Complaints

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• Initial Complaint

  Date:11/23/2022

  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 purchased glasses on 10/21/22 and insurance was not properly billed. I made several attempts, along with my insurance provider, for re-billing, to no avail. I received NO phone calls or letters. Billing made NO attempts to call Anthem HIP/VSP.
  
  November 18th 2020 I was waiting for eyewear adjustment when **** approached me in a loud voice demanding payment. I paid, but they are not re-billing insurance via the portal, despite two attempts from insurance and assurance my claim will be paid.
  
  They only offered 50% refund, even though this is 100% covered. I spoke to Dr. ***** once about the problem and he is aware of these wrongful billing practices. My insurance provider filed a grievance following an unsuccessful phone call 11/23/2022.

  

  Business Response

  Date: 01/02/2023

  Business Response
  The patient came to the office for a glasses adjustment on the day we were reviewing her EOB (explanation of benefits) from the insurance company on 11/18/22. Regarding her claim that the office did not make an attempt to call or contact her or her insurance provider, we had just reviewed the EOB the day she visited the office, and therefore, had not yet had the opportunity to make contact. When our insurance processing employee saw the patient was in the office, she took the opportunity to speak with the patient about the EOB and our next steps. The claim had been filed correctly on 10/21/22, but payment by the insurance was denied and not paid because the patient had used her benefits at another office. The insurance company and the other office were supposed to release the benefits to our office, but it had not been done by the time the claim was filed by our office. We informed the patient that she would have a balance due if the insurance did not pay the claim. She paid in full for the glasses 11/18/22. Our office did a 3-way call with the patient and her insurance company later in the day on 11/18/22. The insurance company said we should refile the insurance after 11/21/22, when the patient's benefits would be available again (paper claim done 11/22/22). Our office refunded the patient 50% of her payment on 11/18/22. She was then refunded the other 50% on 11/23/22.
  
  The insurance was billed properly via paper claim twice and not electronically. Our office has not been able to file electronically on claims where the glasses have already been made/finished by our lab. The insurance company lab bills our office as if the glasses were made by their lab if we file electronically. The insurance agent told our office that she would "open a work order" to find out why our office can't file electronically (why they bill our office) for glasses not made by their lab.
  
  Once the insurance company was able to provide assurance that the claim would be processed and paid by them, we refunded 100% of the patient's money.