ComplaintsforOphthalmic Consultants of the Capital Region

• Initial Complaint

  03/25/2024

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  I went for an eye exam to include dilation because I am a diabetic. I ended up not having my eyes dilated because the doctor was almost an hour late and I had another medical appointment right after. This is the reason why I scheduled my appointment first thing in the morning. The treatment I received was a basic eye exam, that was it. When I had to leave for my next appointment, even though I had no change in my vision and they did not perform a dilation, they would not provide me with a new script which I needed in order to get new glasses. After arguing with the front desk, the manager stepped in and got the new script that I needed. My wife who was with me at this appointment, informed the manager that we would not be back due to the unprofessional treatment I received. I then received a bill for $198.00 which included a CPT Code "92002 New Ophth, Intermediate". I never received any treatment, I just had a basic eye exam and that was it. When I called the billing department, I spoke to an individual by the name of Madison, she informed me she would have to speak to the doctor. Within 2 days, Madison called me back and said "the bill was correct, this is how they bill". When I told her no, this bill was incorrect, you are charging me for a service that was not provided, she then said "well this is what we charge. Have a good day!" and she hung up on me. My wife and I were shocked at the treatment we received from the time we entered the building to the time we left! I am hopeful that your establishment can investigate this charge, and I would very much like a detailed explanation of this charge. All we were told, "this is how we bill" with no other explanation. That does not sound correct to me. Thank you for your time.

  Business response

  04/17/2024

  Per our records noted on the patient's, **** *****, account, the patient called on December 5, 2023 to schedule an appointment for a routine eye exam, lens rx and glasses. The appointment was scheduled for February 8, 2024; however, we called the patient to reschedule the appointment to February 15, 2024 as the physician, Dr. H****** ended up needing to be out. 

  On March 21, 2024, ****'s wife called the billing department. As his wife is not listed on the ****'s HIPAA form, she was informed that we needed ****'s permission to speak with her. The wife advised that **** was not home and that she'd have him call us back. She called back and **** gave permission for us to speak with her. She stated that his exam is usually covered because he is diabetic. Our billing department informed her that it was scheduled as a routine eye exam and Medicare, his listed insurance on the account, does not cover routine eye exams The care plan listed in the EMR is for the patient to return in the early summer for a dilated diabetes exam. The patient had refused dilation at his routine exam on February 15, 2024.  It is also noted in the EMR that the patient refused an lens rx.  The billing representative stated they would reach out to Dr. H*****.  Dr. H***** stated that the exam was routine and the billing codes (92002, New Patient Eye Exam - Intermediate level and 92015, Refraction) were correct. 

  The billing representative contacted the patient to let them know Dr. H*****'s feedback. It is noted that ****'s wife started yelling in the background how they were going to file a complaint about Dr. H***** and the practice to the Attorney General. The patient stopped talking into the phone and his wife continued yelling in the background according to the notes in the account.  The billing representative advised that she was ending the call prior to hanging up as the patient's wife continue to yell in the background. 

  We took proper steps to ensure that the correct appointment was booked based on the patient's request, which was for a routine eye exam. The representative researching the appointment based on the patient's call, confirmed the notes in the patient's chart with the physician who confirmed the patient refused the dilation and the rx lens and that the correct codes were billed based on the events of the visit and it was noted that the dilated diabetes exam would be performed in the summer as discussed with the patient.

   

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