Long story short:
There is MOST definitely a major insurance fraud going on at this place. You will be told that the basic eye exam will go thru your vision insurance, but then you will be told differently at check out as "additional exam was done, so it's considered a medical visit & it won't be covered" - regardless of what conversation you had when making the appt, or reconfirming again with the technicians. The MD will come in the end, do one 'extra' exam and that will be coded differently & they will justify that charge & ask you to pay $200+. This is the summary of several reviews written. Fight it & ask to speak to the manager, that's what I did for it to be corrected/resolved. Read below for full details of my experience & what happened to get my charge corrected!
Details:
Went in for a lasik enhancement (PRK) eval - which was confirmed to be free. I wasn't a candidate (yet), so I was asked if I'd like also like to to go ahead & get a yearly eye exam done for new glasses prescription (refractory exam) - which was also confirmed to be covered thru my eye insurance.
The final retinal exam (done for the PRK baseline eval) was done by the MD and there was an incidental finding that I have early mild cataracts. He said nothing is done it right now & he explained what is expected with PRK, etc
Welp, at check out, I was asked to pay $271 -
Wait? What??? Why!?
Explanation: "because the doctor did an exam & there is a cataract diagnosis, so it is not considered an eval anymore, but charged as full doctors visit" Which made zero sense!! I tried to explain that the exam was done as part of the (free) eval & that I didn't come in for cataract related concern (reason for visit) & nothing was done for it, i.e. you can't just charge someone for an incidental finding!
It's like going in for an oil change with during the routine maintenance check, the mechanic finds that my battery is running slightly low & recc to keep an eye on it (no pun intended) -- the mechanic is not going to charge me for the battery check separately simply bc he told me it was low and found out during the maintenance check!
I also mentioned my conversation about it being covered beforehand, and I should've been informed if something wasn't going to be covered. I even asked them speak to the technician to verify this conversation, but the rep completely dismissed it stating "we are not responsible for what the back office says or does"
wow! Really?! You are not take any responsibility - not even try to clarify the misinformation being given by your own clinic staff?
-- 20+ mins of giving them 5 different analogies to disqualify their ridiculous rationale, going in circles with 3 different rude staff members later, I was finally offered to see the manager, but told that it could be a 30-40 mins wait ~ yet another tactic to discourage someone to be questioning the charge.
I had no problem waiting bc I was 100% sure that charge was wrongly coded & it was wrong to be doing that! Why do I know this? Oh! Bc I am a billing provider myself at a private practice, where we make sure to avoid using "extra codes" and stay in compliance to remain credentialed with insurances and CMS! I was so intrigued & was trying to gauge how extensive this problem is before I file a complaint myself!
Any way, 10-15 mins later, the office manager (holly) comes out, and to their saving grace, she was truly amazing! She took the time to listen to the entire saga, without once interrupting or arguing with me, and she completely agreed that I should have only been charged for my refractory exam (for my eye glass prescription), which would go thru my eye insurance & have a $10 copay!
I should also mention that while waiting for the manager and there were 3 other patients that came out and were said about the exact thing "Oh! The MD did an extra exam, so today's visit won't covered by your eye insurance, and it will be $215 bucks" -- these naive patients all paid without questioning it!! It was all too obnoxious!! It obviously is their standard tactic for them to over-charge for a simple eye exam!
These front office reps / the billing practices seriously need a MAJOR internal review before the place is reported / audited - lose their practice license.
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To properly credit the medical team ~ the eye technician (I wish I could remember his name) did a fantastic job, the MD was alright, and the office manager (Holly) was excellent!! read more