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:12/22/2023

  Type:Customer Service 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 spoke with Larissa on 11/21/23 at 10:59 am and was told that my November appointments were all covered, but December would not be. I asked about the November appointments, and she named each one and that they were all paid. I asked about the appointment on 11/28 and if there were any problems and she reiterated that they were all paid for, even naming each day. 11/21/23 at 11:58am, I spoke with her again, reconfirming that 11/21 and 11/28 were okay and she reiterated they were paid. After my 11/28 appointment, I get my explanation of benefits from my insurance and the appointments after 11/20 were not paid. 11/14, 11/17, 11/21 and 11/28, which I was explicitly told by Larissa as being paid were not. I had no copayments with my insurance so I would have nothing due at the time of service. Now I've been dealing with them trying to submit paperwork to the insurance and they keep telling me it's a problem with the insurance company. It's become a severely awful experience after being told my appointments were paid for.

  Customer Answer

  Date: 12/22/2023

  Chesapeake Bay Aquatic & Physical Therapy 

  9475 Deereco Rd Suite 102, Timonium, MD 21093

  This was the location I visited. I believe the main office is in Laurel, MD, but I am unsure. The phone number from their "authorization" department was ###-###-####.

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

  Business Response

  Date: 01/29/2024

  Thank you for allowing Chesapeake Bay Aquatic & Physical
  Therapy (CBAY) to reply to this complaint.  The patient’s assertion that
  the 4 visits in question which took place in November 2023 were paid for we
  believe was not what was said.  Our Front Desk Coordinator, whose name
  was, unfortunately, used for public consumption in this complaint along with a
  ****** complaint, reports to CBAY she never said “the visits were paid”. 
  What she did tell this patient was “the visit claims were with their insurance
  company, and according to what we know, they should process without an
  issue.”  While seemingly, these two responses seem very close, there is a
  slight difference.  As a healthcare provider, we never know exactly what
  the response from the insurance company will be until we receive payment and
  obtain the corresponding Explanation of Benefit form with the claim, which
  allows us to understand the payment or why it was denied in part or in full. 
  CBAY completely understands this nuance is slight and why the patient would
  think we claimed “the visits have been paid for.”    It is our
  policy, and how we train our Front Desk Coordinators to speak in terms like
  this, to never be absolute as we do not want to give a patient the wrong
  information.  
  In this particular case, we had
  verified upon their first visit they had 20 approved visits per their insurance
  company from the starting date with CBAY which was in August 2023, until the
  end of the year.  The patient’s particular plan for physical therapy
  allows for 50 visits total per calendar year.  Our billing company
  verified they had already received 30 visits to that date, hence why they were
  approved for 20 more for the remainder of the calendar year.  It was
  completely correct in their complaint, that they would not owe CBAY any monies
  for any of their visits as the out of pocket maximum was already reached for
  the calendar year 2023.  However, for their particular plan, chiropractic
  visits also count as physical therapy visits; meaning they had a total of 50
  combined visits between physical therapy and chiropractic services per
  year.  We as a company, diligently try to find out if our patients are
  undergoing chiropractic services, as we know many insurance companies treat
  these visits like physical therapy visits which affect approval for visits to
  physical therapy.  We ask this question on our initial paperwork as
  well.  On this particular patient’s paperwork, which we will include in
  this response, they stated they were not currently undergoing chiropractic
  care.   Our billing company, and in turn our administrative team bases our
  responses about approved visits off this paperwork.  This patient
  underwent several chiropractic visits after beginning treatment with us,
  without our knowledge, which then used up the allowed amount of approved visits
  quicker than we estimated it would.  Our pre approval process had the
  number of approved visits at 20, which would include the 4 November visits in question
  here.   This is the main reason why our office informed the patient that
  most likely these visits would be covered and they probably would have no
  patient responsibility. 
  As an aside, the patient also
  signed paperwork, which included language that our pre approval process is not
  always 100% accurate.  There are times the insurance company may give us
  inaccurate information for a multitude of reasons, which will affect what the
  patient may ultimately owe us for our services.  This is very standard
  across the healthcare community.  This basic and consistent language
  states the patient is ultimately responsible for understanding their insurance
  plan which includes what their portion of the bill may be, their allowed visits
  and/or services, and other pertinent information to what they may ultimately
  owe.  We try our very best, as we did in this case, to find out and help
  our patients to understand their plan, and the costs to them as we know it
  makes a huge difference in their lives.  
  In conclusion, we are very
  sorry the patient misinterpreted what we were trying to explain about their
  obligation for these 4 November visits and understand the frustration. 
  However, CBAY and its billing company did the best they could with the
  knowledge they had, again, not knowing the patient was seeing a chiropractor,
  to give them the most accurate idea of the costs to them.
  CBAY also spent many man hours
  with several different employees working with the insurance company to try and
  get the patient more visits than their plan allows.  Filling out multiple
  forms and getting a letter of medical necessity to try and get more visits
  approved for the month of December.  Any and all communications we may
  have made to this patient, were necessary to update the situation with trying
  to increase the number of visits over the stated yearly cap and just to inform
  them where we were in the process.  We did not get much help from this
  particular insurance company as they were very slow to respond to us, if they
  did at all.  
  In Conclusion, CBAY will be
  owed the “allowed” amount for each of these November visits, as determined by
  this patient’s insurance company as CBAY provided skilled service for
  them.  If the insurance company ultimately denies the access visits, they
  will turn to patient responsibility.   To date we are still trying to work
  on getting these access visits approved, though we are not forced to do so, and
  have not sent out the final bill for patient responsibility.  All the
  paperwork is present and signed for by the patient and is available upon
  request at any time.
  CBAY strives to provide the
  very best outpatient physical therapy service, which includes the clinical
  aspect along with the administrative process and all billing
  requirements.  We work with all our patients to the best of our
  ability.  We are glad to continue to work with this patient to try and get
  these visits approved over his cap.
  Thank you for hearing this long
  response but it was important to get all the details out for context.
  

