Complaint Investigation Report

Interviews confirmed that as every insurance policy is different, every client would have to meet their deductible prior to insurance covering the full cost of admission. As such, a review of Admission Agreements and insurance verification forms confirmed that clients have varying deductibles to meet. If a client has not met their deductible prior to being admitted to this facility, clients are responsible for paying their deductible before insurance covers the remaining cost. In reviewing separate insurance verification forms, depending on whether a client has met a portion of their deductible, a client may only be responsible for $500 of their entire stay at this facility. However, there are other clients that had not met their deductible, thus that client may have been responsible to pay $4000, as they had a larger deductible to meet. Comparatively, if a client has met their deductible for the year, insurance could cover the full cost of their stay at this facility.

However, interviews and record review confirmed that clients would have to pay out of pocket for additional services. Additional services would include acupuncture, massages, hypnotherapy, private yoga, and so on. For example, if a client is admitted on 3/1/2022 and declines additional services, then it is documented on the Admission Agreement as a denial of additional services. However, if that client decided to partake in a session after signing their admissions agreement and it is not covered in their treatment plan, then they would have to pay for the service out of pocket. However, the client directly pays the provider of the additional service, not the licensee. The LPA reviewed audited records and invoices alongside staff and was unable to uncover any inconsistencies or errors. Lastly, the cost for each additional service is available in the signed admission agreement, and clients have to sign a ‘service upgrade request’ form prior to utilizing an additional service.

Based on the information obtained during the course of the investigation, there is insufficient evidence to support the claim that the licensee failed to correctly charge clients for services as described in the admissions agreement. This allegation is deemed Unsubstantiated at this time.

No deficiencies cited at this time. Exit interview conducted. A copy of the report was issued.