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:11/12/2024

  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.

  Someone in Paradigm Health Systems is unable to perform there job and the communication between the employees is lacking. On May 8th, I was established as a new patient with a preventative care visit with the doctor I selected to be my primary care physician. The bill was processed through the insurance as a non preventative care visit. I called my new primary care physician with the insurance company and was explained that they are sorry about the mistake and will resubmit the bill to the insurance with the correct codes. A month later, I am informed by Paradigm Health Systems that the claim has still not been submitted to the insurance with the correct billing codes. I spoke with my primary care physician who explained that he will look into the issue. About a month later, I call to pay my doctors bill and am informed that I still owe a balance on the previous visit from May 8th. I inform billing that my doctor said that was resubmitted to the insurance. The billing department says they are unaware of that and will talk to the doctor. A few months later, I call to pay my bill and am informed that I still owe a balance from May 8th visit. I repeated inform them that that is incorrect and the doctor said that was resubmitted to the insurance. The billing department informs me again that they will reach out to the doctor. I then reach out to the doctor and ask why is this happening. The doctor tells me he will look into that for me. A few months later, I get a call from my doctor's front desk informing me of a balance that is owed. At this point this behavior is entirely unprofessional. Someone is not doing their job and needs to be investigated. Who is the one lying? Why has nobody communicated with each other? Why has the bill never been resubmitted to my insurance with the correct billing codes?

  Business Response

  Date: 11/21/2024

  Ms. ****** statement of being seen in our office on May ******, for a new patient visit to establish care is correct.  During this visit she presented with additional complaints which of course I cannot discuss in this rebuttal without violating the patients HIPAA rights.  Per insurance guidelines if a patient presents with anything other than a routine visit, we must bill with the correct diagnosis code. Her visit most definitely was coded appropriately.   The patient returned to the office three weeks later for a follow up to her issue that she was being treated for as well as five additional times for various reasons.
  We reviewed her entire chart and ledger on November 12th and even spoke with Glory at her insurance company who confirmed that she has a 5% coinsurance.  She just refused to believe that we had taken appropriate action on her account.
  Ms ***** has been combative and rude to staff as well as to the doctor both on the phone as well as in person.  At this point her $9 balance has been adjusted and she has been discharged from Paradigm Health System due to her actions to our provider and staff.
  If you require any additional information please do not hesitate to reach out to me directly at this email address.
  Thank you,
  *********************
  Operations Manager

  Customer Answer

  Date: 11/21/2024

  [I accept the response because the business has finally removed the $9 that I was wrongfully charged. Preventative care is covered 100%. I spoke with my insurance company and they agreed that they have never heard of a company/doctor changing a preventative care code to a diagnostic code for answering the doctors question of do you have any questions or concerns. This question is asked at every preventative care visit and the place to discuss any issues or concerns that you may have. That does not give the doctor the right to change the reason for the appointment without the knowledge to the patient. I was not once rude or combative with the doctor. I liked the doctor and found him to be a very good one. The way Paradigm handled my preventative care visit was quite unethical. I do not know who was responsible for changing the coding of my preventative care visit. I believe anyone would be upset and frustrated in this situation. I was repeatedly told that the miscoding would be corrected and resubmitted to the insurance as a preventative care visit only to be informed by an office staff a few weeks to months later that I am to pay this past due bill. Each time this occurred my reaction is shock that the bill was not resubmitted and angry because I was lied to and someone did not do what he or she said they would do. I am sorry that one appointment has caused this much escalation. I suggest in the future to make patients aware that under Paradigm Health policies, they do not submit anything to the insurance with preventative care codes. Honesty and transparency would have been greatly appreciated and prevented escalation.]
  
  Better Business Bureau:
  
  I have reviewed the response made by the business in reference to complaint ID ********, and find that this resolution is satisfactory to me. 
  
  Regards,
  
  **** *****