  Customer Answer

  Date: 01/29/2024

  I've been struggling with Chesapeake Bay Aquatic since November to get paperwork submitted. When I first started, I was told I had 50 physical therapy appointments. I advsied the previous front desk person that I was already utilizing appointments from Acupuncture and chiropractor and they would have to resubmit their information. They advised me I had "20 appoitments in November." I disclosed both acupuncture and chiropractic services at the time of my initial appointment with the desk person and physical therapist. How would they go from 50 appointments to 20 if they didn't verify? The first time I heard about having 20 appointments remaining was when Larissa *********** advised this when I was called to confirm my appointment. This is also when she advised the appointments were paid, not the misinformation that whomever responded to the BBB complaint said "they beielived I was told." Larissa was very short and aggitated when dealing with simple questions. She also was only there for a week or two to prior to telling me my appointments were paid. 
  
  This provider is has been negligent with filing paperwork. I had attempted to get additional appointments for December and they refused to file paperwork, often blaming *********. On several occasions, I reached out and had ********* directly contact Chesapeake Bay Acquatic to get the previous claims taken care of and additional appointments for December. This was well after the fact that I was told my November appointments were paid and that they were paying the last appointments in the month. I called back on 12/4 at 12:47 PM and Larissa again advised that the claims were paid. There was no concern to them at all, but I disclosed my Explanation of Benefits stated they were not covered. I have dilligently tried to work with this provider who cannot seem to properly file paperwork and utilize the system for *********. I'm not sure how a business can continue to operate when they cannot do basic functions that a single person provider can do with no issue.
  
  I note that in their conclusion, they state that they are owed the "allowed" amount for each of these November visits, but "CBAY" charges a $100.00 for out of pocket visits. Even to the end, there is a huge customer service gap from this provider. I contacted both Larissa and Katie trying to get them to submit paperwork and the only response I got was "I submitted it," yet there was nothing in the ********* portal. 
  
  I have a supervisor from ********* who has apparently managed to get the provider to submit the paperwork and is working to get the initial claims resubmitted and then have the new paperwork submitted. Per my last correspondence with *********, they are working to get the last claims for 11/17 and 11/18 submitted and denied. After they finalize, they will reprocess and apply benefits. I reached out to them tonight to try to see if I can get an update. 

  I do not want to simply reject their response, though I disagree with it. I know they can simply close it out after, regardless of how I answer. I want to make sure this gets resolved and not swept under the rug with a poor response from the provider. I will be contacting the consumer protection bureau attorney general's office next. I would like CBAY to take the time and actually do the right thing before I go that route.

  I appreciate any information you can provide me with or notify me that I should just take this response and use it in my rejection. Please advise.

