Complaints

• Initial Complaint

  12/25/2024

  Complaint Type:

  Billing Issues

  Status:

  Unanswered

  More info

  I am getting billed for an advertised free Covid test from 07/20/2022 by this business. I got sent an invoice on 12/6/2024. They charged a total of $1121.00 for a free Covid test. I only went to this clinic because it was free and I am upset that they are now trying to bill me.

• Initial Complaint

  08/28/2024

  Complaint Type:

  Order Issues

  Status:

  Answered

  More info

  Insurance paid $37.55 for a covid test preformed for a free test on 01/24/2021. Now on 08/15/2024 is asking for $1090 for a service that was already paid for.

  Business response

  09/11/2024

  September 11,2024
  
  Better Business Bureau, ***
  PO Box 218
  *********************
  
  RE: American Family Care (AFC) Complaint 2211604
  
  
  Hello:
  
  I am the General Counsel for American Family Care (AFC) .There has been a complaint against AFC Complaint ********. I will respond to it herein.
  
  The complaints were filed for the collection of ***** medical services rendered to a patient who had insurance which is and was required to pay the full bill but nevertheless has refused to pay the bill because a glitch in the law that says while the insurance company is required under Federal law to fully pay the bill only the federal government can sue the insurance company for payment. This means when the insurance company refuses to pay the medical provider, it cannot sue the insurance company for payment leaving the insured on the hook for the payment which it is not supposed to be liable.
  
  Saloojas, *** the medical billing company for AFC the medical provider, had first attempted to have the insurance companies pay the Covid testing bills. ******** then sought help from the California Department of Managed Health but the request for help was denied because the Department claimed that the insurance plans were Federal plans under ***** and as such it had no authority enforce payments of insurance bills which arose under Federal ERISA plans
  
  Then AFC, then through its billing company Saloojas ***, filed a series of Federal class action lawsuits against the insurance companies for payment and even took one case all the way to the Unites States Supreme Court.Unfortunately, after the case had been docketed and briefed, the US Supreme Court sent the case down to the Ninth Circuit for further hearing. The Ninth Circuit subsequently held that while, in essence, the Federal Cares Act requires insurance companies to pay the full bill for ***** medical services, only the ***** Administration has the standing to bring actions to enforce the CARES ACT and thus dismissed the complaint of Saloojas seeking to require payment of the bill from the insurance companies
  
  As Saloojas cannot directly sue to recover the payment from the insurance companies, despite the Federal CARES ACT requiring them to pay for their rendered ***** services, Saloojas and AFC is left having to sue the patients directly for their bills and therefore is filing small claims actions for said payments. There are now over ****** of such unpaid claims which should have been paid by the insurance companies to Saloojas ie AFC.
  
  All of their patient/insured ***** bills should have been paid contractually under their insurance policy. The patients are being sued for payments of the bills only because Saloojas cannot sue the insurance companies directly for their payments. The Federal CARES ACT law requires the insurance companies to pay the full bills but since they refuse to do so, their insured are sued for the payment. Even though the patients/insured must pay the ***** Bills for the rendered services,they can seek reimbursement from the insurance companies
  
  
  The patients could also sue their insurance companies in small claims court for breach of contract in not paying their bills. In addition the patients can also sue their insurance companies for punitive damages of up to $7,500 for willfully refusing to pay their bills. California law requires insurance companies to pay the reasonable charges for the services rendered. Furthermore, under the Federal Cares Act full payment of the ***** bills is required. As Congress had set the payment as the full posted price of each rendered service under the CARES ACT, the full charges should therefore be considered as reasonable by Congressional determination
  
  AFC is an out of network medical provider and thus the payments of its ***** medical bills by an insurance company are covered by the Federal Cares Act.
  
  I.PAYMENT OF LESS THAN THE FULL POSTED PRICES FOR OUR ***** TESTING SERVICES IS A DIRECT VIOLATION OF THE CARES ACT SEC 3202
  
  Under the CARES Act Section 3202, an out of network provider, which would be AFC as it never agreed to be paid less than its posted price for the ***** services, is to be paid its cash posted prices for its ***** Testing rendered. It is not open to negotiation or adjustment in any way, That is the law as set forth below.
  
  SEC.3202. PRICING OF DIAGNOSTIC TESTING.
  
  (a) ***************************** health plan or a health insurance issuer providing coverage of items and services described in section 6001(a) of division F of the Families First Coronavirus Response Act (Public Law *******) with respect to an enrollee shall reimburse the provider of the diagnostic testing as follows:
  
  (1) If the health plan or issuer has a negotiated rate with such provider in effect before the public health emergency declared under section 319 of the ********************* Act (42 U.S.C. 247d), such negotiated rate shall apply throughout the period of such declaration.
  
