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:06/06/2024

  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.

  Better Business Bureau:I have reviewed the response submitted by the business and have determined that the response does not satisfy or resolve my issues and/or concerns in reference to complaint # ********. Please add your rejection comments below; if you do not provide any details, your complaint will be closed as Answered. 

  [You must provide details of why you are not satisfied with this resolution.  If you do not enter a reason for your rejection, your complaint will be closed as Answered.]
  
  Businesses and Customers should be civil, courteous and polite in their responses to complaints. It is important to remain professional and productive when participating in the BBB complaint process.
  
  FAQ
  
  Regards,

  *****

   

   

  

  Business Response

  Date: 06/07/2024

  Hello,

  I've done an initial review of this account. I will have charges validated as the patient is challenging the services she received. I can say that her insurance paid the claim initially and the patient paid her responsibility, but after paying her insurance than recouped their payment stating that they felt there was another insurance that shoudl have paid. This is called coordination of benefits that comes up between insurances and insured individuals quick frequently. Its the insurances way of making sure they are paying claims that are their responsibility and that there isn't other coverage for the services provided. In this situation the patient needs to contact their insurance to answer the questions on coordination of benefits for that date of service. Once that is complete the patient needs to request that the claim that was recouped is reprocessed for payment to MaineHealth. As stated above I'll be validating through documentation that the charges being billed are accurate. 

  Thanks,

  *********;

  

  Business Response

  Date: 06/11/2024

  *** had the account reviewed and charges stand as services provided by mid-wife who was a MaineHealth provider. This goes back to the fact that patients insurance believed there was other coverage available to pay the bill so they recouped their money. Calling the insurance to address this coordination of benefits issue is what need to occur and asking the insurance to reprocess the claim as well will resolve the issue. Once that occurs we can remove from collection activity as well. Thanks!

  

  Business Response

  Date: 06/11/2024

  We stand behind our follow up and review of this patients account. In my responses below the patient has actions that can be taken to resolve this issue. 

  06/10/24 response.
  Ive had the account reviewed and charges stand as services provided by mid-wife who was a MaineHealth provider. This goes back to the fact that patients insurance believed there was other coverage available to pay the bill so they recouped their money. Calling the insurance to address this coordination of benefits issue is what need to occur and asking the insurance to reprocess the claim as well will resolve the issue. Once that occurs we can remove from collection activity as well. Thanks!
  
  06/6/24 response.
  Hello,
  I've done an initial review of this account. I will have charges validated as the patient is challenging the services she received. I can say that her insurance paid the claim initially and the patient paid her responsibility, but after paying her insurance than recouped their payment stating that they felt there was another insurance that should have paid. This is called coordination of benefits that comes up between insurances and insured individuals quick frequently. Its the insurances way of making sure they are paying claims that are their responsibility and that there isn't other coverage for the services provided. In this situation the patient needs to contact their insurance to answer the questions on coordination of benefits for that date of service. Once that is complete the patient needs to request that the claim that was recouped is reprocessed for payment to MaineHealth. As stated above I'll be validating through documentation that the charges being billed are accurate. 
  Thanks,
  *********;

   

• Initial Complaint

  Date:05/01/2024

  Type:Sales and Advertising 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.

  [A default letter is provided here which indicates your acceptance of the business's response.  If you wish, you may update it before sending it.]
  
  Better Business Bureau:
  
  I have reviewed the response submitted by the business and have determined that the response does satisfy my issues and/or concerns in reference to complaint #********. I understand that by choosing to accept the business response that my complaint will be closed as resolved. 
  
  Regards,
  
  *****************************ng balance of $1045.78. 1. I had been paying $52.00 for 16 months of my 37 month payment plan which did not require auto check payment. 2. I found out on April 22, 24 that payment plan had been canceled. 3. MaineHealth's new payment plan policy of 4/18/2024, was that when setting up a payment plan, you must attach auto pay with a check or card. If that doesn't happen, the payment plan system will terminate the payment plan. 4. They canceled my 37 MONTH payment plan BECAUSE IT DID NOT HAVE AN ATTACHED AUTO PAY WITH A CHECK OR CARD. Of course,There was no such policy in 2022 when I received my 37 month payment plan from Mainehealth. 5. It seem that the logical solution for the implementation of this new payment policy would have been TO NOTIFY ALL MEMBERS WITH OUTSTANDING PAYMENT DEBT THAT THE REMAINING DEBT WOULD BE CARRIED OVER TO THE NEW PAYMENT SYSTEM OF AUTO PAY WITH CHECK OR CARD.

