Complaints

The complaint text that is displayed might not represent all complaints filed with BBB. Some consumers may elect to not publish the details of their complaints, some complaints may not meet BBB's standards for publication, or BBB may display a portion of complaints when a high volume is received for a particular business.

• Initial Complaint

  Date:08/12/2024

  Type:Billing 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.

  On December 27, 2023, my husband and I were sick and went to OneSpotMD for care. The urgent care facility charged us as if our insurance deductible hadn't been met. We paid a total of $150.12 ($75.06 each) and went home to care for ourselves. By January 19, 2024, I noticed the insurance company had processed the claims and made payment to the facility. Our deductible had been 100% met so we owed $0 to the facility. I then called the facility for refund. I sat on hold for a representative for half an hour before ***** came on the line. She said the payment hadn't posted but will put in a request for refund to be issued. More calling and many emails and months later, we still do not have our refund. Please let me know what I need to do. If we are having this much trouble, I can't imagine what's happening to the elderly or disadvantaged!!I will be glad to provide EOB, receipt, and email copies as needed or requested. The billing department has all they need. Refund checks need to be printed and mailed.

  Customer Answer

  Date: 08/09/2024

  We went to OneSpotMD ****************** (*********************************************************************************************************, ************) for medical care. I've attached a pdf with the email chain of communication, payment receipt, and insurance EOBs showing their payment and zero responsibility for us to pay. I listed Experity on the claim because they are the company communicating with me and handling my request for refund. The only information I have for Experity is what is on the email chain. I will be happy to help further as requested. Please let me know if I'm missing anything.

  Business Response

  Date: 02/13/2025

  Experity is a third-party company that provides medical billing services to urgent care clinics.  Pursuant to the terms of the service agreement entered into with each urgent care clinic provider, Experity identifies refunds that are owed as part of the medical billing process but the urgent care clinic client is ultimately responsible for issuing the refunds.  Experity is not granted the authority to issue refunds on the clients behalf from the clients account.  In relation to this complaint, the respective Experity client was notified of the refund request via a refund log provided to the client, with the explanation the patient paid via check.  The refund request was also escalated to the client via their Experity client success manager.  Ultimately, while Experity notified its client of the refund request through multiple communication channels, it is the obligation of the urgent care clinic to issue the refund to its patient and is outside of Experitys authority granted by its client.

• Initial Complaint

  Date:10/18/2023

  Type:Billing 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.

  We moved from a previous electronic health record system to Experity and decided to go with their ************************ team which is the worst decision we ever made. It has been 12-months and their revenue cycle management and billing team has been extremely negligent that they were submitting claims to insurance payers and didn't even realize that the claims weren't going through until we raised a concern asking why we weren't recieving payments from the insurance payers. We had over 700 outstanding invoices for 12-months that they hadn't been following up on and by the time they began to investigate what was going, we realized they were so many billing errors that their team had made and came up with an excuse that there was a software malfunction in submitting claims. But that isn't true because if it was a software malfunction, then it should have affected other businesses too, not just our business alone. And if it took close to 12-months to realize there was a software malfunction, then that's some serious negligence because no one cared to follow up on claims to know why they hadn't been paid. The billing team is so negligent, that they didn't even realize all the errors until an investigation was done. The billing team overlooked so many services that we provided that they just billed as a zero charge when these are services that cost us thousands of dollars. They didn't care to bill the services correctly, they just put a zero charge which means we have been providing the service free of charge while it costs us thousands of dollars. The billing team submitted claims to the insurance company with zero charges which is completely unheard of. Their revenue cycle management and billing team is a complete nightmare and after 12-months, we have suffered a significant loss of revenue because of all the billing errors and gross negligence of the revenue cycle management and billing team. I will never recommend any practice to use them for billing services.

  Business Response

  Date: 02/03/2025

  It is unfortunate that the complaining party has mischaracterized the events surrounding the transition from their previous vendor to the Experity revenue cycle management services and has further mischaracterized the software issue that resulted the delay in submission of certain claims.  It is true there was an initial delay in the submission of certain claims, but that delay was due to a combination of (1) an issue with claim headers in the clearing house's system (not within Experity's control); and then (2) a lack of visibility since there were still payments from claims going to the client's lockbox with the previous vendor.  Experity was completely reliant upon client for information on those claims.  Ultimately all claims were corrected/resubmitted with approximately 11 being denied for untimely filing.  Despite the contributing factors outside of Experity's control, client's account was credited for the claims denied as untimely.