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:11/05/2024

  Type:Order 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.

  My doctor recommended RGI for genetic testing for a health problem. *** requires payment out of pocket first and resubmit for insurance. My doctor did a prior authorization which was approved. I was provided with an itemized bill and called to confirm this was the total cost for everything involved and I was told yes. Approximately one month later I got an additional bill and was informed no additional testing could be completed until payed. I referenced the recorded call which they stated they have noted but they could not do anything further and the next bill was due. I was told after paid they would provide me with an itemized breakdown to submit to insurance. I received this- my insurance was asking for an additional code which they refuse to provide or help me find (DEX Z code off procedure code *****) They refuse to speak to my insurance to help fix this delicate health situation . I also asked for an additional breakdown for a portion I knew I was responsible for paying out of pocket and they have refused to provide this. The out of pocket remaining charge is *******

  Business Response

  Date: 11/20/2024

  The privacy of our patients is very important. We are anxious to provide a detailed response with additional documentation for review to support our response. However, we are unable to do so until we have a HIPAA release form on file that shows the patient is ok with us sharing private health information in order to address this complaint. Once a release is provided, we will promptly address these claims. To the best or our knowledge, the patient has been informed that such a release is needed on 11/6/2024.
  In general, many *** services consist of two parts: Setup and Testing. Setup must be completed before testing can begin and is charged first. All patients are required to review and sign consent forms for services as well as financial agreements. The testing consents and financial agreements detail all services and pricing specific to each patient.
  We understand that navigating insurance and billing can be complex, and we are more than willing to review the services and charges with patients as often as needed.

  Customer Answer

  Date: 11/26/2024

  Attached

  Business Response

  Date: 11/27/2024

  The *** services were completed, and the test results were provided to the patient on October 16, 2024. The patients bill with RGI has been fully paid, and no additional services have been requested at this time.
  The services performed by *** were requested by the referring provider and consist of two parts:
  Setting up patient-specific testing
  Testing of samples
  The patient has already received two service summaries, as mentioned in the documents we initially shared.
  RGI is out-of-network with the patients insurance provider, the financial agreement they signed (attached) explains that not all services may be covered by insurance. Unfortunately, were unable to provide specific insurance coding for some services due to the lack of applicable codes. However, we do offer insurance consultations to help answer any questions about coverage and/or billing.
  We understand that dealing with insurance and billing can be challenging. If the patient would like, were happy to go over the services and charges with them again to provide further clarity.

  Customer Answer

  Date: 12/08/2024

   
  Complaint: 22514778
  
  I am rejecting this response because:

  1. *** is claiming services were completed a provider to myself. The attached documents show a discrepancy in the itemized bill provided after services provided. I called to ask for a breakdown of the remaining $1773.50 for PGT A testing and I was told no. *** is claiming no additional services were requested which is not true.

  2. While *** only accepts cash pay and provides a bill of provided services to submit for reimbursement from insurance, ************ has a pre authorization covering 100% per United healthcare policy *** Z codes are required in additional to procedure codes and Z codes. I have reached out numerous times and *** has refused to corporate. ************ also called on 11/5/24 counseled them on the policy and they refused to comply. And my insurance has reached out 2 separated instances and they have picked up the phone and hung up. This is documented by a *** representative. Per UHC policy they requires labs to simply register and put in the procedure code- this process takes under 5 mins. 

  3. I have also notified *** of a phone call by their representative - all calls recorded by their facility that confirms the final cost before proceeding which I was informed was $4750.00, I then signed consents and proceeded. I was informed after an additional charge of > $3000.00 (where I referenced the above mentioned call to investigate the employee who confirmed the final cost for all testing.)- again I am not trying to pursue financial compensation from *** or refund I am requesting the *** Z code required by UHC that only  the testing facility is capable of generating. 

   

  I have attached the link to UHC's requirement. BBB is welcome to contact UHC requiring this requirement for reimbursement. 

  ***********************************************************************************************************************

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

  Business Response

  Date: 12/12/2024

  We would like to address all three concerns from the customer:

  1. *** is claiming services were completed a provider to myself. The attached documents show a discrepancy in the itemized bill provided after services provided. I called to ask for a breakdown of the remaining $1773.50 for PGT A testing and I was told no. *** is claiming no additional services were requested which is not true.
  

