New York
I’ve have not received replies from my cataract surgery provider or Health Insurance provider regarding an explanation for the following.
I was required to pay my cataract surgery provider in full out of pocket prior to surgery because the surgeon will only implant upgraded “multi focal lens” by use of laser technology and neither the laser procedure or upgraded lens are covered by Medicare, (which was a curve ball). They failed to mention they would submit additional claims to my health insurance provider beyond the two $350 co pays toward the separate operative out-patient facility.
All the forms they provided including the breakdown of funds and ledger are obfuscated with multiple descriptions for each fee and charge that seem to be intentionally misleading. Even the charges are conflicting.
My Health Insurance provider stated I was responsible is for two $350 co pays = $700, plus two lens upgrades of which I was charged $1900 each = $3800, however I was also charged additional surgery fees of $2890 ($1445 ea.)
My visa payment of $6,690 does not appear on their ledger that I requested. What does appear on their ledger is my $700 co-pay, the $6,086.68 claim they submitted to my Health Insurance provider for the surgery and lens; and their adjusted payment received of $2,609.77 (attached kindly see my revised accounting of their ledger)
It appears to me the necessity to submit a claim of $6,086.68 to my Health Insurance provider and receive adjusted payment of $2,609.77 after I paid $6,690 out of pocket is a form of consumer and healthcare fraud.
Thoughts anyone?
I’ve have not received replies from my cataract surgery provider or Health Insurance provider regarding an explanation for the following.
I was required to pay my cataract surgery provider in full out of pocket prior to surgery because the surgeon will only implant upgraded “multi focal lens” by use of laser technology and neither the laser procedure or upgraded lens are covered by Medicare, (which was a curve ball). They failed to mention they would submit additional claims to my health insurance provider beyond the two $350 co pays toward the separate operative out-patient facility.
All the forms they provided including the breakdown of funds and ledger are obfuscated with multiple descriptions for each fee and charge that seem to be intentionally misleading. Even the charges are conflicting.
My Health Insurance provider stated I was responsible is for two $350 co pays = $700, plus two lens upgrades of which I was charged $1900 each = $3800, however I was also charged additional surgery fees of $2890 ($1445 ea.)
My visa payment of $6,690 does not appear on their ledger that I requested. What does appear on their ledger is my $700 co-pay, the $6,086.68 claim they submitted to my Health Insurance provider for the surgery and lens; and their adjusted payment received of $2,609.77 (attached kindly see my revised accounting of their ledger)
It appears to me the necessity to submit a claim of $6,086.68 to my Health Insurance provider and receive adjusted payment of $2,609.77 after I paid $6,690 out of pocket is a form of consumer and healthcare fraud.
Thoughts anyone?
| Claim & | BCBS | Client | ||||
| DOS | ACTIVITY | Charge | Pmt / Adj. | Visa. | Balance | |
| 4/29/2021 | PanOptix - Vivity Lens (Multifocal Lens Purchase) | Chg. | $2,045.00 | $2,045.00 | ||
| 4/19/2021 | PanOptix - Vivity Lens (Cost of Lens OR Surgeon Service of Surgery?) | Visa | $2,045.00 | $0.00 | ||
| 4/29/2021 | Phacoemulsification With IOL (Surgery Claim $1000) | Claim | $1,000.00 | $1,000.00 | ||
| 5/24/2021 | Blue Cross of WNY PMT ($645.97 + $354.03 = $1000) | Ins. | $645.97 | $354.03 | ||
| 5/24/2021 | HealthNow New York in ADJUST (Already Paid in Advance for Surgery) | Adj. | $354.03 | $0.00 | ||
| 4/29/2021 | Blue Cross of WNY (Surgery Claim $2043.34) | Claim | $1,034.38 | $1,034.38 | ||
| 5/24/2021 | Blue Cross of WNY PMT (Ins. Copay $375 + $659.38 = $1034.38) | Ins. | $659.38 | $375.00 | ||
| (Already Paid in Advance for Surgery Center?) | ||||||
| 4/29/2021 | Surgery Center Fee OR Copay OR Copay to Surgeon? | Chg. | $375.00 | $375.00 | ||
| 4/29/2021 | Surgery Center Fee OR Copay OR Multifocal Len Fee OR Cost of Lens? | Chg. | $950.00 | $1,325.00 | ||
| 04/19/2021 | (Unaccounted on Ledger $950 + $375 = $1325) | Visa | $1,325.00 | $0.00 | ||
| 1/6/2022 | PanOptix - Vivity Lens (Multifocal Lens Purchase) | Chg. | $1,959.00 | $1,959.00 | ||
| 1/4/2022 | PanOptix - Vivity Lens (Cost of Lens OR Surgeon Service of Surgery?) | Visa | $1,959.00 | $0.00 | ||
| 1/6/2022 | Phacoemulsification With IOL (Surgery Claim $1000) | Claim | $1,000.00 | $1,000.00 | ||
| 1/24/2022 | Blue Cross of WNY PMT ($595.04 + $404.96 = $1000) | Ins. | $595.04 | $404.96 | ||
| 1/24/2022 | HealthNow New York in ADJUST (Already Paid in Advance for Surgery) | Adj. | $404.96 | $0.00 | ||
| 1/6/2022 | Blue Cross of WNY (Surgery Claim $2043.34) | Claim | $1,034.38 | $1,034.38 | ||
| 1/24/2022 | Blue Cross of WNY PMT (Ins. Copay $325 + $709.38 = $1034.38) | Ins. | $709.38 | $325.00 | ||
| (Already Paid in Advance for Surgery Center?) | ||||||
| 1/6/2022 | Surgery Center Fee OR Copay OR Copay to Surgeon? | Chg. | $325.00 | $325.00 | ||
| 1/6/2022 | Surgery Center Fee OR Copay OR Multifocal Len Fee OR Cost of Lens? | Chg. | $945.00 | $1,270.00 | ||
| 1/6/2022 | ($91 Tax?) | Chg. | $91.00 | $1,361.00 | ||
| 1/4/2022 | (Unaccounted on Ledger $945 + $375 + $91? = $1411?) | Visa | $1,361.00 | $0.00 | ||
| 05/07/2021 | (Practitioner Copay) | Visa | $40.00 | ($40.00) | ||
$10,758.76 | $3,054.91 | $6,730.00 |
