Complaints

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• Initial Complaint

  Date:05/16/2023

  Type:Service or Repair 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.

  A year and a half after the surgery they are saying it was not preauthorized and that I have to pay for the surgery. I had appropriate insurance, it was confirmed that I was preauthorized to have the surgery. They say it was preauthorized, but insurance says it was never authorized. So here I am stuck in the middle of an issue that is no fault of mine. They keep blaming insurance and insurance insists that it is the doctor's fault. Someone in some compacitu has royally screwed up and somehow I am on the hook for a bill I can't afford and should not be mine to worry about in the first place. After speaking with insurance it is legally documented that they spoke to someone in their office that not only recognized the error, but cleared me of all responsibility. Ironically, the doctor's office says that conversation never took place. Something feels so shady about this entire situation. They have told me that they have fought the insurance company on this issue and I recognize that. They have also reduced my bill. However it is still a large expense to have to pay when I was appropriately covered annd preauthorized at the time.
  
  I only want the responsibility of this bill to be erased. I did everything right on this situation. Somebody made a mistake and it was not me.

  Business Response

  Date: 06/08/2023

  Please see the attached full response letter.

  The fact is that our office has done everything we could possibly do in order to obtain coverage for this patient, and we should not be made to suffer financial loss due to the greed of the insurance company. Prior to the surgery, we contacted BC/BS and were informed by their representative that Pre-Authorization for this procedure was not required. This was a regular occurrence in the peri­ and post-Covid environment, and we have multiple examples documenting this from other patients who had the same insurance (BC/BS of Kansas City ). Therefore, we performed the procedure in good faith, based on the information provided to us by BC/BS. We can only proceed based on the information we are provided, and should not be held at fault for misinformation given us.

   

  Subsequently, we fought with BC/BS for over a year and a half on behalf of the patient, through multiple levels of appeal and grievance. In each instance, we submitted significant and appropriate documentation that definitively showed that pre-authorization was not required. Despite all of this,

   

   

  BC/BS has continually ignored our documentation, and has persistently refused to provide payment, leaving the patient responsible for the totality of the charges.

   

  Both BC/BS, and the patient in her complaint, have attempted to claim that an individual in our office recognized some error, accepted responsibility for the situation, and cleared her of any responsibility for payment. This is absolutely untrue. No one in our office made any such comment. We eventually determined that the individual they referenced is employed by the billing company, which is a separate entity, and does not work in, or for, our office. Furthermore, no one in the billing company has any authority to accept or refute statements or offers from any insurance company on our behalf - they simply process the paperwork for submitted claims. More importantly, when we spoke to the individual, she informed us that the BC/BS representative was extremely aggressive and forceful during their call, badgering her to accept that we could not bill the patient. However, they were not aware in this call that the patient had previously signed the aforementioned Financial Agreement, acknowledging her responsibility.