ComplaintsforThe Gift of Speech

• Initial Complaint

  10/06/2023

  Complaint Type:

  Service or Repair Issues

  Status:

  Resolved

  More info

  My son was recommended to this place by his pediatrician. We brought him here to help with his speech delay. The business is in network with our insurance so they accepted my son. He got evaluated and they asked for our insurance back in February. This company scheduled my son every Monday 4 times a month. I received a call gift of speech today 10/05/23 letting us know we owe them $270 because we exceeded 4 visits when it was already ***ed out. They never reached out to our insurance to verify how many visits per year he had. They blamed my wife and I for thier mistake saying we were supposed to call and find out ourselves. They should have mentioned this when my son was enrolled. I explained to them that they are the health care provider and should have called themselves to verify all information regarding *** visits. ***** the person I was on the phone with was reading the fine print when my son was enrolled. There was nothing about us calling insurance what so ever. I was told they will now let everyone know how many visits the insurance allows from now on. They are going to correct it because they are in the wrong. Why should I pay for their mistakes? I am seeking a resolution for them to take responsibility and wipe the balance. Next step would be small claims if I can't get a resolution here.

  Business response

  10/16/2023

  ************** **ntacted this office to discuss 4 sessions provided after the maximum sessions per year of 24. This therapist checked the website for his current medical insurance, Anthem. The website stated he currently had 24 visits available. The reason for denial stated on ************** son's explanation of benefits was maximum number of sessions per year exceeded. Since *********** in a calendar year was reached, ************** was refunded his ** insurance and the sessions were written off. This **mpany revised its policies and procedures/therapy policies. They now read: 

  All effort will be made to verify insurance **verages, service limits, and payments. All insurance is verified at time of evaluation and initial treatment session. It is patient responsibility to verify **verage, **-insurance, and ** pay information as well as to inform this clinic of insurance changes. Should a maximum be reached, payment for services falls on the patient responsibility. Co-pays are due at the time of service. 

  This **mpany will be appealing the denied claims with Anthem, as there is a primary diagnosis which suggests dispute is warranted and Anthem website states 24 visits available. With medical justification, Anthem will many times extend **verages. Should **verage be extended ************** will be called to offer **ntinued speech-language services.

  Respectfully,

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

*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. ↩