ComplaintsforMetropolis Dermatology

• Initial Complaint

  06/06/2022

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  I went to Metropolis Dermatology in Los Angeles for visits on the following dates: January 29, 2022, February 26, 2022, April 2, 2022, and May 7, 2022. Their representatives only submitted a claim to Empire BCBS for my April 2nd visit. I have been asking their representatives (including their manager, **************) about the claims since February. Metropolis representatives took out-of-pocket payments from me for each of those visits (for the full cost of the procedures, and on two occasions, an extra $40 as well). From January through May, their representatives repeatedly stated they were unaware of how much they would receive from Empire BCBS. They purposely did not submit a claim until May. The exact same procedure was done during each visit. I repeatedly contacted Empire BCBS about this issue; the majority of the representatives suggest nonsensical solutions (e.g. "If I were you, I would get a new dermatologist.") rather than take immediate action. According to an Empire BCBS representative, ************** lied to the representative, stating that she was unaware that I had paid out of pocket during the visits. As I am responsible for only $40 for each visit (according to Empire BCBS), I must receive a refund from Metropolis Dermatology for the out-of-pocket portion I was not supposed to pay. Please assist. Thank you.

  Business response

  10/10/2022

  Consumer Response /* (2000, 9, 2022/06/23) */ Resolved Consumer Response /* (3000, 15, 2022/09/16) */ From: ************ <*****************> Sent: Thursday, September 15, 2022 11:48 AM To: **************** Subject: Case #******* Unresolved Hello. My case is unresolved. The business did not submit all the health insurance claims. I see my complaint listed on: *********************************************************************************************************** Thank you. ************ Consumer Response /* (3000, 15, 2022/09/16) */ From: *********************************************************************************************************************************** Hello. My case is unresolved. The business did not submit all the health insurance claims. I see my complaint listed on: ************************************************************************************************************ Thank you. ************ Business Response /* (1000, 24, 2022/10/10) */ Good morning, In response to this case, this situation has effectively been closed since June. We did submit all claims to insurance, but with no expectation that they would reply, due to the timeframe that had passed. Additionally, the patient was also refunded the out of pocket expenses she was owed in June. If there will be anything further, please do not hesitate to let me know. Thanks, -- ************************************************************************************************************************************************************************************************************* Consumer Response /* (3000, 26, 2022/10/17) */ (The consumer indicated he/she DID NOT accept the response from the business.) Some of the health insurance claims were submitted too late according to Empire Blue Cross Blue Shield. Therefore, I am not financially responsible for those visits. I must receive a refund. One of the four claims, the one for the January visit, still has not been submitted. Business Response /* (4000, 28, 2022/10/18) */ Please have the claimant confirm which dates of service she believes she is owed a refund for and the amount(s) paid. Consumer Response /* (4200, 30, 2022/10/18) */ (The consumer indicated he/she DID NOT accept the response from the business.) Empire Blue Cross Blue Shield states that I am not responsible for the claims for the visits on 02/26/22, 04/02/22 and 05/07/22. The claim for my visit on 01/29/22 still has not been submitted. Business Response /* (4000, 32, 2022/10/27) */ Blue Cross allows a 90-day window to bill for services, so we cannot submit insurance claims for any services. The patient originally paid out of pocket for the January visit, which we refunded in June. We are not seeking compensation from the patient nor her insurance at this point, so I am yet unclear why this case remains open or was at all needed. I would much rather speak to her directly, to resolve the matter in whichever way is appropriate, but whether or not that is possible, is up to the patient.

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