing in a unknown name was and followed up with patient ********** who requested a new provider. ************ met the patients needs and scheduled him with a new provider on 1-18-2024.
  -On 1-18-2024 the patient was scheduled with ************, PMHNP for a standard 20 min med mgt appointment, she reviewed his current medication with him, reviewed his overdose risk score from his Eforce of 520: Narx scores are as follows: Sedative-431, Narcotics-291, Stimulants-402.  Patient accepted risk, again declined gene *****, declined non controlled medication, and declined request for prior records.
  - On 2-1-24 the patient was set for a standard 20 min follow up which was extended to a 26 min visit with **********,PMHNP as time allowed and he had stated increased stress resulting from his verbally and physically abusive girlfriend leaving him.   He screened positive for depression and again declined any medication other than controlled substances.
  - On 2-15-24 the patient was set for a standard 20 min follow up appointment with **********, PHMNP which was extended to a 32 min appointment as time allowed and he was still having a hard time with coping with his girlfriend leaving him, he screened positive for depression and stated he stopped seeing his therapist, he refused gene ***** testing to help chose a better medication and declined any non-controlled medication.  His medication was continued.
  - On 2-23-24 the patient was seen for a standard 20 min follow up of which 18 min of the appointment was utilized.  He continued to have issues with his girlfriend,leaving him and things reminding him of her. He provider T Ewin, provided talk therapy and medication mgt per usual and recommended antidepressant and CBT which he declined.  Side effects of controlled substances and tolerance and dependance and loss of memory were reviewed with the patient.
  -On 3-22-24 the patient was scheduled for a standard 20 min follow up appointment with ********** and she had extra time after his appointment and the patient was needing additional time due to continued statements of not doing well so he was seen for 34 minutes.  He said his controlled medication for sleeping was not working anymore and wanted to go back to the one he had told ************** was not effective. The provider educated him on gene ***** again, he declined.  The provider educated him on his risks which he accepted, and she changed him back to his prior controlled med for sleeping per his request.  The patient did agree to start therapy.
  - On 3-28-24 the patient was seen for a 60 min therapy appointment with A ******, LSCW he specifically asked that his psychiatrist and therapist both part of the same practice do not collaborate with his care and treatment.
  - On 4-2-24 the patient was seen for a 60 min therapy appointment with A ******, LSCW-
  - On 4-5-24 a patient was scheduled for a 20 min standard follow up appointment with **********, PMHNP, he was seen for 50 in this day as he had multiple complaints about his medication, he asked for Halcion to sleep, which was a medication the dentist gave him.  Halcion is a international medication, not US medication, flupentixol and melitracen which is actually an antidepressant but not one that is used in the **.  He was offered other medication which are commonly used for sleeping such as trazodone, melatonin, doxepin, Seroquel, and he declined all of them and then later agrees to add on ******* as needed for sleeping.
  - On 4-11-24 he same day cancelled his 60 min appointment with Therapist ****************, LSCW, he has signed an agreement that he will be charged $75 late cancel fee which was not charged due at discretion of the office to avoid causing him any increased stress, he asked to reschedule and was scheduled for 4-18-24 with A *******, LSCW, therapist for a 60 min appt.
  On 4-18-24 he again same day cancelled his 60 min appointment with Therapist ****************, LSCW, he has signed an agreement that he will be charged $75 late cancel fee which was not charged due at discretion of the office to avoid causing him any increased stress
  - on 4-19-24: Patient was scheduled for a standard 20 min medication mgt appointment with **********, PMHNP which was extended due to his need and her availability to 41 min.  He reported that he was not able to ever get the Doxepin, so he never tried it.   He again requested ******************** ********* was provided that this medication has high risk and was not able to be provided.  Restoril which is another controlled medication for sleeping was recommended and agreed upon as he refused to take Doxepin and this new medication was sent to the pharmacy.
  - On 4-26-24 patient was scheduled for a follow up appointment, 20 min by standard for providers, he was seen for 26 min by **********, PMHNP, he was noted to be depressed and they again discussed taking an antidepressant medication he refused to accept recommendations.  He said the prior medication for sleeping was not working Restoril, controlled med, sedative and asked this was increased.  The provider educated him on his risk of this medication and per his request increased his medication for sleeping.