  ******

  Business Response

  Date: 01/31/2024

  Chesapeake
  Bay Aquatic & Physical Therapy Second response:
  
  Thank you
  again for your response to our response. 
  I am sorry if it came across that we would be “sweeping it under the
  rug” and close it out after our response. 
  Please understand CBAY has been responding and working on this
  particular case since we found out there was an issue, brought to our attention
  by the patient, that November 2023 visits would not be covered.  We will attach a log of all the people and
  their time working on this one case as we want it known that as we do with each
  and every patient we have, we dedicate as much time and effort as we can to get
  the situation resolved as completely as we can for both the patient and our
  company.
  We also
  apologize for any slight perceived or any poor manners or attitude our front
  desk coordinator displayed on the phone or in person.  We constantly do training to make sure we
  give the best possible customer service and if we don’t we appreciate hearing
  about it and attempt to train so it will immediately get better.  To answer the specific claims made in the
  patients response:
   “I was told in I had 20 visits in November” We already attached  the original paperwork signed, August 14, 2023, that states his plan allows for 50 visits per year and that 30 had been used to date, leaving 20 for the rest of the calendar  year.
  We also previously attached the original paperwork that states no other services are currently being used which would affect the number of visits.  We, nor do most health care companies, constantly re verify benefits, except on a yearly basis, or if a patient switches insurances during their care.   Again, if asked, which occurs occasionally, to re verify a patient’s benefit status we would happily do that as a courtesy. Please understand, even our initial verification is a courtesy, as it is with all health care companies.  As stated in our first response, it’s the patient that needs to understand and work with their own insurance company to fully understand their benefits and what their share of liability might be.  It should be further noted that in the insurance world, there is never a guarantee the information is 100% accurate.  We have often been quoted inaccurate numbers or information which is thought to be accurate at the time.   There is no guarantee they will be exact or accurate.  At some point the final ruling occurs by the insurance company.
  
   Our billing team quoted this patient he had 20 approved visits on August 14, 2014.  He attended the following visits:
  August 14 and 29th: 
  total =2
  September: 1,5,8,12,15,19,22  total
  =7
  October: 6,10,13,27  total=4
  November: 3,7,10,14,17,21,28: total=7
  Overall total is 20 which CBAY, according to initial verification, should
  all be paid for by insurance.  This is
  why the patient was told, in mid November  
  all four November visits would be paid. 
  We also informed him after Nov. 28th, he would not have any
  further visits approved and would need to move to self-pay.
  The patient underwent other services, i.e. chiropractic most likely,
  during the time after we did our initial verification, which is why a discrepancy
  occurred and these 4 visits went over the limit.  Again, this is not a “real time” system.  We can’t get a perfectly accurate quote at
  any given time, due to a plethora of reasons, and therefore why there is a
  form, attached, we have patient’s sign which  states the patient is responsible for any final
  bill the insurance company does not cover.  
   “CBAY has been negligent in filing paperwork”.  CBAY takes great umbrage with this statement.  It implies we are “failing to exercise the care expected of a reasonably prudent person in like circumstances”.    We take great pride to make sure all paperwork is filed immediately and followed up on as well as can be expected.  We will also attach a log of all efforts attempted in this case.  Again, noting, this is talking about paperwork for the patient to get visits his plan does not allow for (December visits).  This is next to impossible in the insurance world and very rarely is authorized, but we still have done our best to accomplish this for the patient.  The physical therapist felt it would benefit him, so we did our best to make it happen.   The patient’s reference that our administrative team was negligent is very detrimental and wrong and if allowed to be published publicly would be absolutely detrimental to the company in a very competitive health care market.    Speaking to supervisors in the insurance company will always come off as if they have no part in the poor outcome but CBAY did all it could to try and assist the patient, again as a courtesy and out of an effort to help him.  The patient is presenting this aspect, going above his 50 visit limit, as if CBAY had to perform this service and because it wasn’t a positive outcome for him it must be CBAY’s fault.  The truth is he is attempting to get services that are not allowed according to his insurance plan, that he negotiated a rate for with his insurance company.  Again, CBAY absolutely apologizes if communications were short or negative during the timeframe of late November and December as we were attempting to get more visits, but again, CBAY had nothing to report as we had no answer from the insurance company.  That does not excuse any poor manners on our part and again, training for customer service will continue to be done.
  To address self-payment numbers.  All companies have the right to charge what they feel is appropriate for a session.  CBAY charges 100 dollars for a session.  This is actually most likely, but not verified, less than the rest of the market.  CBAY is absolutely willing to collect, if it came down to it, the “allowed” amount as determined by the insurance company.  Meaning, if the reimbursement that we would get from an approved visit is less than 100 dollars, we will accept that amount from the patient.  We apologize if that came across the wrong way.  We would accept whichever is less. 
   We do re-emphasize that nothing has been finalized.  If the insurance company issues approval for the 4 visits in November, there will be no payment due.  CBAY has not even issued a bill or statement to date that says as much.  The issue of the patient not getting December visits, in our view, most likely would never have been approved as we have rarely if ever seen visits approved above a hard cap.  On the rare circumstances they are approved, it takes weeks if not months even when all steps are performed immediately and accurately on both sides.  We always sympathize with our patients when this occurs
  In conclusion, we do not want it to seem we do not care, and apologize if this is how it seemed.  We are here to work with the patient to try and resolve this with the insurance company.  We also apologize if we did not communicate what was going on better for the patient’s satisfaction.    We will unfortunately not just waive the fees for these final 4 visits in November.  We will absolutely work with the patient if necessary with a payment plan, etc., but hope it never gets to this point and that the insurance company will cover those visits.
  We also hope the patient recognizes seeing  all the supporting documentation we did the best we could to help, not only getting the November visits paid but attempting at the time to get more visits for December.
  Just FYI, to respond to: “whoever” is writing this response, I am a physical therapist with almost 30 years in the industry, outpatient orthopedics. My background includes owning my own business/practice, operating 15 clinics for a national chain, and several years directing the entire outpatient rehabilitation department at **** ******* main hospital branch.  I have been working for and with the CEO of this company for the last 8 years.   I have been trained on and experienced in all aspects of this field including insurance verification reimbursement, etc.  I also have been trained on mediation and arbitration settlements and worked with employees, unions, and individuals in the public to resolve disputes.  That being said, I want to make sure my current company does not get slandered across multiple websites and while we would love to have worked this out personally, and not in these forums, we have complied but now feel threatened.  CBAY will undergo any sort of scrutiny desired by this patient as we keep the highest ethical principles and billing practices.  If the evidence we have now presented along with these two lengthy responses is not enough and we continue to get slandered publicly we will be forced to take our own remedies to make sure the public understands the facts and will seek retribution for any damages that may occur.
  In 30 years with vast experience, I have never had a situation so quickly
  escalated in such a public fashion.  We
  completely get the frustration, but working with health care and with insurance
  companies is difficult.  We do this all
  day every day for thousands of patients. 
  That all being said, CBAY would love not to pursue this further, let the
  insurance process play out, and then work with the patient to the best of our ability
  as detailed above.

