Complaints

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• Initial Complaint

  Date:08/22/2023

  Type:Product 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.

  Seen on 06-14-2023 for acupuncturist care, charged co-pay $10.00. My insurance carrier is United Healthcare (UHC)Seen 06-28-2023 for acupuncturist care and I was told by receptionist co-pay is $25.00. I replied how odd as last visit my co-pay was$10.00,receptionist left & came back & said that I'd have to pay$105.00 for visit as UHC was delaying payments, so I paid.On **** checked UHC & no claims ever filed. Sent email to Heartwood Healing of ********************************* responded on the 11th that she'd look into & is in network. On **** ************************* from her office called & said delays with UHC, I advised if not resolved I'd report issues. On ***** UHC **** left message no claims & not in-network & likely I'd be denied by UHC if I filed complaint. On ***** received email Heartwood Healing ********************* is moving **** ******************************************************** ***** & not one word on my situation. I am requesting that I be reimbursed the $105 that I paid & the complaint is listed against Heartwood Healing ********************* as well as Revitalize health and wellness ***********************, ND as they are in this business together. Supporting documents uploaded to this complaint. .

  Business Response

  Date: 08/26/2023

  Dear BBB,

  Please see our response to the complaint filed by ******************************* 8/21/23 (complaint #********).

  Warm regards,

  ***********************, ND, MPA:HA

  Owner
  **************
  F**************
  29702 SW Town Center Loop ** ***** C
  ***********, ** 97070
  ***********************

  Customer Answer

  Date: 08/31/2023

  August 31, 2023
  BBB
  Complaint 20502361
  Dear Investigative Manager:
  This is my rebuttal to Revitalize Health & Wellness (RHW)answer on August 23, 2023, answer. I will state that I am NOT interested in getting into a Writing War with the provider(s.) I reported only in the hopes of the BBB could assist in a resolution of my case. I will seek to respond to each paragraph as she argued.
  My services were with ********************* a licensed Acupuncturist,the receipts from the visits of June 14 and June 28, 2023, both state Heartwood Healing, *********************. I wasnt privy if ********************* was leasing space, an employee or some other type of relationship at Revitalize Health & Wellness. I was simply asking for resolution of the payment I was forced into making on June 28, 2023, for $105.00 when I had a valid ******** advantage insurance contract with ****************** (UHC.)
  *********************** of RHW states that I pressured ************************* the patient care services manager to bill my insurance carrier. What pressure??? Upon my first call for my first appointment of 2023, I advised that I had UHC Advantage plan, and that I was having right sided neck and shoulder pains. I was told by ******************** that they have over 30 claims pending at this time, and that there is quite a delay in the handling of their ********. He further stated UHC specifies that the care should be for low back symptoms as that is what UHC allows. I advised him that I have sacral Tarlov Cysts that cause low back and leg symptoms. His statement was confusing to me as ********************* had previously provided acupuncture care to my entire spine.  I didnt understand if this was a deceptive insurance practice when in fact, I specifically told him it was my neck and shoulder that were symptomatic, and desperately sought care.
  UHC did personally advise me over the telephone that there was 1) NO Limitation on which part of the body is treated and 2) there is no limitation on the number of visits.
  I did not misunderstand the co-pay portion of my UHC contract; ****************** claimed that the co-pay was anywhere from $20-$40. Why I was charged a co-pay of $10.00 on June 14th and then told the co-pay was $25.00 on June 28, 2023. Did the provider just guess the numbers of $20-$40; did they call UHC to confirm my insurance was valid, the allowances and the amount of the co-pay for the visits, I can only presume apparently not?
  I have not been provided with the ******** regulation 42 CFR ****** and ****** which ****************** stated does not cover care by an independent acupuncturist so my care wouldnt be covered. I do not have ********. In previous years when I was treated by *********************, ************ there was not a supervising MD, DO, PA, NP, or CNS that I was ever aware of. Why wouldnt this independent ************ not be covered if ****************** claimed she was her employer? Is ********************* an Independent or an employee of ******************?
  ****************** is asking me to compare apples to Oranges when she states Heartwood Healing visits in 2018 were denied; that this fact was unknown due to a billing error on the part of ************** ****** (Optum) at the time. Should providers use Optum as their billing service then the provider needs to provide accurate and proper supporting evidence which is submitted in a timely manner for the insurance carrier to consider payments. I had no idea services were denied, ************ never notified me of this. I do know that in 2018 ********************* of Heartwood Healing Center was an In-Network provider through UHC.It is my understanding that if a provider is under contract to be an In-Network provider then they are Not allowed to bill the patient for services that were not paid.
  ****************** claims services **** to be $325 yet UHC (claim 0067)has been billed only $200 for that date of service, is she trying to up-charge me personally now? Further she claims the ****th charge was $200 for which UHC did receive same.They claimed the fee was $200 to UHC but the receptionist told me that I had to pay for the entire visit in the amount of $105, are they up charging UHC now; both services were billed under RHW.
   The problem ***************** may not be aware of is that the claims submitted by Optum or whomever did NOT contain the proper evidence, for example:
   The National Provider Identifier (NIP) was Missing (N4) for each billing.
  UHC advised that they cant process these ******** without the NIP,supporting evidence etc.  Ive never seen ******** from RHW with the proper line-by-line ICD and CPT coding. Im curious if RHW billed for lumbar complaints, for which I had NO care to my lumbar areas.
  ********************* claimed to me that she was an In-Network provider with UHC which is evidenced further by her email of July 11, 2023,stating the same.  ****************** claims she was an In-Network provider but then goes on to say shes not an In-network provider with UHC. I recently did a search for ****** [****] ****, Heartwood Healing,****************************** and *********************** as well as the address and telephone number, and found under all entities Ive noted I could not find any of them as In-network provider. I further called an advocate at UHC and gave them all four names address and telephone number, and they found no In-network provider listing.
  Ms. ******** claim that I made threats to ************************* is incorrect and not the truth.  I agree that I was perturbed, it was confusing to me if what was expiring by RHW was legitimate,I did not at any time threaten anyone. I did state if this matter wasnt resolved in the immediate future that I would be filing complaints with the various entities, for which I have done.
  In closing ****************** claims she will file a fraud claim against me unless the claim is dropped on behalf of RHW, Heartwood Healing,********************* etc. and that I make a payment of $130. Why is it a fraud to make a claim requesting assistance?  I will not be intimidated by coercion, and I have every right to present to the various entities the facts of my case. I worked for a major insurance company for 38 years, I handled insurance litigation for many of those years, and had the most successful Trial Wins in the ***************. Thousands and thousands of dollars were entrusted to me. While I wasnt involved directly in insurance ********,I did understand the difficulties.
  I thank you in advance again for taking your time in considering my rebuttal, and I do wish for a speedy resolution.
  Best regards,

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

   *An attachment has also been provided of my rebuttal