ComplaintsforMalibu Wellness

• Initial Complaint

  01/06/2022

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  Malibu Wellness (chiropractic) treated me 7/16/21-7/23/21, three visits for a dislocated rib. My ****** co-pay is $15 in San Diego, but I was teaching in Malibu. I was in pain and it was an emergency, and the receptionist (Kat) assured me a dozen times they would submit claims and they know "all the codes" and will resubmit claims until my insurance pays. This was all a lie. They charged me IN FULL, cash out of pocket. They promised reimbursement as soon as insurance paid. Their billing lady failed to submit a claim to the correct insurance (she filed with ******, and not with their chiropractic provider, ****************** Health Plans. She never called to confirm anything, and never followed up with me or insurance (violating the receptionist's promises). I was out the cash payments. So I called ****** and discovered the claim was only denied because it was the wrong party. I called and appealed to ****************** Health. This required a dozen calls and many hours from July through December 2021. Malibu Wellness did nothing. Then ******/****************** Health granted a one time courtesy reimbursement for this "out of network" provider (since a ****** supervisor had told me they were "in network"). BUT ****** paid Malibu Wellness $****. Malibu Wellness billed me in full as a cash payment for $850. They kept an over-payment of $****. (Again, Malibu Wellness charge me *in full* and I paid *in full*: a total of $850. Not a dime more.) After I made the calls and received a courtesy reimbursement, Malibu Wellness refunded my $850. But they are keeping the over-payment of $****. Their services were not worth $850 in the first place (one adjustment per visit for $350?!) Malibu Wellness is keeping the over-payment, and emailed me today (1/6/22) that the case is closed. This is completely unethical, illegal, and unwarranted for lame, ineffective service that would have been $45 in my San Diego network (but an outrageous $850 at their scam shop).

  Business response

  02/09/2022

  Business Response /* (1000, 5, 2022/01/20) */ Response to complaint: Ms. *** (as per paperwork states) walked into our office in tears, the doctor treated her, and she said "I feel 150% better already". She even asked for business cards so she could give them to her Yoga students. She paid a New Patient Office Visit fee. She returned the next day and reported that she was "very happy with (her) fast progress". She paid for her office visit as well as a massage. She returned a week later and stated that she has improved significantly - she paid for her office visit and massage. She also said she would be getting new insurance shortly, and would send over the new card. On 7/31/21 she wrote a detailed letter explaining she was unhappy with the front desk - said she couldn't even enjoy her last massage, so we REFUNDED the ENTIRE visit here. The front desk person did not lie, as she has stated, we do bill all codes (therapies, adjustments, modalities, massage) correctly that are done here. We can only file an insurance claim to the INSURANCE (card) the patient provides to us. We are not advised if ****** uses an independent evaluation company - ASH - to process their bills until we get a notice from said insurance, that they were forwarding our claims to ASH. This did not happen in this case. When we bill insurance, we must bill EACH CPT code (and document it) that was actually DONE on the patient. These codes were billed, correctly, from day 1. Every code was billed correctly; as it was serviced to the patient. The insurance company, ******, denied the claim because we are an "out of network" doctor and ****** is an HMO (not sure if they have in-network Chiropractors in this area). When Ms. *** called ******, they incorrectly told her we were "in network". This happens frequently with other insurances as well (Anthem, Aetna); and I have to tell the patient that what they have been told is incorrect. It is their decision to seek treatment with us; or find a doctor that IS in network. Ms. *** began to text and email. I explained to her (as it is our policy) that everyone pays up front a CASH price (as if I did not have to bill insurance) and of course I would bill her insurance for her, but there is NO GUARANTEE they will pay. If they do pay, I would certainly reimburse her any payment she made here. Her insurance was billed promptly; as a courtesy. We pay a fee for billing (and re-billing of course). This was explained to her at the time of her visit(s); hence her payment. On 10/27/21 we rebilled all charges to ASH (******************* Health) as per the patient's request. On 11/23/21 ****** requested we send all doctors notes and bills for this account. The patient had sent an APPEAL to get these charges paid. On 12/17/21 The patient sent an email stating that ****** would be paying the bill in full, can I please send her the remainder of the money she paid here. On 12/17/21 I refunded the patient the balance so she was REFUNDED IN FULL. I believed her when she said ****** was sending the money for this case, even though we did not receive it yet. Ms. *** said she was happy to get this finally resolved in 2021!! On 1/5/22 Ms. *** wrote an email: "Please update and resolve this ongoing, exhausting plight., I do not want to pursue further action" On 1/6/22 I sent a detailed email explaining (again) what our policy is here; she was reimbursed ALL monies she paid; and ****** paid the bill. We are a full-service facility. We treat each patient the same. We lose patients everyday on the phone because we tell them that we are an OUT OF NETWORK doctor. Many people think they have great insurance, but unfortunately, it is not true. This is why we always collect first and then do the billing for the patient, as a courtesy. If their insurance pays for a service they paid for here, we gladly reimburse them. We have thousands of very happy patients. We do everything we possibly can to make sure everyone leaves happy and healthy. We did everything this patient asked, including refunding ALL monies she paid here (even before her insurance company reimbursed us). She made an appeal to the insurance company and they did exactly what she requested: Paid our bill so she could get reimbursed for what she paid here. We were glad we helped her in her time of need and wish her the best; even though she has posted lies about our company on Yelp. She has also informed us that she has contacted every agency to file a complaint. We have done nothing wrong; and we have spent a lot of time and energy trying to make her happy. We REFUNDED ALL of her monies paid here, but she is stating that we didn't. Please advise if any documentation is needed: receipts of reimbursement(are attached), patient ledger, doctor's notes, text messages and/or various email chains. Thank you for taking the time to read this. Our doctor has been in practice for 35 years and we have never had a complaint filed. Appreciate your help. I have attached two receipts (you can clearly see the date they were refunded), Please advise if anything is needed from our office to clear this matter. I can also send emails/texts messages. Thank you for your time. Best, ************* Office Manager, Malibu Wellness Business Response /* (-10, 6, 2022/01/20) */ Business supplied email: *************************************** Use this address for any contact with the Better Business Bureau

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