ComplaintsforLAM Dermatology

• Initial Complaint

  10/24/2023

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  Was referred to ********** with *** Dermatology by my ******* Care Physician. I called *** Dermatology to verify the referral had been received and was approved by the insurance company. I was informed that it had been, so I scheduled an appointment. Was seen on 2/21/2023. I had several appointments at *** Dermatology following the initial appointment. They are now requesting an additional referral for *******************, **-C., because the insurance is denying payment due to the referral being for *********. I requested my ******* Care Physician, *********** send an additional referral for *******************, **-C, however, *********** has informed me that referral cannot be sent for a Physician's Assistant. The appointment dates for **** were 2/21/2023 and 4/11/2023. Now *** Dermatology is billing me for $1,230.00 for the dates they had **** see me instead of **********. They knew the referral was for ********* instead they had the physician's assistant see me.

  Business response

  11/29/2023

  Hello,

  Due to limitation on characters for response, I have attached a PDF that contains our response.

   

  Our office received the patient referral on 2/8/2023. The referral was only directed to our Practice as
  a whole with no specification on the intended medical provider. In reference to the verbiage in the
  patient's complaint regarding verification, we did confirm that we were in possession of the referral
  and that we are contracted with their insurance payer. Patient was scheduled with our physician
  assistant, Nhung ****, PA-C on 2/21/2023 and 4/11/ 2023. Patient scheduled another appointment
  with Dr. Yaohan *** on 5/15/2023.
  Our financial policies in the initial patient registration packet states that we hold our patient
  responsible for understanding their insurance policy and to contact their insurance company for any
  clarification prior to services being rendered including, but not limited to authorization, and then to
  inform our office if there are any special requirements for their specific plans. Failure to do so will
  result in the patient being held financially responsible for any denied claims. We have a signed
  document that states that the patient acknowledged, read, and understood the office and financial
  policies, and to be bound by its terms on 2/21/2023.
  The claims for the date of services on 2/21/2023 and 4/11/2023 were denied due to no authorization
  for Nhung ****. Please note that referral authorizations can only be submitted by a primary care
  physician for the specialist's office. Therefore, we can only request the patient and/or PCP's office to
  remit the authorization in the case the claim is denied. Our office was made aware of the denied
  claims on 7/17/2023 by our billing company. Our office manager (OM), Chelsey Todd, reached out as
  a courtesy to the referral coordinator at the PCP's office via phone call and email on 7/19/2023 to get
  a backdated referral for Nhung **** to cover both office visits. OM followed up with the PCP's office
  on 7/25/2023 after receiving no correspondence to our request. OM again called on 8/7/2023 and
  was able to speak to Kathy at the central referral site to assist with the backdated referral. At the
  time of that call, Kathy stated that she will have a new referral sent over to our office with the
  Practice's NPI instead of a specific provider so that the patient has flexibility to be seen at any of our
  offices and with any medical providers. Due to no receipt of any updated authorization, OM reached
  out for the fourth time on 8/21/2023 to inquire on the status during which another representative,
  Kaydee, promised to fax our way. With no development on the updated authorization, OM reached
  out for the fifth and final time to the PCP's office on 8/28/2023 and was only able to leave a
  voicemail.
  After no receipt of an updated authorization or response from the PCP's office, Chelsey reached out
  to the patient on 10/13/2023 for assistance on this matter. OM spoke to the patient's wife about the
  situation and the wife was audibly upset and stated that they would not pay the bill if our office was
  unable to obtain the authorization. As previously stated, our financial policy holds the patient
  responsible for understanding their insurance plan and as a courtesy, we have tried to assist the
  patient as best as we could with no success before requesting for their involvement on the issue.
  Our office can provide a self-pay discount if the patient was unsuccessful with getting the backdated
  approval, but unfortunately, we have not heard back from the patient since the phone conversation
  with OM on 10/13/2023 hence why the office transferred the denied claims to the patient's
  responsibility

  Kind Regards,

  ******************

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