ComplaintsforSoutheast Urgent Care, Inc.

• Initial Complaint

  04/02/2024

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  I have been working with the billing department in regards to them billing my insurance. They had been unable to bill my insurance as, at the time of service, I had not presented my insurance card. I had provided them the name of my insurance company, the group number, and my id number. Because I didnt have the card, and it wouldve taken weeks to get a new one I had done a three way call with the billing department and my insurance provider to resolve this issue. The representative from the Juneau urgent care billing department stated in that phone call that they had collected all necessary information in order to bill my insurance. I just received an email, responding to my email for assistance from December, from the billing department still requesting my insurance information. I had plainly stated that the representative over the phone had collected all the information needed in order to bill my insurance.I had originally believed that this issue had been resolved, given the phone call between my insurance and the representative with the Juneau urgent care billing department. I need to have this issue resolved as I do not want to risk the amount due going into a collections status.

  Business response

  04/09/2024

  I received the notification letter of complaint regarding billing on April 9,2024. I would first like to provide clarifying information to BBB and the patient, we do not have an internal billing department, we contract a third-party company and it seems this is with whom the issue concerns, not our clinic. However, I will respond to this complaint against our company name and by default the billing company.  Upon receiving the letter in clnic, I reviewed the billing history and communication with ************************. and all billing entries are as follows: 
  
  no reg form/no insurance card was attached only in pvm it was stated the member id number and when it run in CMD subscriber not found im forwarding this to may to call the pt to get the right info  or details of her providence insurance for DOS(08/30/2023)--noted by ******** on 08/30/2023

  
  Providence denial in PB 9.28.23 as unable to identify as member.  Notified *****.- noted by jschalow on 10/26/2023

  
  Reception forwarded an email from this patient regarding her correct insurance number. Sent a reply requesting for a copy of the insurance card to verify correct claims address and payer ID.- noted by pbaltazar on 12/13/2023
  Called patient to follow up on statement no answer, LVM- noted by ebasco on 2/21/24
  
  Pt CB we had a triway call w/ the payer. I was able to get the correct payer ID as well as mailing address. Resubmitting claim now- noted by ****** on 02/21/2023

  
  Claim rejected at clearinghouse. Electronic submission not available for payer at this time.Requested for user print and mail- noted by pbaltazar on 03/05/2023

  
  I looked up the plan name Providence Health Plan based on the insurance name listed on the Solv Reg.  I set up Providence Health Plan and submitted the claim for DOS 08/30/2023 today.- noted by jschalow on 04/01/2024
  Called Providence Health Plan at ********** to verify patient's information and claims address. 
  ******* claims address should be PO BOX *****, ***** ** 97309
  Correct member ID should be KM00K6G
  Member's policy is active on ********.- Noted by pbaltazar on 04/02/2024

  
  Called Providence Health Plan at ********** to verify patient's information and claims address. According to rep. ********* correct claims address should be PO BOX *****,***** ** 97309; 
  Correct member ID should be KM00K6G
  Member's policy is active on ********.
  
  Electronic submission not available for payer at this time due to Change Healthcare security issue.Requested to user print and mail to insurance. Emailed **- noted by pbaltazar on 04/02/2024

   
   -----End of billing notes----------

  
  From the entries here I can see that ************************ should have been billed at the time of service as she did not have the proper insurance information with her at the time of service. However, instead of being charged as a self pay visit we did the courtesy of attempting to verify and bill her insurance with the minimal information she provided,  and we did not receive the proper billing information until 3 months after the visit. ************************ could have taken the time to call the clinic and she would have been informed the claim had to be submitted via paper due to the NATIONWIDE CYBER ATTACK on changehealthcare , her insurance companys clearing house. This is not a delay on our part and ************************ received 2 statements prior to December 2023, and since then has not once received a statement indicating she would be going to collections as she is not in danger of that at this time. Her complaint is based on annoyance with the medical billing process and circumstances outside of the compnay's control rather than a true compliant based on the integrity of our business.

  
  Should ************************ have any questions she is welcome to reach out to me in clinic at ************.

  Sincerely,
  *************************;
  

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