ComplaintsforMatossian Eye Associates

• Initial Complaint

  09/15/2022

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  I went to Matossian for RGP contacts due to an eye condition. I repeatedly informed Matossian associates my insurance will cover the contacts if the provider submits a pre-authorization and claim and confirmations the eye condition. I received and paid for the general eye health exam with the understanding a follow up exam was necessary for the contacts fitting. After the initial eye health exam, it took more than 20 phone calls to schedule an appointment for the contacts. Again, each conversation included the acknowledgment that Matossian needs to submit the pre-authorization and claim to the insurance. After being assured Matossian had my insurance information and will fill the pre-auth, I scheduled the next contact fitting appointment. The Dr tried to convince me to order the contacts but I refused stating Matossian needs to request a pre-authorization to the insurance before we order the contacts for the insurance to cover the claim. After repeated calls to confirm Matossian requested the pre-authorization I finally reached the office manager who told me Matossian does not submit pre-authorizations or claims for contacts to insurance. At this point I told her my frustrations and she told me she will resolve the bill for the confusion. 1. The RGP exam was never completed. 2. Matossian never provided the RGP prescription. 3. Matossian never submitted the pre-authorization 4. Matossian never provided the RGP contacts. I do not owe the $137 as the service was not finished and the contacts were not provided. Matossian needs to provide me a $0 balance due receipt to resolve this issue. 

  Business response

  12/07/2022

  November 4, 2022 

  Dear ******** *******, 
  

  Thank you for your letter dated September 28, 2022, regarding the complaint you received from our patient. I appreciate your letting us know of the concerns that our patient brought to you. I also appreciate your allowing us time to investigate the specific circumstances. 
  

  I want to assure you that we take these concerns very seriously. We have investigated the specific concerns and have delineated our findings below.

  Regarding the patient's statement that it took more than twenty phone calls to schedule an appointment, I know that we were short-staffed during the time period in question. I am truly sorry that the patient experienced a delay in scheduling an appointment. 
  

  Regarding the submission of the pre-authorization and the claim, we have documentation that when the patient was at our office, the physician told this patient that we do not perform prior authorization for ordering of Rigid Gas Permeable, or "RGP" lenses. We also have documentation that on another date soon after that, I personally relayed the same message to the patient. 
  

  Our protocol is that we do not bill insurance companies for RGP lenses. We request payment up front for these lenses. This has been a long-standing policy here at Matossian Eye. The prescription for RGP was never provided to the patient, as the payment was never furnished by the patient for the RGP lens process to proceed. The RGP contacts were also never provided to the patient for that same reason. 
  

  I cannot say whether or why the patient was told by a front desk staff member that we would gather a prior authorization. Nonetheless, we have provided education to all team members, so as to prevent a reoccurrence. 
  

  We do have documentation that at least one eye exam was completed. When a patient is seen for an exam for a diagnosis such as the one that this patient had, this exam includes a slit lamp exam to assess the health of the cornea as well as the posterior section of the eye. This is a billable visit. This particular patient was not billed for a fit of RGP lenses but was billed for the exams to assess overall eye health. 
  

  We can supply the patient with a receipt to submit for reimbursement; however, a refund will unfortunately not be possible by our practice, as the service was, indeed, provided. As for the $137.00, the charges not covered by insurance, are not charges for a fit of the RGP lenses, but again, they are for the exams that the physician performed. 
  

  If the patient has any further questions or concerns, we would be happy to assist with these. 
  

  Sincerely, 
  

  Jenis L****** 
  Office Manager 

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