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:01/04/2024

  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.

  I started with a new primary care provider (Nina ****) and attended my new patient physical on November 3, 2023. I was not expecting to pay much out of pocket as this was an annual physical, I am healthy, and did not ask for any special care (other than a script for a MRI to check on a ****** ***** I've had since I was 13).
  
  My insurance covers preventative care and since Sanctum Integrated Health and Nina **** billed me for asking for a script for MRI (****** ******** ** **** ***** ** **** ***** ****) as well as for ********* ******, ***** ********, my insurance did not cover the physical or blood work and I now have to pay $162 for the physical and $66 for the routine lab work out of pocket.
  
  I understand that the MRI needs a diagnosis and so I will learn from this and pay for that diagnosis for the MRI. However, I do not have any sleep problems. Nina had mentioned that she provides sleep consultation and I said I don't have any sleep issues other than my twin toddlers getting up throughout the night which will resolve itself once they sleep through the night. I do not think it is fair to bill me for that and I would like that removed from my record. I want to mitigate any future implications that could arise from having that on my record (if insurance denies me for something later because of a preexisting condition that I never had).
  I am looking to have my billing adjusted to have any codes related to ********* ******, ***** ********, removed from my records as they are false. She even said that because of my *****, she would have checked my magnesium levels anyway - which I know is not normally checked with routine lab work.
  I've called Sanctum twice and asked for the billing department to get back to me and I've emailed Nina through the patient portal requesting the same thing. I have not heard from anyone and am now seeking assistance from the BBB. Ideally I would not have had to go this route if they just communicated with me. Thank you.

  Business Response

  Date: 01/24/2024

   I hope this letter finds you well. I am writing to address the concerns and issues that have arisen since your visit to our clinic on 11-3-23. I want to assure you that your satisfaction and well-being are of utmost importance to me, and I take your feedback seriously. During our encounter, you discussed your sleep pattern and the need for better sleep due to disruptions caused by your children. Additionally, you requested an MRI for a ****** ***** on **** **** I provided counseling and guidance on improving sleep, as well as informed you that an MRI may not be covered as a first-line test, and an X-ray may be required initially. You mentioned the possibility of providing a previous MRI report for reference, but I have not received it thus far. Approximately two weeks after your visit, you sent a detailed message requesting  additional  medical conditions be added to your chart, which you had forgotten to mention during the appointment. I advised you to schedule an appointment for appropriate evaluation. However, I must express my concern regarding the omission of such important information during our face-to-face examination, especially considering my background and advocacy in women's health. I understand that you have expressed a desire to modify the information in your chart, but it is important to note that patients cannot dictate what a provider follows up on,or  monitors. I assure you that any information documented in your chart is based on the discussions and assessments made during our visit. It is not appropriate to request the removal of accurate information and replace it with information that was not discussed during the appointment. Subsequently, you contacted our office with lab and billing questions, and you scheduled a visit for the new conditions you mentioned. I attempted to reach out to you twice to address your concerns, and you informed me by message that you had canceled the appointment. I want to clarify that I promptly informed ******* *****, who handles coding, billing, and credentialing on my behalf, about your request to speak with someone regarding billing. I was not aware at the time that they had not contacted you, nor was I aware of your dispute with your insurance company and the subsequent appeal, which was denied. Upon receiving your message via the portal, I reviewed the process and discussed the matter with *******. It became apparent that there was a lack of communication on their part, as they did not attempt to contact you as they are contracted to do for any billing, coding, or credentialing queries or concerns. At Sanctums, we strive to treat all our patients as VIPs, and I apologize for any shortcomings in our patient relations in this particular instance. I want to assure you that you have not received a bill from my office for my services.  I have made the decision not to send you a bill. It is important to me that we maintain a positive patient-provider relationship, and I believe this course of action reflects that commitment. As a provider, I understand that although I subcontract certain services and tasks on Sanctum's behalf, I am ultimately responsible for ensuring my patients' satisfaction. Since this ordeal, I have spoken with you and  informed you that you  will not be billed for my services. I want to emphasize that I will not be coerced or pressured into altering information discussed during a visit or replacing it with information that was not discussed. I am committed to providing accurate and comprehensive medical care based on our face-to-face interactions. I have taken steps to enhance the documentation process by recording and dictating visits with patient permission. It is unfortunate that providers are unable to write reviews or file complaints regarding malicious attacks from patients attempting to avoid payment and control the content of their medical records. I have duly noted your disagreement with the sleep disturbance and your request to add  long-standing pre-existing medical  problems to your chart without proper evaluation.  However,  Your insurance has already documented your dispute and appeal regarding the claim of the entire bill. I want to reiterate that I have not sent you a bill. According to your insurance, your deductible must be met before insurance will cover any claims.on your behalf.  It is important to understand that your insurance does not pay me directly; you are responsible for payment of services until your deductible has been met,  and I have not issued a bill to you. I appreciate the opportunity to address your concerns and clarify the situation. I remain committed to providing the highest quality of care and ensuring my patient's satisfaction. If you have any further questions or require additional clarification, please do not hesitate to contact me by official mail.  
  Sincerely, 
  Nina **** ****   

