Complaints

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• Initial Complaint

  Date:08/17/2024

  Type:Service or Repair 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 started going to this doctor in April of 2023. Since then the doctors office has already told me about three different times that I had a balance with them although every time I have gone I have given them my card and they charge me the copay they say is according to my insurance benefits ! I was being charged $35 monthly for about 10 months for a CPAP machine and one of the times about 6 months ago one day I went and paid for my CPAP supplies $35 and next thing I know I'm told I have a balance because when I paid the $35 for the supplies they put $20 towards another balance I had and when I asked what that balance was the front desk lady refused to tell me. Now I'm being told I have 2 balances one for $21 and one for $35 and no explanation as to what the balances are from when the last time I went for my new supplies I was told they were covered at 100% but now all of a sudden I owe $35. This is fraud to constantly be told I have a balance when I always go and pay what they tell me to pay!

  Business Response

  Date: 08/27/2024

  Good afternoon,

  *** ***** accused the office and staff of fraud and went as far as calling us thieves. This is *** ******* message received via the patient portal on 8/17/24:
  

  "Have the doctor to call me before I go to the better business bureau about this office and your horrible billing g practices! How do I have a balance !?? Each and every time I have gone to your office I always pay exactly what you all tell me the copays are and the last time I went to get supplies you told me they were covered 100% but you always end up telling me I have a balance ! This is fraud and I'm reporting it! Dr ********* is an excellent physician but his front desk and billing staff are HORRIBLE and a bunch of frauds! I'm done being bilked and played with and I'm reporting this immediately! Please remove my phone number and all of my sensitive info from your files I am discharging myself from this practice and taking my healthcare elsewhere where the office staff is as good as the doctor and caring as well instead of trying to steal from the patients"

  I replied to *** ******* accusations on 8/19/24, which are false, unfounded, and damaging, it is slandering. We are not committing fraud. I advised her we have only billed her health plan for services provided, and provided copies of the detailed billing statement via our HIPAA compliant text messaging solution, which she has not read; also attached for your reference. However, when the health plan processes claims, sometimes there is additional financial responsibility assigned to the patient. In her case, there were two dates of service where this happened: (all this was communicated to *** *****)
  

  3/21/24: Office visits, we collected $40 copay, however when the claim processed, health plan applied it towards patient's deductible and made her responsible for $61.02, therefore she has a balance of $21.02.

  4/9/24: this is for the **** supplies, we collected nothing for the supplies, however health plan assigned her a $35 copay, therefore she has an additional balance of $35.

  Per *** ******* request, she has been discharged from our practice. Since there has been a serious deterioration in our physician-patient relationship, we are no longer able to serve *** ***** as her physicians.

  Best Regards,

  ***** ******

  Customer Answer

  Date: 09/13/2024

   
  Complaint: 22158930
  
  I am rejecting this response because:

   

  Thank you for this email. The $21 balance the office claims makes no sense since when I went to pick up my supplies about 1 month later they never told me I had a balance which they claim the deductible applied to the visit but I had already met my deductible and it makes no sense how the office would not confirm the amount I need to pay before I come to the visit. Also, the $35 copay for the supplies makes no sense since before I went to pick up my supplies the office told me they were covered at 100% after verifying my benefits with the insurance. In fact when I ordered supplies this last time recently which i never hsd the chance to pick up they told me the very same in their text message to me that the supplies are covered at 100% and in fact when I went to pick up 5he supplies in April of this year they told me they were covered at 100% so it seems they are giving me misinformation or not being transparent and this is why i claimed fraud. My past communications with the front desk staff has always been difficult because like I mentioned like the second balance notification I received from them last year the lady I spoke with couldn't even tell me how I had that balance stating it was too hard to explain and she also gave me a lot of attitude. The front desk staff is very rude on that office. Healthcare 101 the patient is always right and you should never let them go away hurt and upset especially a patient with a severe condition as I suffer. They should have called me and tried to explain, when it comes to money this is a sensitive subject and they never handled it with sensitivity and ***** even from the beginning when I first started dealing with them last year. They are unprofessional and really left me hurting. There is a better way of interacting with the patient and I hope they can one day learn the better way. Through patience and communication a lot of conflicts can be solved but it seems they didn't care about me as a patient. 

  Thank you,

  ****** *****
  

  
  
  Sincerely,
  
  ****** *****

  Business Response

  Date: 09/19/2024

  Good morning, please be advised that we have submitted and adjudicated all claims through the patient's health plan, ultimately it is the patient's health plan that determines the final patient responsibility.  ** charge the patient what is assigned to them by their insurance.  ** have tried to explain to Ms. ***** how this process works, and have provided proof.  When claims are submitted, it can take up 45 days before we receive a response from the payer.  ** post payments once remittance advice is received, and often times the patient is assigned additional responsibility by their health plan.  ** collect payment at time of visit based on our contract and fee schedule with the health plan, and always verify the benefit with the patient's health plan prior to the visit.  However, every time we contact a health plan, the disclaimer is "benefit verification is not guarantee of payment", therefore we cannot really know final patient financial responsibility until after the claim processes, which could result in additional patient financial responsibility.  All patients in our practice are advised and asked to sign a consent where patient agrees to be financially responsibility for any balance or fee not covered by insurance, Ms. ***** signed such form.  

  I would recommend Ms. ***** contact her health plan if she needs further clarification as to how claims were processed, and why she was assigned the financial responsibility. 

  Best regards.