Complaints

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• Initial Complaint

  Date:08/10/2023

  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.

  I had surgery on March 1st, 2023 provider was Podiatry Associates, Inc. Patient ***** ****** *** ******* was my surgeon. They had the wrong insurance information and claim was denied. They called **** health and welfare in inquire and were given the updated insurance information with new participant and group numbers so they could refile claim with correct information in June. They refilled they claim the claim was denied for timely filing? My claims office has never received the claim. Claims office states it is stuck at ****** **** ***** **** ****** and that the provider (******** ***********) needs to file an appeal and will then be paid. Podiatry associates told me it's not their problem or their fault and I need to and or my claims office needs to resolve it and I need to just pay the bill. However that is not how the process works according to the claims office their hands are tied and it is on the provider to file the appeal. I had 3 seperate claims for this surgery, One with surgery center one with podiatry associate and one with anesthesia company. One of them has already been filed and paid. Every time I try to get information to facilitate this with ******* ********** the billing department (there is only one woman who works in the office) Is very defensive and rude and is placing all the blame on me and we get know where as she continually hangs up on me. There has got to be a way to communicate and resolve this claim and get it paid correctly. I have never been treated so terribly. I have asked them on Aug 11th 2023 to file the appeal as instructed by my Claims office that works with my insurance company and to send my a copy of the appeal. I have no faith after the way I have been treated and talked to that they will follow through on their end and am not in a position to pay a bill this high which is why I have heatlth insurance and would not have had the surgery or used this Doctors office had I known how difficult they would be. Please assist. Thank you.

  Business Response

  Date: 08/16/2023

  Patient apparently did not provide our office with current insurance ID number on 1/26/23, the time of her consultation for surgery.  Upon our phone call to her union on 2/1/23, **** representative "Sheila" stated she was covered, no authorization for surgery was required for proposed procedures, deductible and co-insurance were stated to us, so proposed surgery was scheduled to go forward.  Surgery took place on 3/1/23.  Claims were sent and started to be denied.  On 3/8/23, A call was made again to ****, at which time we were told to go ahead and push the claim through again, as there were no cuts in coverage.  On 3/14/23, the claim was getting "hung up" electronically so we decided to send it on paper.  Paper claims usually get paid last, so we waited several weeks before following up.  After not hearing from insurance for quite some time, on 6/30/23, we called the union (****) to inquire as to why the claim was not yet paid.  We were told that the patient had a new ID card and asked if the patient had given that to us, in which we replied "no".  At that time, ***** from **** gave us the new information and we filed the claim electronically on 6/30/23 to her insurance with the new ID number.  On 7/6/23, we received a reply from the patients insurance that we would not receive any reimbursement because the claim was untimely.  Per our contract with the insurance carrier (Anthem) we have only 90 days from the date of service to file a claim.  I understand the patient doesn't feel 90 days is sufficient for claim filing, but that is what the insurance company requires to contract with them.  We let the patient know what happened so she could contact her union and let them know what had transpired.  Not to be rude or inconsiderate, but to let her know that she would need to get involved because our contract was with her insurance company, not with the union, and we were unable to fulfill our obligation due to her not providing current ID number.  We have since requested an appeal due to the circumstances mentioned above, and have copied both the patient and her union. I spoke to the patient on 8/15/23 to let her know what all has taken place on our end, and to expect a copy of our appeal to arrive in the mail.  She apologized for being short and stressed and was happy with what was taking place currently.  I asked her to be patient, that appeals would sometimes take a couple of months, but we would work with her and her insurance company to try and get a positive outcome.  She thanked me and I relayed to her that we would continue to pursue this issue until all avenues were exhausted.