ComplaintsforThe Children's Eye Doctor

• Initial Complaint

  03/31/2022

  Complaint Type:

  Sales and Advertising Issues

  Status:

  Answered

  More info

  Went in for a simple Annual eye exam for my child. They decided to use the seasonal allergies that my son has for past 5 years and is being treated by a separate medical provider and billed the eye exam to my medical insurance and instead of my ***************** Despite asking them to fix the billing and **** my **************** not medical their billing department refused it. Add to that their Office manager was rude and disconnected the call, while I was talking. As per vsp insurance - if the eye doctor documents a medical code in they can "choose" to **** medical insurance and not *************** and they do that as medical coverage is more and they get more money. My medical insurance does not cover a single ***** of the eye exam and there is no discounted rate either negotiated for the "eye exam" service so these people are now able to game the system to extract more money out of me. So IMO they just create fake charges to make money. My child was sent home without describing any new medical issues to me or giving any prescription. I am left a **** of $171 to be paid. which is made up on "unknown" medical code charged to my insurance.

  Business response

  04/04/2022

  ******************, Unfortunately, there are several incorrect statements and assumptions about how you think insurance billing should be done.  First, it is not a choice of what is billed, it is what is presented during the exam and what the plan of care is for the patient.  The doctor can not simply omit a diagnosis so that you have better insurance coverage.  You state that you did not know anything about the seasonal allergic conjuctivitis.  However, there is extensive documentation by the doctor as well as comments about her speaking with you concerning solutions.  Our exam records are always open for independed review by insurance companies.   Secondly, Premera did adjust off $68.50 and the remainder of the charges went to your deductible.  You state that not a ***** was covered.  There is a difference between insurance coverage and you not owing anything for your visit.  Your visit was covered and processed appropriately from Premera.

  Lastly, speaking over billing staff because you are not getting the resolution (no amount due) you want and not allowing for explanations to be given does not make staff rude.  There is no point in continueng a phone call where there is only one person speaking.  I stated that I would not be continuing the phone call if you would not allow us to say anything.  Perhaps you did not hear that as you continue to speak over us.  I then stated I would be hanging up now, but you continued to speak over us.

  Please consult your insurance plan for a summary of your benefits.  Your signed agreement of your understanding concerning billing is attached.

   

  Customer response

  04/08/2022

   
  Complaint: 16968397
  
  I am rejecting this response because:

   

  I scheduled a well eye Exam visit for both my children. My daughter eye exam is covered in full by the *** vision insurance and that is what I expect for my son too.  But my son's exam is not covered because the doctor did not **** it correctly or what ever the billing department did to make it a sick visit instead of a well eye exam.  They billed to Premera and Not ***.

  They are billing for discussing a concerns that is already well documented for my son. We did not choose to bring it up during the exam. The doctor asked us about the redness around the eye and we told her that yes he gets pain in his eyes, we also told her that we use eye lubricant drops (OTC) and "Tacrolimus" ointment for his eye issues-- which is prescription from "Northwest Allergy and Asthama"  and has been there on his file for past many years.  The eye doctor told us to continue those.  

  We never brought up the issue of  any "seasonal allergies"  -- no new diagnosis was done by the eye Doctor. We only went there for Annual eye Exam and did not  "voluntarily" discuss any other sickness. If the doctor asks me about my child's medical history -- what do you expect me to do ? tell the doctor that I will not disclose it  because it is a well visit ? 

  What kind of billing is this - first ask the patient what are your existing issues and existing medications -- then give it a new medical diagnosis code and **** it to the medical insurance instead of vision insurance ? *** has not received any claim from you for my son they have received only for my daughter, because you billed it to Premera. For my daughter you billed it to *** correctly but for my son you have billed to Premera. *** has not deductible Premera has deductible. 

  The business is more than welcome to  read my son's medical records from "NorthWest Allegry and Asthma" that will tell them that his eye issues -- redness and dryness around eyes and other eczema issues -- etc are nothing new. We have seen NW allergy and Asthma multiple times in past and that condition is well managed with his current prescriptions. Nothing new was diagnosed no new prescription was given by the eye doctor so how does that become a sick visit? 

  He has been seen at Allegro Pediatrics and *******'s children too for his seasonal allergies and eczema. I do not have the need to go to the eye doctor for seasonal allergies. If you choose to give it a new fancy name  ---- to make it sound scary -- "Conjuctivitus"  -- but without viral or bacterial infection ... blah blah ... that is not my concern. I do not care about the name of thing.  Nothing new came out the diagnosis. And I did not ask the doctor to look into his eye redness -- We simply scheduled a Annual eye exam. The doctor asked for his current medical status about redness around his eyes and that was provided. That does not constitute discussing an acute illness, and hence it should be billed as "Well Eye Exam"  and billed to ***. Not to Premera as a sick visit. 

  Regarding your rude Staff -- go read your reviews on Yelp website. Almost everyone says the same. And this wrong billing is also documented by other patients on Yelp. Nothing new again. In my opinion this business commits' insurance fraud and fake billing. 

   

   

   

  
  Sincerely,
  
  ***************************

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