Complaints

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• Initial Complaint

  Date:12/07/2024

  Type:Billing Issues
  Status:

  AnsweredMore 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.

  I was recommended to this provider by my primary care physician after completing a sleep study that diagnosed me with mild sleep apnea. After an initial exam the provider said I was a good candidate for an oral appliance for sleep apnea, I had questions about how this would be submitted for a claim to my insurance and the provider stated that they are a cash up front business but they would submit claim on my behalf and they would "fight" for me to get it covered by insurance. I was hesitant about this, but they promised me that they can submit a gap waiver and that they work with insurance all of the time. I was suffering from bad sleep and so I agreed to this. I feel like they used predatory practices to get me to agree to the deal. After I received the device I noticed no change in my sleep quality at all. After it was complete they waited approximately 40 days to submit the claims to my insurance to process. The communication was so bad at one point I had to use a UHC rep to call them and ask them why the claims weren't submitted. Once the claim was submitted, it was either submitted wrong or the insurance processed the claim wrong because they didn't see the gap waiver. Ultimately the claim was rejected by insurance, The provider submitted an appeal that was rejected again for out of network. The provider gave up trying to appeal and seemed like they exhausted all options. The appliance doesn't provide the relief I need for sleep and I believe they over estimated the claims of the efficacy of the device they sold as well in the consultations.

  Business Response

  Date: 12/09/2024

  Dear ****,
  Thank you for taking the time to share your concerns. We are truly sorry to hear that you feel dissatisfied with your experience, as it is always our goal to provide exceptional care and support to all our patients.
  We would like to address the points you raised to ensure clarity:
  Out-of-Network and Fee-for-Service:
  As an out-of-network and fee-for-service practice, this was communicated to you multiple times throughout your experience with us. We always inform patients that while we submit claims to insurance as a courtesy, coverage is not guaranteed, and reimbursement decisions ultimately rest with the insurance provider.
  Efforts to Submit and Appeal Insurance Claims:
  Our records show that we submitted your claims and appealed them twice on your behalf. Unfortunately, your insurance denied the claim each time, including the appeal for the gap exception. We have exhausted all avenues within our control to assist in obtaining reimbursement and have documentation of these denials (the latest one attached here), which we are happy to provide for your review.
  Follow-Up and Therapy Completion:
  We designed and provided you with an FDA-approved oral appliance specifically for your diagnosed sleep apnea. Follow-up visits are a critical component of ensuring the appliance works effectively and addressing any necessary adjustments. However, you did not return for these visits to complete your therapy. Without these essential follow-ups, the appliance cannot be fully optimized for your needs.
  Communication and Resolution Attempts:
  We have made multiple attempts to contact you via phone, email, and text to discuss your concerns and work toward a resolution that satisfies you. We remain committed to addressing your dissatisfaction, but unfortunately, we have not received a response.
  We understand that this situation has been frustrating for you, and we regret that the outcomes have not met your expectations. While we stand by the quality of care and efforts provided, we are still open to discussing potential solutions with you. Please reach out to us directly at 302-239-1757 or respond to the email I sent you directly so we can work together to resolve this matter.
  Thank you again for your feedback, and we hope to hear from you soon.

  Customer Answer

  Date: 12/12/2024

  Dear Pain and Sleep Therapy Center To address a few points:I understand that you are a Out-of-Network and Fee-for-Service provider, My concern is that Susan Wolfe your Director of Financial Management made deceptive/misleading remarks. I was hesitant about purchasing the device and I had questions about the insurance and she made statements that you guys work with insurance all of the time and that you would "fight" for me. I believe it's unethical to make statements such as these and this lead me to believe this would be the case. The second point is I don't believe their were attempts to reschedule my appointment. I canceled my appointment in the spring after expressing dissatisfaction with Pain and Sleep Therapy center. I spoke with a receptionist on the phone and told her of my discontent and was told that the appointment was already included in the $4K I was charged. I'm sorry, I was mislead once and it wasn't going to happen again. I don't want to go back and forth too much about this, all I want is a full $4K refund. If this is not satisfied, I will contact legal representation and we can handle it that way. Thank you,HelloI have reviewed the response made by the business in reference to my complaint and have determined that this does not resolve my  issue.  For your reference, details of the offer I reviewed appear below.
  **In order for the bureau to continue to assist you, you MUST provide your view on the matter or your complaint will be closed as answered.
  
  
  
  
  Regards,
  Complaint ID: 22653987