  (2) Reimbursement. Public information. Web posting. If the health plan or issuer does not have a negotiated rate with such provider, such plan or issuer shall reimburse the provider in an amount that equals the cash price for such service as listed by the provider on a public internet website, or such plan or issuer may negotiate a rate with such provider for less than such cash price.
  
  AFCs posted prices were set forth below and have not changed from the date of posting. The codes are those provided by the American ******************* for use for describing the services rendered under the Care Act. Therefore,if there is a question look to the service description in the posted prices , see that it is for a ***** testing and then pay for the service.
  
  Posted on *****************************
  
  CARES ACT POSTED PRICESFOR ***** SERVICES
  
  SERVICE RENDERED BILLING CODE FOR SERVICE CASH PRICE OF SERVICE
  CODE ***** $383 SINCE
  January 2, 2019
  Established Patient, Doctor visit Code CODE ***** $385 SINCE
  January 2, 2019
  Services at URGENT CARE Center POS 20 CODE S9088 $364 SINCE
  January 2, 2019
  Procedure of Collection of Covid Nose swab CODE G2023 $90 SINCE
  May 20, 2020
  Covid Protective equipment PPE, CODE ***** $85 SINCE May 20, 2020
  
  
  II.REDUCTIONS FOR CO-PAYS OR DEDUCTIBLES ASSESSED TO THE INSURED IS A SEPARATE VIOLATION OF THE CARES ACT SECTION 3202
  
  Under the CARES Act Sec 3203, there is no cost sharing permitted for ***** testing between the insured and the insurer. This means that the insured cannot be assessed a co-pay or deductible for the ***** Testing. There has been instances where the payment to Saloojas contains ldeductions for the insureds co-pays and deductibles for the ***** Testing. The CARES ACT specifically makes it illegal to reduce the payments for services rendered to ***** Testing for any co-pays on deductibles assessed to the insured. The insurer is required by law to to pay the full amount without any adjustment for ***** Testing services.
  
  
  SEC.3203. RAPID COVERAGE OF PREVENTIVE SERVICES AND VACCINES FOR CORONAVIRUS.
  
  (a) IN GENERAL.Notwithstanding 2713(b) of the ********************* Act (42 U.S.C. 300gg13), the Secretary of Health and *************** the Secretary of Labor, and the Secretary of the Treasury shall require group health plans and health insurance issuers offering group or individual health insurance to cover (without cost-sharing) any qualifying coronavirus preventive service, pursuant to section 2713(a) of the ********************* Act (42 U.S.C. 300gg13(a)) (including the regulations under sections ************ of title 29, Code of Federal Regulations, section *********** of title 26, Code of Federal Regulations, and section ******* of title 45, Code of Federal Regulations (or any successor regulations)). The requirement described in this subsection shall take effect with respect to a qualifying coronavirus preventive service on the specified date described in subsection (b)(2).
  
  CONCLUSION
  
  The patients/insured should not be facing a small claims collection for non payment of the Covid bills. The primary coverage and thus responsibility to pay lies with the insurance companies. When the insurance companies improperly refuse to pay, there is both a breach of contract and violation of the CARES ACT for which the insurance companies are liable to the patient/insured.
  
  Ultimately the patients should not owe anything for their bill. If they sue the insurance companies for payment of the bill which they should have paid, the court should find in the patent's favor and if asked the court should also award punitive damages against the insurance companies for not paying the bills and instead forcing the patents to do so when they were not primarily liable to pay the bills
  
  While AFC is suing to collect for its rendered services from the patients,the patients should also sue their insurance companies in small claims court not only got the bills but also ask for punitive damages for the obvious violation of the law. Such lawsuits are only just so as to punish the insurance companies for failing to honor their commitments and follow the law and pay the just claims of their insured.
  
  
  If desired AFC would even help and assist in drafting templates for such complaints.
  
  Respectfully

  
  **********************************
  General Counsel
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  

  
  

• Initial Complaint

  08/19/2024

  Complaint Type:

  Service or Repair Issues

  Status:

  Unanswered

  More info

  *************** keep on sending me a bill of $3,687 charging for Covid test that was done last ********* and they are threatening me to small claims court. I went to AFC 2x for the Covid-19 test way back ********* because I was required by my work to show proof that I had Covid-19. I called my medical Insurance and I was told that they paid the charges and I owe nothing. AFC told me before they did my Covid-19 test that it will be covered by my medical Insurance. I tried to call AFC several times but no answer. My medical insurance member representative also called but nobody answered, so they wrote a letter to AFC that they were already paid and I don't owe anything but AFC still sending me the bill and threatening me.

