ComplaintsforOptum Medical Partners

• Initial Complaint

  09/13/2024

  Complaint Type:

  Service or Repair Issues

  Status:

  Unanswered

  More info

  My son needed vision therapy services, and a referral was put in by his doctor. After more than six months of attempts to get services approved, we appealed through Blue Shield of CA for the medical group, Optum, to approve out of network services since the providers Optum were sending him to did not have any openings to be seen for more than a year. Blue Shield of CA approved our appeal and we were notified that we could proceed with vision therapy services, with Optum auth # *******. The outpatient therapy group ********************************************************* does not bill directly to insurance, so we were notified we would have to pay out of pocket and then submit a claim for services to insurance directly. We began services and submitted our claims through Blue Shield of CA in June 2024, but were then advised we would need to submit all future claims directly through Optum as the medical group to a PO Box. I voiced concerns with this method as there is no way of tracking your claims submission however I was notified this is the only way to submit our claims for reimbursement through Optum. I have submitted our invoices for reimbursement multiple times, with the most recent being sent on 8/13/24 via certified mail. After weeks of pending payment with no notification of receiving our claims, I reached out for assistance through Blue Shield of CA as Optum medical group is impossible to get a hold of. They assisted and advised the medical group denied the claim even though *********** approved the appeal for an out of network provider, and also advised they mysteriously only received one invoice out of the eight that I sent in the same packet. They are stating I have to resend all documents, except still with no way of me tracking they are receiving it other than repeatedly sending things via certified mail. The medical group has made receiving reimbursement for services impossible, and is an egregious abuse of the insurance system and is fraudulent.

• Initial Complaint

  07/19/2024

  Complaint Type:

  Service or Repair Issues

  Status:

  Unanswered

  More info

  I have a pending surgery that was recently rescheduled because the pending authorization with Optum Care Network is taking an unreasonable time to be finalized. The usual turn around for pending authorizations is 14 days. When I called Optum regarding the status of the pending authorization, they replied that they are under staffed and that they could not give me a time frame when the authorization process would be completed. The surgery is now scheduled for August 16, 2024 and I am concerned that the authorization process will not be completed in a timely fashion.. The remedy I am seeking is for Optum to complete the authorization process prior to my scheduled surgery date. Optum does not seem to care about the detrimental health affects a delayed covered surgery can cause.

• Initial Complaint

  04/03/2024

  Complaint Type:

  Billing Issues

  Status:

  Unanswered

  More info

  I went into urgent care in little neck ******** with an appt I was treated horrifically I was screamed at by the receptionist Was made to wait over an hour with an appt and than told I had to pay a 25,00 dollar copay or to get out I told her I do not have any copay to submit my claim and if I did I would pay it I had already met my cost sharing so I had no copay to pay . My benefits where never verified thru my insurance instead I was refused care and thrown out

• Initial Complaint

  03/01/2023

  Complaint Type:

  Billing Issues

  Status:

  Resolved

  More info

  Received services on 6/14/22 and received a bill from Optum in July of 2022, and Anthem BC paid the claim. Received a duplicate bill in December and Anthem BC contacted Optum and Optum indicated it was an error and I could disregard. In January received the bill again, and again Anthem BC contacted Optum and was told that since it was paid I could disregard the bill as it was an error. February 21, 2022, I received the same bill with a letter indicating that Optum was going to turn me over to collections for non-payment. Anthem BC contacted Optum, with me on the phone, and they again acknoweldged it was an error. I was concerned about the collections and they said that they could not do anthing about the letter because it was automatic but they could forward me to a manager. They sent me to a mailbox that was full and I could not leave a message. The bill that Optum sends actually shows the line items where Anthem paid the claim. The account number they list on my bill is ******, but every time I call they say they cannot find that acct number even though it has been on every bill. They then look me up by name and DOB, and then say they can't find me in their system so they need to look in another system, and then they are able to find me. I sense the fact that the acct number on the bill they send is incorrect, and some how I am in a different system, they keep sending me a bill that is already paid. Optum is making no attempt to fix their error, they are threatening to send me to collections for something they acknoweldge was paid and that Anthem BC has offered to show them the reciepts for the checks cashed by Optum for the full amount. However, they continue to bill me for something that was paid and that they acknowledge was paid, but they show no interest in fixing the problem they just keeping saying to disregard the bills.

  Business response

  03/23/2023

  Please be advised that for services rendered on 06/14/2022 the account balance has been paid in full by ********************** insurance company and the correct adjustments have been made accordingly.

  I contacted the patient on 03/03/2023 and advised his account was corrected and he understood.

  Thank you,

   

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

  Customer response

  03/24/2023

   
  Better Business Bureau:
  
  I have reviewed the response made by the business in reference to complaint ID ********, and find that this resolution is satisfactory to me.
  
  Sincerely,
  
  *************************************

• Initial Complaint

  02/17/2022

  Complaint Type:

  Billing Issues

  Status:

  Unanswered

  More info

  On 10-28-2021 I visited a doctor who is part of the Optum Health Network. I paid the bill at the counter which they acknowledge, then as they often do, they sent me another bill for $36 which I paid on 12/01/2021 . Pics below, On 12/28/2021 Optum sent me another bill for $36 and I called to resolve the issue sent pics of the receipt and was assured the issue would be looked into. Recently I received a past due notice for the same bill I've paid twice. I would not hesitate to pay it again if this were not approximately the 10th time this has happened it's practically standard procedure at this point. All I seek at this time is for my good faith payments to be honored. Thank You

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