  - on 5-1-24 the patient was scheduled for a standard follow up appointment 20 min in length and reported he was not sleeping, he saw T ****, PMHNP.   He reported he has been to the hospital for poor sleeping, and he was discharged with no treatment.   He stated the Ambien,Lunesta that he requested did not work, He stated the Restoril he agreed to also try a controlled substance, sedative did not work even at highest dose, he declined taking any non-controlled medication he had stopped taking his stimulant medication/ADD med at this time, Adderall for a period of 1 week.  He also reported that his Valium was no longer working, and controlled medication for anxiety.   He refused medications that were recommended, he refused gene ***** testing for reasons why his medication was not working and of note has no longer kept or is going to his therapy appointments -which he only attended twice on 3-28-24 and 4-2-24.   He requested another opinion and was scheduled with another provider per his request ************, PMHNP the next day to make sure that his needs where met.
  -on 5-2-24 he was scheduled with ************ PMHNP for a standard 20 min appointment, she had some extra time and was just getting to know him, so he was able to be seen for 28 minutes.   During this visit he again requested medication Halcion which he said he had during a dental procedure.   He again declined to take any medication that is not controlled medication.  Again,of note Halcion is under the antidepressant drug class under international medication, is not available in the **************   He did say he would try other benzodiazepines, controlled medication, Xanax of Ativan when provider agreed to order Ativan to see if this would help with sleeping,the patient declined, he declined any antidepressant, declined gene ***** and declined record request for past medical records and set a follow up appointment with ************ for 5-6-2024 at 2:20 which she scheduled for 40 min slot to try to better assist him.
  - At the time of this report to the BBB He also posted the same report to ****** Reviews and Yelp reviews under different names and has not yet had his requested follow up appointment on 5-6-2024 which we are happy to continue for him as we understand that he is reaching out for help and is only making these reports due to the stress that he is under.  We understand working in the mental health field that this can occur but we can fully support that each of his claims that he has made are false and hold no actual truthful information.
  
  
  Full Summary of Charges:
  Payment Receipt For ***************** ****** LEARNING TO ACHIEVE WELLNESS Dates 1/1/2023 to 5/4/2024 ************************, B All Provider Profiles Phone: ************** Fax: ************** Visit # DOS Insurance Portion Patient Portion Payment Amount Date Payment Code Payment Description Check # ******** 11/20/2023 $150.00 $0.00 Charge: ***** - BRIEF EMOTIONAL/BEHAV ASSMT ******** 02/23/2024 $140.00 $0.00 Charge: ***** - PSYTX PT&/FAM W/E&M 30 MIN ******** 02/23/2024 $240.00 $0.00 Charge: ***** -***************** VISIT EST ******** **/22/2024 $165.00 $0.00 Charge: ***** -PSYTX PT&/FAM W/E&M 45 MIN ******** **/22/2024 $240.00 $0.00 ************** ***************** VISIT EST ******** **/28/2024 $260.00 $0.00 Charge:90791 - PSYCH DIAGNOSTIC EVALUATION ******** 04/05/2024 $180.00 $0.00 Charge:90838 - PSYTX PT&/FAM W/E&M 60 MIN ******** 04/05/2024 $240.00 $0.00 Charge: ***** - ***************** VISIT EST ******** 04/02/2024 $260.00 $0.00 Charge: ***** - PSYTX PT&/FAMILY 60 MINUTES ******** 04/11/2024 $0.00 $75.00 Charge: NOSHOW - NO SHOW LATE CANCELLATION ******** 04/26/2024 $240.00 $0.00 Charge: ***** - ***************** VISIT EST ******** 05/01/2024 $140.00 $0.00 Charge: ***** - PSYTX PT&/FAM W/E&M 30 MIN ******** 05/01/2024 $240.00 $0.00 Charge: ***** - ***************** VISIT EST ******** 05/02/2024 $140.00 $0.00 Charge: ***** - PSYTX PT&/FAM W/E&M 30 MIN ******** 05/02/2024 $270.00 $0.00 Charge: ***** - ***************** VISIT EST ******** 05/02/2024 $80.00 $0.00 Charge: ***** - NEUROPSYCHOLOGICAL TESTING EVALUATION SE ******** 11/06/2023 $362.44 $37.56 $150.24 Charge: ***** - ***************** VISIT NEW 11/23/2023 PI PAYMENT - INSURANCE TZ64314912 $150.24 ******** 11/20/2023 $253.17 $21.83 $87.34 Generated 5/4/2024 09:36:54 PM Page 1 of 7 Payment Receipt For ***************** ****** LEARNING TO ACHIEVE WELLNESS Dates 1/1/2023 to 5/4/2024 ****************************************** All Provider Profiles Phone: ************* Fax: ************** Visit # DOS Insurance Portion Patient Portion Payment Amount Date Payment Code Payment Description Check # Charge: ***** -***************** VISIT EST 12/11/2023 PI PAYMENT - INSURANCE TZ65088151 $87.34 ******** 11/20/2023 $162.07 $12.93 $51.70 Charge: ***** - PSYTX PT&/FAM W/E&M 30 MIN 12/11/2023 PI PAYMENT - INSURANCE TZ65088151 $51.70 19607114 12/04/2023 $253.17 $21.83 $87.34 Charge: ***** - ***************** VISIT EST 01/06/2024 PI PAYMENT - INSURANCE TZ67979309 $87.34 19607114 12/04/2023 $162.07 $12.93 $51.70 Charge: ***** - PSYTX PT&/FAM W/E&M 30 MIN 01/06/2024 PI PAYMENT - INSURANCE TZ67979309 $51.70 ******** 12/18/2023 $253.17 $21.83 $87.34 Charge: ***** - ***************** VISIT EST 01/06/2024 PI PAYMENT - INSURANCE TZ67979309 $87.34 ******** 12/18/2023 $162.07 $12.93 $51.70 Charge: ***** -PSYTX PT&/FAM W/E&M 30 MIN 01/06/2024 PI PAYMENT - INSURANCE TZ67979309 $51.70 ******** 11/06/2023 $362.44 $37.56 $37.56 Charge: ***** - ***************** VISIT NEW 01/18/2024 PP PAYMENT - PATIENT ***** **3771 AUTH: 250614 $37.56 ******** 11/20/2023 $253.17 $21.83 $21.83 Charge: ***** - ***************** VISIT EST 01/18/2024 PP PAYMENT - PATIENT ***** **3771 AUTH: 250614 $21.83 ******** 11/20/2023 $162.07 $12.93 $10.13 Charge: ***** - PSYTX PT&/FAM W/E&M 30 MIN 01/18/2024 PP PAYMENT - PATIENT ***** **3771 AUTH: 250614 $10.13 Generated 5/4/2024 09:36:54 PM Page 2 of 7 Payment Receipt For ***************** ****** LEARNING TO ACHIEVE WELLNESS Dates 1/1/2023 to 5/4/2024 ************************,B All Provider Profiles Phone: ************** Fax: ************** Visit # DOS Insurance Portion Patient Portion Payment Amount Date Payment Code Payment Description Check # ******** 12/18/2023 $253.17 $21.83 $21.83 Charge: ***** -***************** VISIT EST Note: PD BAL- DOZ 1-4 01/04/2024 OF PAYMENT -OFFICE ***** **3771 AUTH: 341705 $21.83 ******** 12/18/2023 $162.07 $12.93 $12.93 Charge: ***** - PSYTX PT&/FAM W/E&M 30 MIN Note: PD BAL- DOZ 1-4 01/04/2024 OF PAYMENT - OFFICE ***** **3771 AUTH: 341705 $12.93 19607114 12/04/2023 $162.07 $12.93 $12.93 Charge: ***** - PSYTX PT&/FAM W/E&M 30 MIN Note: PD BAL- DOZ 1-4 01/04/2024 OF PAYMENT - OFFICE ***** **3771 AUTH:341705 $12.93 ******** 11/20/2023 $162.07 $12.93 $2.80 Charge: ***** - PSYTX PT&/FAM W/E&M 30 MIN Note: PD BAL- DOZ 1-4 02/05/2024 PP PAYMENT -PATIENT ***** **3771 AUTH: 787650 $2.80 19607114 12/04/2023 $253.17 $21.83 $21.83 Charge: ***** - ***************** VISIT EST Note: PD BAL- DOZ 1-4 02/05/2024 PP PAYMENT - PATIENT ***** **3771 AUTH: 787650 $21.83 19618550 01/04/2024 $194.44 $80.56 $0.37 Charge: ***** - ***************** VISIT EST Note: PD BAL- DOZ 1-4 02/05/2024 PP PAYMENT - PATIENT ***** **3771 AUTH: 787650 $0.37 **/19/2024 $0.00 Charge: UNAPPLIED Note: The member's plan doesn't cover services from out-of-network providers. **/19/2024 PI PAYMENT - INSURANCE 992407501073543 $0.00 Generated 5/4/2024 09:36:54 PM Page 3 of 7 Payment Receipt For ***************** ****** LEARNING TO ACHIEVE WELLNESS Dates 1/1/2023 to 5/4/2024 ***********************************, B All Provider Profiles Phone: ************** Fax:************** Visit # DOS Insurance Portion Patient Portion Payment Amount Date Payment Code Payment Description Check # **/19/2024 $0.00 Charge:UNAPPLIED Note: The member's plan doesn't cover services from out-of-network providers. **/19/2024 PI PAYMENT - INSURANCE 992407501073543 $0.00 19618550 01/04/2024 $194.44 $80.56 $0.00 Charge: ***** - ***************** VISIT EST 04/01/2024 PI PAYMENT - INSURANCE ************ $0.00 19618550 01/04/2024 $137.00 $38.00 $0.00 Charge: ***** - PSYTX PT&/FAM W/E&M 30 MIN 04/01/2024 PI PAYMENT - INSURANCE ************ $0.00 19618550 01/04/2024 $194.44 $80.56 $24.63 Charge: ***** - ***************** VISIT EST Note: PD BAL-DOZ 1-4 04/02/2024 OF PAYMENT - OFFICE ***** ** AUTH: 341705 $24.63 19618550 01/04/2024 $194.44 $80.56 $12.00 Charge: ***** - ***************** VISIT EST Note: PD BAL- DOZ 1-4 04/02/2024 OF PAYMENT - OFFICE ***** ** AUTH: 341705 $12.00 19618550 01/04/2024 $137.00 $38.00 $13.00 Charge: ***** - PSYTX PT&/FAM W/E&M 30 MIN Note: PD BAL- DOZ 1-4 04/02/2024 OF PAYMENT - OFFICE ***** **AUTH: 341705 $13.00 19618550 01/04/2024 $137.00 $38.00 $25.00 Charge: ***** -PSYTX PT&/FAM W/E&M 30 MIN Note: PD BAL- DOZ 1-4 04/02/2024 OF PAYMENT - OFFICE ***** ** AUTH: 341705 $25.00 19626351 01/18/2024 $198.74 $51.26 $0.00 Charge: ***** - ***************** VISIT EST 04/09/2024 PI PAYMENT - INSURANCE 610044458883 $0.00 19626351 01/18/2024 $137.00 $38.00 $0.00 Generated 5/4/2024 09:36:54 PM Page 4 of 7 Payment Receipt For ***************** ****** LEARNING TO ACHIEVE WELLNESS Dates 1/1/2023 to 5/4/2024 ****************************************** All Provider Profiles Phone: ************** Fax: ************** Visit # DOS Insurance Portion Patient Portion Payment Amount Date Payment