• Initial Complaint

  04/30/2024

  Complaint Type:

  Sales and Advertising Issues

  Status:

  Unanswered

  More info

  I am being billed for 2 COVID tests (1 for myself and 1 for my husband) during the pandemic. I am also being billed for 3 COVID vaccines (2 for my child, and 1 for myself) The business had a sign outside that said "FREE COVID TESTS AND VACCINES". I made the appointments at www.myturnca.gov and was given the appointments at this Clinic, AFC *********** Newark. The business has billed my insurance, and they are saying I am responsible for the remaining bill. They are saying we owe over $3,000 for these tests and vaccines even though our insurance has already paid their share. They had sent me a statement that said I had a "zero balance", but now they are billing me once again. On the insurance statement, it shows that AFC has charged for seeing a ******* ********** and a charge for "holiday or weekend" visit. There are charges on there that we don't understand what they are for, since we did not see a doctor. There are also several complaints on ****** and Yelp about how this has happened to many people and they are in the same situation as we are. I am pregnant and have been stressing a lot over this problem. Please help to get this resolved.

• Initial Complaint

  04/11/2024

  Complaint Type:

  Billing Issues

  Status:

  Unanswered

  More info

  Original COVID testing took place in Dec. 2020, business accepted insurance for what should have been free testing mandated by WHO, and local Health and ***** services office. Dr. ******** eventually filed a lawsuit seeking reimbursement for highly inflated COVID testing services. District court Judges dismissed 4 separate cases filed against differing insurance companies. AFC ****** care is now seeking payment from hundreds, maybe even thousands of patients who were all provided services at this clinic. The amounts requested vary based on number of visits, and insurance provider agreed upon rates at the time of service. But essentially the clinic was charging upwards of $1000 per test at a time when most testing labs and clinics were performing the same test at $150. Lawyers and Judges in the case all agree the clinic is gouging patients, not to mention the fraudulent practice of billing 4 yrs later. This clinic needs to be reprimanded and charges to all patients liquidated and removed from crediting agency reports.

• Initial Complaint

  04/04/2024

  Complaint Type:

  Service or Repair Issues

  Status:

  Unanswered

  More info

  (Account #***** and Account #******** December 9, 2020, my family of five received covid tests in the parking lot of this urgent care center. The center took our insurance (Cigna) and our insurance company then issued a payment for $140.89 for each test given. It is now 2024 and I am receiving two bills (for three tests) totaling $2,343.33. This urgent care center has already been paid and this is the most egregious and fraudulent billing scam I've ever seen. The average covid test costs $150. There was no medical service provided, there was no real urgent care appointment - there was a ***** second interaction with a man in a tent where the sample was taken to get covid test results. The company is claiming they will take us to court over this, but this is abuse of consumers and price gouging during a pandemic crisis.

• Initial Complaint

  04/02/2024

  Complaint Type:

  Service or Repair Issues

  Status:

  Unanswered

  More info

  We are being predatorily targeted by this companies billing departed for fraudulent charges. Three and a half years ago we obtained ********** services covered by employers insurance at this faciility. Now were are being sent bills for nearly $2000 stating our insurance never paid them. After speaking with a Cigna representative I was told these charges are not appropriate and beyond the statute for filing.

• Initial Complaint

  11/02/2022

  Complaint Type:

  Service or Repair Issues

  Status:

  Unanswered

  More info

  I visited *** *********** on Jun 10th, 2022, as I had a light fever and sore throat. I went into the *************** on *********************** ****** main office and filled out my information. This was my first time going to this urgent care. I was told to wait for my name to be called. Then, a nurse came out and ask me to talk to the team outside, becuase they worried my syptoms could be related to COVID. I followed their instruction and talked to a dr ******** of the building. I was prescribed an antibiotic for tonsil infection. A few days ago, I finally got the billing from ***. They billed me as a Out-of-Network rate. I checked with my insurance that *** is an In-the-Network provider, and that's the reason why I visited that office. The *** billing person told me that I saw the doctor that was not In-the-Network. I found this to be unacceptable. As a patient, I am responsible to make sure that I visited a provider that is in-the-network, so I know my co-pay of $45 will be my cost, given that I didn't do any other exams that costs extra. However, there is no way that I know a doctor that seeing me is or not in-the-network. My insurance company told me that since I was visisting an urgent care, *** should bill me under *** ****** care In-the-Network code. That way, only co-pay of $45 is associated with it. Now, they are charging me $176, which is almost 400% of the cost that I should pay. I think this is not a right way of doing business.I really appreciate that you take time to review my claim. If you have any question, feel free to contact me via email or phone. Please leave me a voice mail in case I am in the meeting or on another line.Thanks,***********

*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. ↩