  RGI has provided the following services:
  Preimplantation Genetic Testing for Monogenic conditions (*****) which consists of:
  Custom testing Set-up
  Testing of samples received
  Preimplantation Genetic Testing for Aneuploidy (PGT-A) which consists of
  Testing of samples received
  No CPT procedure codes are available for PGT-A testing or coordination fees,therefore, *** is unable to provide an Insurance Summary for this service.These fees are not billable to insurance.
  Please refer to invoice #***** for a breakdown of the above charges:
  Case Coordination Fee $150.00
  PGT-A by NGS 7 embryos $1525.00
  Credit/**** Card Transaction Fee 2% (of total invoice fee) $98.50
  TOTAL: $1773.50
  The Insurance Summary (referred to as Itemized bill by the customer) provided on September 23, 2024 outline the ***** setup fee (see above 1.a).
  The Insurance Summary provided on October 16, 2024 outline the ***** testing fees (see above 1.b).
  The credit card processing fee is clearly outlined in the invoice and known to customers prior to and at the time of payment.
  All fees are outlined in the financial agreement, signed by the customer. Please see page 2, item 5 on the financial agreement, which outlines PGT-A billing limitation.
  
  2. While *** only accepts cash pay and provides a bill of provided services to submit for reimbursement from insurance, ************ has a pre authorization covering 100% per United healthcare policy *** Z codes are required in additional to procedure codes and Z codes. I have reached out numerous times and *** has refused to corporate. ************ also called on 11/5/24 counseled them on the policy and they refused to comply. And my insurance has reached out 2 separated instances and they have picked up the phone and hung up. This is documented by a *** representative. Per *** policy they requires labs to simply register and put in the procedure code- this process takes under 5 mins. 
  

  Our team has communicated with ***************** on numerous occasions regarding the *** Z codes. These codes are specific to United Healthcare. As an out-of-network provider, *** is not required to register with ***************** to obtain such codes. However, as a courtesy, we have indeed applied for *** Z codes with *****************. This process is ongoing, requires a multi-page application, and it is unknown to us how long the process will take. We can confirm with certainty that it is longer than 5 minutes.  The process requires detailed information about our testing techniques and platforms and is specific to each laboratory. The allegation claiming our representatives have hung is unfounded. However, we will investigate this instance further.
  Coding limitations are clearly outlined in the financial agreement signed by the customer and her partner,prior to starting any services at ***. Please see Page 2, 4.l.i of the financial agreement.

  
  3. I have also notified *** of a phone call by their representative - all calls recorded by their facility that confirms the final cost before proceeding which I was informed was $4750.00, I then signed consents and proceeded. I was informed after an additional charge of > $3000.00 (where I referenced the above mentioned call to investigate the employee who confirmed the final cost for all testing.)- again I am not trying to pursue financial compensation from *** or refund I am requesting the *** Z code required by UHC that only the testing facility is capable of generating. 
  
  RGI does not record phone calls. The above allegation does not match our records.
  Testing consent forms and financial agreement clearly outline the various testing services provided. Our notes indicate on July ****** pricing was initially provided for setup AND testing to the customer via phone and later confirmed in writing via the financial agreement signed by the customer.
  The fees above reflect the costs of ***** services for Setup (see 1.a and 1.b above) charged at $4750 and $3250, respectively.
  The *** Z codes are assigned by ***************** for the testing laboratory. Codes are specific to United Healthcare, with whom *** is out of network. No such coding is currently available. 

   

  Attached, please find the full financial agreement signed by the customer. 

  Customer Answer

  Date: 12/15/2024

   
  Complaint: 22514778
  
  I am rejecting this response because:
  
  

   

  1. *** is claiming to have communicated with ************* care numerous times regarding DEX Z codes. RGI was counseled by UHC that genetic testing is reimbursed to the patient and funds will be dispensed after DEX Z code can be provided. Business also claims "
  
  However, as a courtesy, we have indeed applied for DEX Z codes with *****************. This process is ongoing, requires a multi-page application, and it is unknown to us how long the process will take."

  - Writer of this is looking for confirmation in writing this has been submitted to DEX Z codes to receive the code for ****** *******/UHC.

  2. BBB can confirm with *** per their call logs they have indeed hung up on them numerous times and has been documented by date by insurance. Per escalation team of *** they will continue to counsel providers offices to avoid *** for PGT testing moving forward. Center for Excellence- ********************************** has also been notified by self and insurance that if not resolved they will refer patient to alternate genetic testing companies. Per *** escalation team manager a call was placed to *** on 12/12/24 asking for genetic testing report and was laughed. Informed per *** team they have not encountered such poor business etiquette. Requesting to include *** team in close contact who can testify to above allegations.- Again only request if for DEX Z code for services provided. RGI has mentioned this has been completed as a courtesy.

   

  3. Requesting BBB input regarding writer seeking legal action if business does not submit DEX Z code request and provide to patient.
  
  

   

   

   

   

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