Complaints

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• Initial Complaint

  Date:06/18/2024

  Type:Service or Repair Issues
  Status:

  ResolvedMore 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.

  So back in 2023 I was referred to the sleep lab for a sleep study. The first sleep study was a home sleep study where I took the machine home and slept with it and returned it the next day upon getting the results from my sleep study, I was asked to come in for an in hospital sleep study Was scheduled for January 22, 2024. I go in for the sleep study. I have it done. I go to pick up my CPAP after they found out that I stopped breathing in my sleep a couple months later I got a letter from the insurance company said that they werent covering the sleep study because it wasnt medically necessary , so I called the insurance company to figure out why the insurance company told me that the hospital did not get a pre-authorization for this sleep study so I called the hospital And I spoke to a woman named ******. I am not sure of her last night. I explained to her the situation and I also had the insurance company contact her. She was told to backdate the preapproval and resubmit it that was done. The insurance company still denied it so I went back to ****** and she went back to the insurance company and its been a back-and-forth issue up until this day and the biggest issue is that when other insurance company calls the hospital nobody answers the phone, I went to the hospital personally on May 20 to talk to someone the lady that I talk to at the hospital cannot get a hold of anyone regarding this issue. She had to send out a message on ********* teams to get anybody to respond. finally she gets ****** to respond and ******* response was basically Ive talked to your insurance company several times and theyre denying it. Theres nothing else I can do so I called the insurance company right after this conversation and they told me that they would get a hold Of the hospital I recently just talked to the insurance company and they are still telling me that they cant get a hold of anybody in this hospital. This is unacceptable, but if it was a medical Emergency.

  Business Response

  Date: 06/28/2024

  To Whom it May **************** am reaching out in response to customer complaint *****************.    
  

  On 06/25/24 0730 I received written notification of the patient complaint.  Immediate investigation reveals the customer had a home sleep study in Dec 2023 that indicated mild obstructive sleep apnea. Recommendations by Sleep Specialist/Pulmonologist were to correlate with patient history and symptoms and repeat sleep study if indicated. 
  

  12/08/23 Home sleep study results were sent to the customers primary care physician office along with recommendations. 
  

  12/12/23 @ 1514 Medical assistant at ******* Care **************** documented a telephone conversation with the customer to discuss home sleep study results.  ******* Care Provider ordered a **** titration study CPT ***** for OSA.  **** order was sent to referral management to verify insurance and obtain prior authorization with customers insurance company prior to scheduling of **** sleep study.
  

  12/21/23 @ 0855 referral management coordinator spoke with customers health insurance provider, UMR, at ************.  Per UMR representative for CPT *****, no authorization required.  Reference # from UMR documented in the customers clinic electronic health record by referral management. 
  

  12/21/23 @ 1505 Direct Referral form faxed from PCP referral office to the Sleep Center.  The direct referral form was complete and consistent stating No prior auth needed.  Referral form is also clearly documented in customers hospital electronic health record.   
  

  01/22/24 In lab **** titration study performed. 
  

  The organization acted in good faith and took appropriate measures to verify with the customers health insurance provider,prior to testing, that no prior authorization was needed for the **** titratation study.  All information is clearly documented in the customers electronic health record by ********************** staff.
  Thank you for the consideration of this matter.  If there are further clarifications required, please advise.  
  

  Respectfully,
  *************************
  Manager, Sleep Center / Diagnostic Cardiology and Chest Pain Coordinator
  MercyOne **************
  
  MercyOne
  
  T  = ************
  F  = ************
  C  = ************
  
  *****************************************
  
  **************************************** Center
  Diagnostic Cardiology
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  MercyOne.org