Complaints

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• Initial Complaint

  Date:08/09/2024

  Type:Delivery Issues
  Status:

  UnansweredMore info

  Complaint statuses

  Resolved:

  The complainant verified the issue was resolved to their satisfaction.

  Unresolved:

  The business responded to the dispute but failed to make a good faith effort to resolve it.

  Answered:

  The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.

  Unanswered:

  The business failed to respond to the dispute.

  Unpursuable:

  BBB is unable to locate the business.

  Medical Paradigm Solutions (MPS) is the billing service vendor for my obgyn. The procedure was a C-section delivery performed by my obgyn, who has his own practice and is not employed by the hospital. The hospital is his preferred birthing facility and is in-network. My insurance is ****************** On 7/26/2024, I received a bill from Medical Paradigm Solutions for $6,223.21 for a service labeled as a C/S delivery package. Anthem had denied the billing services claim for this, stating "zero patient responsibility," because they had already approved a similar charge from the hospital--the hospitals bill was for "facility charges," which included a different doctor (not my obgyn) who checked on me after the delivery.Medical Paradigm Solutions had sent an appeal to Anthem, to which Anthem did not respond (Anthem claims they dont have the appeal on file). The bill sent to me mentions Anthem has not responded [to the appeal] within the required time frame, per California law. Absent their payment, this is your balance. The bill has no due date.I contacted Anthem and they told me this issue is due to a procedure code error (they needed to include a modifier to note that it was separate procedures by separate providers), and that MPS needs to perform a procedure code review and resend the appeal. They confirmed that the claim was rejected with "zero patient responsibility," (in attached EOB) meaning I shouldnt have been billed. They also tried contacting MPS but received no response.Medical Paradigm Solutions has been unresponsive. *** tried reaching out to them via phone and email to relay what Anthem told me. Their phone number goes straight to voicemail, and despite leaving messages, *** received no callback. The one email response I received simply asked if the procedures they billed for seemed correct, to which I confirmed, but I haven't heard back since. I have since found out that what they've done could be a violation of the insurance contract.