  thank you

  
  

  Customer Answer

  Date: 02/03/2024

  First, I want to apologize, as I have been dealing with this issue for months.
  
  I have been reading a lot of this emotionally from your end and writing emotionally. I was prepared to reply the first day I received your response, but instead waited two days and have been reading your responses more openly. I do acknowledge that CBAY has not sent me a bill as of today 2/3/24 and while I am worried about the amounts on my explanation of benefits. I do appreciate that CBAY is not sending me notice of payment due. I do thank you for that. I will still attach what my response would have been, but with smoothing.
  
  Ma'am/Sir, I appreciate your credentials and that you have been a part of the industry for an extended period. I believe there is a disconnect between your training, knowledge and experience and the ones who are doing the work. I don't care whether this information is posted on the BBB or not. Frankly, everything can be redacted less the fact that there is a complaint. I feel we can address that amicably with the BBB. My interest is resolving the issues at hand. It also appears, in the end, that you are too. I also want the insurance company to pay you, which is why I have been working so hard since the end of November, once I realized I was misinformed by an employee of CBAY and received an explanation of benefits from my insurance company. I also realize that simply "appealing" through the insurance company doesn't yield great results. I had been constantly trying to work with CBAY and continue to fight my insurance to get it addressed. The last correspondence from the supervisor at ********* was that I was going to get another denial from the remaining November visits that were resubmitted, which I received the end of this week. Then the supervisor states they will work to get the benefits applied after. I am currently awaiting a follow up response for an update. 
  
  Being told that I don't know the difference between, "your claim is paid," and "the visit claims were with their insurance company, and according to what we know, they should process without an issue,” is strange and I realize is a general response that should be utilized, though the latter was never spoken to me. I understand that being a front desk customer service individual comes with its own pains. I hope this is a utilized as a learning experience for that individual rather than an X on them. 
  
  I feel like the responses I received from this BBB complaint had been an excuse as to errors made on the providers behalf, placing blame on the patient and insurance company. I personally do not understand how a business, which employs multiple facilities has an issue navigating the provider portal for my health insurance, but my chiropractor and acupuncturist, who are single person providers, were able to get medical necessity for appointments. 
  