  Customer Answer

  Date: 02/05/2024

  Hello,

  Thank you for closing the case!  This one was tricky for me and I typed out my response to the business but sat on it for a long time because I didn't know what to.  Ultimately, the resolution I wanted was for the CPT code to change as it was false and I was worried about any long term repercussions with insurance (e.g. if something is deemed an existing medical condition when it was really isn't).  I wasn't worried about the actual money amount of the bill - the bill was was alerted me to look into what I was being billed for.

  When I read the business's response it seemed like it was taking a more personal turn and I felt that if I responded publicly, I'd cause more harm to the small business than necessary so I chose not to respond. However, I would like to send you my response so that it's documented. In the end, I think the fault is with the 3rd party billing company that business contracts with but I couldn't get a response one way or another which is why I submitted my complaint.  When I talked to Nina **** on the phone shortly before she responded to the complaint, she couldn't explain why she chose to use ********* ************ ******** for my routine lab work.  This is the part that I was concerned with - I feel like patients do not have any defense against what is written about them in notes during a visit (which they do not see or approve), or what is billed. And from what I've experience with this specific situation, you can't fix the error either because it's your word against the physician's/nurse practitioner's.  

  My response:
  

  I have reviewed the response made by the business in reference to complaint ID ********, and I accept the resolution of not being billed by Nina **** from Sanctum Integrated Health.
  
  I would like to respond to some of the points made in the business response as I feel this is my only opportunity to do so.
  
  - I do not agree that sleep counseling was provided during my physical.  This was the sole reason for my request to remove that specific CPT code (Circadian rhythm, sleep disorder).  If it was valid, this wouldn't be an issue.  This is how I remember how sleep even came up during my physical: you told me that you were certified to provide sleep counselling and I said I don't have sleep issues and joked other than if you consider my toddlers waking me up at night. I said that I would just need to go to bed earlier to counteract their nightly wake ups.  That does not seem to fit with having a circadian rhythm disorder or having sleep counselling. I made an obvious comment in jest which is now being used to label me with a disorder. 
  
  - The MRI request had nothing to do with my complaint and so I'm not sure the relevance here or why it was mentioned at all in the response.  I gave it as an example of what I found when I started looking into my billing. I normally don't do that but because this was an unexpected expense, I inquired with my insurance company who gave me all of the specifics.  To add, I've never received a script for an ultrasound or a MRI.  
  
  - The detailed message you mention, which I sent to you early December, was something that had just happened to me.  I was nervous about it and messaged you via the portal explaining what I was experiencing and asking if I should be seen for it/was it something to worry about.  This also has nothing to do with my physical or my complaint and I'm not sure why it shows up in your response.  You have revoked my access to the patient portal and I am unable to view our messages or visit summary so there is no way for me to prove that to you other than explaining here.  I never asked you to alter information because of this message - I set up a virtual appointment with you as a result of that message.
  
  - When we spoke on the phone a couple of week's ago, I let you know that I'm fine paying my bill. I also noted that in my BBB complaint.  I understand how insurance works and I also understand how businesses work.  Had I not sent this complaint, you would have billed me.  I saw the amount to be billed ahead of time because of the EOB that was sent to my insurance company which is why I was inquiring about it before I had received a bill from your office.
  
  - I also let you know that your phone number comes through as ***** ******** (it's still in my phone for every time you called / left the 2 messages).  I did not pick up your calls the first couple of times because I thought it was spam. I did see you left a voicemail (the first one asking me to call back or the option to talk to me at my virtual appointment; the 2nd letting me know that you would field my questions to the biller with no request to call you back).  I hope you can understand that I would seek help from the BBB after about a month goes by without hearing from anyone and after calling the biller a third time with no success.  
  
  I've been thinking about this a lot and I do think this was the product of many miscommunications that could have been solved had the billing company contacted me back.  I do not appreciate the accusations in your response and that is why I felt the need to defend myself. I am still willing to pay my bill but I would still like the Circadian Rhythm diagnosis code removed from the billing as I still feel that is inaccurate and as a business, I would expect that a mistake be rectified. I know that many times, patients are put into problematic circumstances if something in their medical history is considered existing and is then not covered by insurance. My fear is that something like this will impact something in the future and I would like to make sure that if it's connected to me, it is factual.
  
  Sincerely,
  
  **** *******