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:10/06/2023

  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 have not heard anything from this business. They have not communicated with me regarding the complaint. nce; they contacted her to clarify. She finally started to submit claims after being told to do so by them.
  I noticed she was overcharging me per the Explanation of Benefits EOB. $300.88 on initial evaluation and $14.79 per session. I asked her about it and was told "my fee is my fee". I contacted the insurance company again. They called her to inform her that she is not allowed to charge the difference per the agreement of being an in-network provider. She was told to issue a refund to me. She has not and it has been 3 months. She also got paid $170.42 on ck 1063 from insurance company in August for sessions I already paid cash for, this should have been refunded to me since she was not due any payment and I had already met my full deductible so should have paid Zero. I contacted the insurance company again. They called and informed her of her faulty business practices and told her to refund the $648.78 in overages (this includes the $170.42 as well as 12 sessions overcharges and evaluation overcharge).

  Business Response

  Date: 11/04/2023

  First I do not believe this is from the complainant but his wife.  I had a very good relationship with him.  When I started working with him he had not met his deductible so was making cash payments. His insurance was not being billed. Several months later he asked that I let his insurance company know what he paid so he could apply it toward his deductibles.  He was given receipts for each visit but, he said he was being pressured by his wife to report it to the insurance company as she was unwilling to send in the receipts to the insurance company. I proceeded to let the insurance company all the payments that were made when he was a cash client. Cash customers are not under any insurance company rates until I start billing the insurance company. The payments were not "up front" payments. Payments were given each time the client was seen. It is also not true that clients cannot submit receipts to their insurance companies for reimbursement. I submitted claims with what was paid prior to any call from the insurance company.  In addition, the only call I received from his insurance company was when his wife filed a complaint with them stating she was over charged. I explained to the insurance company he was a cash client. Therefore his wife was unhappy and gave me a bad review on ******. I never spoke with the client after he left counseling so to say I spoke with him is a lie. I was never told to refund this client by the insurance company as I was not billing under their contract but, just informing of what was paid so it would apply toward his deductible. I was never called and told to repay anything at any time due to faulty business practices. I have never had a complaint with the BBB and I know I am not a member of the BBB and do not even need to respond to this. I have been in the field of substance abuse  & mental health for 36 years and without an issue. I am only responding to this because I respect the work the BBB does.  If you have any questions please email me.  I am sorry I did not respond earlier I do not remember getting an earlier email or I could of thought it was anything but a complaint.

  Sincerely,

  ****** Bresnahan, MLADC, SAP, LCS

  Customer Answer

  Date: 11/06/2023

  
  
  Complaint: ********
  
  
  
  I do not accept the business's response as a resolution to my complaint because: All emails with the insurance company have been saved, where they state they contacted ****** multiple times to explain the policy and business practices and that they were not being followed. Yes, I agree I had a good relationship with ****** but told her upfront from day one that I had insurance. She was the one who insisted on cash payments at every appointment. Telling me to submit claims but the insurance would not accept them. I was told that she must submit them as she has the codes needed to process claims,

  Even if I agree to let the overcharges go. That does not make up for her accepting the payment on check # 1063 that was mailed to her on 8/4/23 in the amount of $170.42 from my insurance (copy attached)  that was for services that I paid cash to her (receipts already submitted). At the very least this $170.42 should be refunded to me since she was paid twice for the two sessions in question, and this is the amount that I should NOT have had to pay since my deductible was met. Morally and ethically, the proper thing is to refund the $648.78 due but in the least the $170.42 is the legal remedy. 
  
  
  
  Sincerely,
  
  
  
  **** *****

  Business Response

  Date: 11/06/2023

  Good Afternoon,

  I previously stated I spoke to the insurance company one time and have not received any emails from them regarding this case. They would of called me and not emailed me. As previously stated I spoke with them once to let them know Mr. ***** was a cash client until he meets his deductible. I was told Mr. ***** had insurance which I accept however, he was informed he had to pay his deductible first before they would pay.  He agreed to the cash amount I charge. I did not insist on anything as people are free to choose their providers. All payments are due when a client is seen unless I am billing their insurance then only their copayment is due. I never said submit claims, I said "submit your receipts to your insurance company as they stated what the receipt was for so it would be applied toward his deductible" 

  Due to HIPPA I cannot go into detail about what the $20 was for in addition to his copay however, if **** was writing this he would already know.  I am not responsible for what Mr. ***** reports to his wife. I can only say this $20 fee had nothing to do with his insurance and was a separate item. I will not keep restating what I have already said. and going back and forth, if they would like to go to court I am more than happy to do that.

  ****** Bre4snahan, MLADC, SAP, LCS