  

  Business Response

  Date: 05/01/2024

  I will be having a manager from my team contact the complaintant to review desired resolution and come to an outcome that works for the patient. 

   

  Tony 

• Initial Complaint

  Date:09/05/2023

  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 do not accept this answer because as I have stated since June 1st this seems to be a billing issue NOT an insurance issue.My claim(s) was paid EXCEPT for the line billed as a cat scan.On my EOB it says this was rejected because there was no prior authorization.There was no cat scan ordered so there was no authorization.All it takes is someone from the billing **** to look at my last three echos and how they were billed to see that the 2nd echo was billed correctly and therefor paid in full.Nowhere does it state that the two billed incorrectly were denied because they were out of network.So Mainehealth is billing my insurance for something not done nor ordered.

  out to Included Health who now tells me that the WRONG preauthorization code was used when the claims were submitted BY MAINEHEALTH and that she has resubmitted BOTH claims with the correct code.First of all Id like to know why nobody from the mainehealth billing **** could figure this out-specifically,*****-the first person we spoke to who went over all the coding for the procedure with the person from New ************************* and when she couldnt answer the specific question about why code #xxxxxx was used she defaulted to Well this bill is for coinsurance.Its NOT.I met my out of pocket before January ended.This bill is way overdue because nobody in the Mainehealth billing ****. seems to know what to do.So now after much incompetence from the billing ****. I was sent a final notice for one of the two bills in question. MY insurance rep is doing the billing ****s. job.If this goes to collections there is going to a problem.

  

  Business Response

  Date: 09/11/2023

  Good morning,

  We have reviewed this case and are following up with the patients insurance. Patient portion being denied, is being listed as out of network.  I pushed back and told insurance auth #s for DOS were on the claim he is sending both DOS in question back to the home plan as they are the ones that applied the pt portion.  I will move this back to insurance follow up and ask for it to be removed from self pay while we wait for determination. We will continue to follow up with insurance until this is resolved. 

  

  Business Response

  Date: 10/03/2023

  Good afternoon,

  We are reviewing all charging to ensure it is correct and continue to work with the insurance who denied a portion of the claim for out of network. More to come as we do our additional follow up. Feel free to communicate directly with me at my email address; ************************************************************* May be easier than through the BBB site. Whatever is your preference. 

  Thanks,

  *********;

  Customer Answer

  Date: 10/04/2023

  Better Business Bureau:I have reviewed the response submitted by the business and have determined that the response does not satisfy or resolve my issues and/or concerns in reference to complaint # ********. 
   
   Still trying to pin this on insurance when actually my husband reached out to a friend whose wife works at Mainehealth who found the issue which is a coding issue(exactly what I had mainehealth look into in the beginning of June). Still being billed for it as of today. I find it ridiculous that between myself and my insurance rep we spoke to I think 8 people and nobody could figure out the problem. I dont work for an insurance company or a billing **** and I was able to see what the problem was from the get go-way back in June. I still have the email response from the coding **** telling me everything was coded correctly when clearly it wasnt. Ive had to pass all of these billing issues (because its not just one bill) to my husband to take care of because I couldnt deal with the stress any more.

  
  FAQ
  
  Regards,

  *****

   

   

• Initial Complaint

  Date:09/15/2022

  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.

  [A default letter is provided here which indicates your acceptance of the business's response.  If you wish, you may update it before sending it.]
  
  Better Business Bureau:
  
  I have reviewed the response submitted by the business and have determined that the response does satisfy my issues and/or concerns in reference to complaint #********. I understand that by choosing to accept the business response that my complaint will be closed as resolved. I wish I didnt have to go through the Better Business Bureau in order for someone to call me back. I have been trying for 4 months to talk with someone.
  
  Regards,
  
  *****************************

  

  Business Response

  Date: 09/21/2022

  Good afternoon,

  I've reviewed this particular case and have forwarded to my team to have this removed from collections and to work with the patient to establish a payment plan that works for the patients needs. Contact attempts will be made with the patient today.

   

  Thank you!

  *********;