ComplaintsforDr. Terry L. Kaiura, MD

• Initial Complaint

  11/28/2022

  Complaint Type:

  Billing Issues

  Status:

  Resolved

  More info

  I paid for consultation for an eye issue. I specifically asked the front desk associate to NOT bill my insurance as I would pay with my HSA card (see photo of proof of payment at POS). I paid with HSA card for the consultation and the provider still billed my insurance for the same consultation that I already paid for. I have been on several calls with the dr’s office to have the claim reversed, the dr’s office assured me several times that the charge would be reversed and taken care of. They have failed to follow through with this even though I have had my insurance company reach out to them several times.

  Business response

  12/15/2022

  This letter is written in response to the above complaint to dictate what has occurred.
  

  As the patient has stated, he paid for his exam with his HSA card to avoid billing his insurance. Unfortunately, the claim was unintentionally submitted to his medical insurance plan. After his insurance company made the customary contractual financial adjustments to the claim, the remaining balance was applied to the patient’s deductible; therefore, we never received a payment. The process of refunding the insurance would have been much faster than reversing the claim.
  

  When we realized that we made the billing error, we apologized and began the process of reversing the claim, as requested by the patient. We understand that the patient felt we failed to get the claim reversed in a timely manner. We made several attempts to have the claim reversed as instructed by a representative from his insurance company. We initially called the insurance company to no avail. We then wrote a letter to have the claim reversed. We faxed the letter on 11/14/2022 to the number we were given, but unfortunately, the insurance company never received the letter. Although the patient claims he had his insurance call our office to correct the billing error, the insurance company did not contact us until today, 12/14/2022. Today, both the patient and his insurance company called our office for a conference call regarding the status of the claim in question. Today, I learned that we did not have to submit an appeal letter but could have called to verbally request the claim reversal.  Today, I verbally requested, to the patient’s insurance company, that they reverse the claim (ref. # 3983). I learned from the insurance agent that the patient also verbally requested the claim be reversed today. I was told that the reversal process can take up to 5-10 business days. I hope the claim will finally be reversed and we will be able to put this matter to rest.
  

  Unfortunately, when we call insurance companies, instructions on the process for correcting a billing error can vary from agent to agent. We sincerely apologize that our billing error caused the patient so much frustration.
  Please see the attached copy of the written request to reverse the insurance claim.
  Feel free to call me at the office, (805) 489-8286 for further clarification.
  
  Sincerely,
  *** H.
  Office Manager, Dr. T**** ****** 

  Customer response

  12/15/2022

  
  
  I have reviewed the response made by the business in reference to complaint ID 18472688, and find that this resolution is satisfactory to me even though *** has not conferred the truth to how many times I and my insurance reps reached out to their office to have this issue resolved. (Please see voicemail transcripts left by front office worker Devon in the attachments dated 10.28.22). I accept ***'s apology even though she was not present at the time of the occurrence. Also I would like to distinguish the fact that this issue has nothing to do with the service directly provided by Dr. Kaiura as her consultation was great and its unfortunate that the billing experience from her front office staff has made this experience into something less than desirable. With that being said, my experience is anecdotal and should be taken into consideration by any other consumer. 
  
  Regards,
  
  M***** *******
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  

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