Complaints

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• Initial Complaint

  Date:10/26/2023

  Type:Billing Issues
  Status:

  UnresolvedMore 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.

  This clinic is performing insurance fraud. I was told by them verbally and written that my insurance covers all procedures needed for my IVF cycle. However, during the process I would get calls and messages stating I needed to drop off multiple cashiers checks for my services, upon calling my insurance I found out that they had not been filing insurance claims using the proper tax ID and instead using one that is not in my insurance network ( for my covered services) and instead charging me cash. They are currently being investigated.

  Business Response

  Date: 11/08/2023

  First off we did discuss with patient, in a financial discussion, what is covered and not covered by her insurance. We also explained her deductible and co-insurance to her. We explained that the clinic is in network, and that the embryology services will be using her out of network benefits. We do require non-covered services to be paid upfront, and patient complied and moved forward with services.

  After the procedure we billed insurance for services rendered. we then billed patient based on the *** (enclosed).

  Patient contacted a patient advocate, And we were notified. This advocate-did not tell patient that we had billed the wrong codes. But wanted to know what we could do to help her since she owed and couldn't afford this. I told the advocate that our contracts with premera, did not allow me to bill one companies' patient services under another company's tax id. without being in breach of my contract. I told the advocate, after verifying we had billed correctly to tell the patient to appeal to her insurance. Since we had done nothing wrong.

  In the meantime, ******* has written numerous 1-star reviews, in one she just put up a 1 star, and no comments. then two others where she called us basically a scam artist. and then reported to Yelp stating that we pay people to take down their reviews-- all of which is false. 

  I have enclosed the *** from insurance, the refund we did send her, and a letter stating what insurance told us after contacting them to see if they could help. The insurance contact said she would reach out to the patient and try to explain things so she would understand.  Insurance is not investigating us in this mater, that is a false statement on her part.

  We have dismissed this patient from our clinic, she is seeking continuation of her care elsewhere. in conclusion we were successful in helping this patient get a healthy embryo, and despite being successful, she is spiteful.

  Customer Answer

  Date: 11/08/2023

   
  Complaint: 20787433
  
  I am rejecting this response because they are providing false statements. I will respond below.

  Hello,
  I would like to address each of the false claims in Overlake Reproductives Response. I will refer to them in my responses as: ORH
  
  
  First off we did discuss with patient, in a financial discussion, what is covered and not covered by her insurance. We also explained her deductible and co-insurance to her. We explained that the clinic is in network, and that the embryology services will be using her out of network benefits. We do require non-covered services to be paid upfront, and patient complied and moved forward with services.

  
  My response: I did have a financial consultation in which I was told all services I would have done at ORH was covered by my insurance and the clinic and doctors were in Network. I have attached the original financial consultation document. I was never told that anything I would have done or receive at ORH was out of network. They do in fact require services to be paid upfront because that is exactly what I was told. I had to drop off a cashiers check or money order for $4,686.00 by a certain date in order to begin my IVF cycle. I asked humberous times for an explanation of why I was paying cash for services covered by my insurance and never received a sufficient answer. I was told this is our policy to collect this money upfront. If I would have been told that any part of my services would not be covered by my insurance I would have chosen another clinic.
  
  
  After the procedure we billed insurance for services rendered. we then billed patient based on the *** (enclosed).

  
  My response: I paid $4,686.00 upfront, then paid $150 to be taught how to inject my medications, then another $700 for anesthesia. All things that should have been covered by my insurance if billed properly.
  Patient contacted a patient advocate, And we were notified. This advocate-did not tell patient that we had billed the wrong codes. But wanted to know what we could do to help her since she owed and couldn't afford this. I told the advocate that our contracts with premera, did not allow me to bill one companies' patient services under another company's tax id. without being in breach of my contract. I told the advocate, after verifying we had billed correctly to tell the patient to appeal to her insurance. Since we had done nothing wrong.

  
  My response: Yes. My advocate who has been working with me the entire time and confirmed with the clinic and with ******* that the doctor and clinic were in-network did in fact notify me that ORH submitted my claims using a tax ID that is not associated with their clinic or the one that ******* had. My advocate supports my claims that ORH is conducting business unethically and fraudulently. My advocate has assisted me in filing an appeal and a complaint with my insurance against ORH.
  
  
  In the meantime, ******* has written numerous 1-star reviews, in one she just put up a 1 star, and no comments. then two others where she called us basically a scam artist. and then reported to Yelp stating that we pay people to take down their reviews-- all of which is false. 

  
  My response:  After posting an accurate review of my personal and negative experience, I received a prompt response from the clinic the following day. They mentioned that they had come across my review online. I wrote the review with the intention of cautioning other women who might find themselves in vulnerable and urgent situations. It is crucial for them to be aware that this clinic preys on desperate women, resorting to fraudulent practices rather than submitting accurate insurance claims. I was then told by my advocate that the billing manager **** said our hands are tied until the review comes down. So I obliged and removed the review and waited two months for them to resubmit the claims in which they did not. So then I re wrote the review and placed in on ****** and Yelp. I did not leave any 1-star review without a comment, I clearly have a lot to say about this clinic. I have also attached a copy of my review.
  

  I have enclosed the *** from insurance, the refund we did send her, and a letter stating what insurance told us after contacting them to see if they could help. The insurance contact said she would reach out to the patient and try to explain things so she would understand.  Insurance is not investigating us in this mater, that is a false statement on her part.
  
  My response: Revised: Following four months of pursuing the matter, including an insurance fraud claim, an online review, and a complaint filed with the BBB, I finally received a refund of $536.27. Unfortunately, the refund provided no explanation. The expected refund amount should have been nearly $10,000. Surprisingly, upon canceling my second retrieval and requesting a refund, there are suddenly "new charges/bills" that were never disclosed to me until I ended care with ORH and requested the refund. I have not heard from the insurance contact (******) and yes Pramera is investigating ORH.
  
  
  We have dismissed this patient from our clinic, she is seeking continuation of her care elsewhere. in conclusion we were successful in helping this patient get a healthy embryo, and despite being successful, she is spiteful
  
  My response: I made the decision to discontinue my treatment at ORH and pursue care elsewhere, as I believe this clinic engages in unethical practices, compromising my sense of safety. Additionally, I have concerns about their involvement in insurance fraud.
  I am also concerned about my embryo that is still at their facility. I want to ensure that I receive it in my possession and it has not been tampered with.

  
  Sincerely,
  
  *************************

  Business Response

  Date: 11/15/2023

  We did not commit insurance fraud. we billed insurance per our contract, with codes that our contract has approved. the embryology services were out of network, and we did not balance bill the patient. Her advocate even said she did not tell her that we used erroneous codes. we are obligated to collect what is on the **** because that amount goes towards the patients out of pocket. She had an obligation to pay per her contract with her insurance company.

   I did tell the advocate that i would reach out to Premera and try to get them to put us in network with the particular plan an get it back dated so it would help this patient.  this is what i received from premera:

  "Hi ****, 
  
  I apologize for the delay. I wanted to let you know that our Network Team is currently in the process of adding Heritage Prime to your contract. If you have follow up questions, you can reach out to us.
  
  We appreciate your patience with our process. 
  
  Thank you so much, 
  
  Premera Blue Cross 
  Provider Relations | Provider Network Operations  
  premera.com/provider 
  PW 2398150"
  

  we told her advocate to have the patient appeal the insurance decision. that is her best weapon when she does not agree with how her insurance paid. we are obligated to collect based on what insurance tells us and we use her credit on her account to cover those charges per the **** we also contact ******* and were told they would reach out to her.