  The provided documentation of efforts is from the patient's outreach to resolve the issue; less faxing paperwork. The phone calls and emails state they are for getting approval for December visits, none of which were utilized, as paperwork was not submitted (whether sender or receiver error). To this day, I am still working to ensure my visits are being authorized via ********* because I care that the provider is paid by the insurance company, even though I was ensured by CBAY that my claims were paid on multiple occasions. 
  
  I have attached my notes from my attempts with CBAY and one of my medical necessity appointment approvals. As I told *********, I will continue to fight to get my claims paid. 
  
  Thank you for your time and I look forward to your response. 

  Customer Answer

  Date: 02/12/2024

  It appears that the only concern of this business is how they are perceived and not the concerns of the customer. I thought that they would consider aiding, but their response were only really geared toward how they would look because they don't care about concerns of patients. It's a shame that they are more worried about the outcome of not assisting patients rather than assisting patients.

  Business Response

  Date: 02/13/2024

    Thank you again for allowing CBAY to respond.  We have now given two lengthy and detailed
  responses to this public complaint.  We
  will not be writing another  response
  after this one.  We feel these responses are
  causing the messages to get confusing.  We also at this point, feel regardless of what
  is said or explained, it won’t be enough to satisfy this particular
  patient.  With that being said, we really
  do attempt to make all our patients as happy with our service as possible.  We feel in this particular case, we did all
  we could to make this patient happy and resolve the issue to the best of our
  ability.  We will certainly continue to
  answer any particular question the patient has.
  In our opinion, there are three issues:
   4 PT visits that occurred in November may not be approved and may fall into patient responsibility:
    The
  patient feels he was told they had already been paid and therefore should not
  owe anything.  We totally understand the
  frustration of being told something that turns out to be not true.  We have a slightly different version of
  events and exact phrases used but regardless, the legal documentation signed by
  the patient states that he will be responsible for any part of the balance not
  covered by his insurance.  Again, we
  totally understand and feel bad that the message conveyed was they would be covered
  and to this point have not been. We have already explained in detail twice why
  CBAY thought they would be covered.    We
  processed all claims correctly and how **** ***** asked us to, without
  delay.  We do not know why they paid
  partial payment for his chiropractic care in December.  We can only control what we can control and
  to date they have not paid CBAY for November dates of service.  The patient ultimately is responsible for
  knowing and understanding their coverage. 
  CBAY goes out of our way to try and help the best we can.  CBAY did not make an error and did not make a
  mistake with any of the mechanics of billing in this situation.  The claims were processed correctly and
  timely.
  
  The matter of attempting to get more visits in December of 2023 since the limit had been reached.
    Our
  authorization experts reported these would not be covered.  We made every attempt and followed the
  directions from **** ***** to attempt to get more visits than he was allowed by
  his insurance company.  Any statements
  that CBAY worked negligently or improperly in this respect are false.  We communicated any information we had with
  the patient whenever asked.  Ultimately,
  **** ***** did not give us approval and the patient chose not to pay self-pay
  rates.
  
  Customer service: 
       The
  patient feels we communicated incorrectly and with poor service with short
  responses.  If this occurred (there are
  no recordings of the calls), we want to apologize greatly for now the third
  time.  We feel terrible if any patient
  feels they received poor service.   We
  constantly train our team to always be as nice and helpful as possible.  If we fell down, in this case, we apologize
  vehemently and can only promise that as a company, we will constantly be
  working to improve our customer service, this with all our employees.
  
  Again, if there is a specific question the
  patient would like us to answer we will be glad to do so, personally. 
  We will continue to work on his case as we
  have for the past several months.   While
  it has been considerably more work than most of our patients, we don’t mind and
  will continue to try to obtain the best outcome possible. This, despite the
  fact our company and billing team has been publicly disparaged multiple
  times. 

  Thank you again for allowing us to respond.

  Customer Answer

  Date: 02/13/2024

  
  
  Complaint: ********
  
  
  
  I am rejecting this response because:

  The provider is now concerned with their image, rather than addressing the issues. The provider told the patient the visits were paid, not submitted for coverage or anything close to that. All efforts to get issues resolved we're handled by the patients in attempts to assist even though the provider told the patient multiple times the 4 November visits were paid. They have provided no documentation regarding getting the dates resolved that were unprompted, but rather lead by the patients efforts. There's no correspondence left where the provider initiated contact with the insurance company other than follow up from the patients efforts. The provider is only trying to cover up for trying the patient that the visits were paid for. 

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