Code Payment Description Check # Charge: ***** - PSYTX PT&/FAM W/E&M 30 MIN 04/09/2024 PI PAYMENT - INSURANCE 610044458883 $0.00 19626351 01/18/2024 $31.00 $119.00 $0.00 Charge: ***** - PSYCHOLOGICAL AND NEUROPSYCHOLOGICAL TES 04/09/2024 PI PAYMENT - INSURANCE 610044458883 $0.00 19626351 01/18/2024 $102.00 $48.00 $0.00 Charge:***** - NEUROPSYCHOLOGICAL TESTING EVALUATION SE 04/09/2024 PI PAYMENT -INSURANCE 610044458883 $0.00 04/16/2024 $0.00 Charge: UNAPPLIED Note: N130 -Consult plan benefit documents/guidelines for information about restrictions for this service. 04/16/2024 PI PAYMENT - INSURANCE 992407501073543 $0.00 04/16/2024 $0.00 Charge: UNAPPLIED Note: N130 - Consult plan benefit documents/guidelines for information about restrictions for this service.04/16/2024 PI PAYMENT - INSURANCE 992407501073543 $0.00 19627655 02/01/2024 $194.44 $80.56 $0.00 Charge: ***** - ***************** VISIT EST 04/25/2024 PI PAYMENT - INSURANCE 610044923369 $0.00 19627655 02/01/2024 $137.00 $38.00 $0.00 Charge: ***** - PSYTX PT&/FAM W/E&M 30 MIN 04/25/2024 PI PAYMENT -INSURANCE 610044923369 $0.00 19632082 02/15/2024 $194.44 $80.56 $0.00 ************** ***************** VISIT EST 04/25/2024 PI PAYMENT - INSURANCE 610045407488 $0.00 19632082 02/15/2024 $137.00 $38.00 $0.00 Charge: ***** -PSYTX PT&/FAM W/E&M 30 MIN 04/25/2024 PI PAYMENT - INSURANCE 610045407488 $0.00 19632082 02/15/2024 $31.00 $119.00 $0.00 Generated 5/4/2024 09:36:54 PM Page 5 of 7 Payment Receipt For ***************** ****** LEARNING TO ACHIEVE WELLNESS Dates 1/1/2023 to 5/4/2024 413 W *********, B All Provider Profiles Phone: ************** Fax: ************** Visit # DOS Insurance Portion Patient Portion Payment Amount Date Payment Code Payment Description Check # Charge: ***** - PSYCHOLOGICAL AND NEUROPSYCHOLOGICAL TES 04/25/2024 PI PAYMENT - INSURANCE 610045407488 $0.00 19632082 02/15/2024 $102.00 $48.00 $0.00 Charge: ***** - NEUROPSYCHOLOGICAL TESTING EVALUATION SE 04/25/2024 PI PAYMENT - INSURANCE 610045407488 $0.00 19627655 02/01/2024 $194.44 $80.56 $25.00 Charge: ***** - ***************** VISIT EST 04/26/2024 OF PAYMENT - OFFICE ***** ** AUTH: 324444 $25.00 19651265 04/19/2024 $240.00 $0.00 $99.75 ************** ***************** VISIT EST 05/04/2024 PI PAYMENT - INSURANCE 802224386 $99.75 19651265 04/19/2024 $165.00 $0.00 $71.46 Charge: ***** - PSYTX PT&/FAM W/E&M 45 MIN 05/04/2024 PI PAYMENT - INSURANCE 802224386 $71.46 19651265 04/19/2024 $80.00 $0.00 $31.92 Charge: ***** - NEUROPSYCHOLOGICAL TESTING EVALUATION SE 05/04/2024 PI PAYMENT - INSURANCE 802224386 $31.92 19651265 04/19/2024 $195.00 $0.00 $94.33 Charge: ***** - PSYCHOLOGICAL AND NEUROPSYCHOLOGICAL TES 05/04/2024 PI PAYMENT - INSURANCE 802224386 $94.33 Generated 5/4/2024 09:36:54 PM Page 6 of 7
  
   Payment Receipt For ***************** ******
  Payment Code Payment Description
  Payment Amount Total OF PAYMENT - OFFICE $147.32
  PI PAYMENT - INSURANCE $864.82
  PP PAYMENT - PATIENT $94.52
  Current Patient Balance: $454.12
   Insurance Pending Balance: $2,835.00
  Signature: Generated 5/4/2024 09:36:54 PM 

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