ComplaintsforTemecula Valley Emergency Physicians Inc
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Complaint Details
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Initial Complaint
06/10/2022
- Complaint Type:
- Billing Issues
- Status:
- Unanswered
On September 12, 2020 I woke up in the early hours of the morning to severe abdominal pain and went to the Temecula Valley Emergency Room for services. They diagnosed me with passing a kidney stone. I paid my co-pay of $100 dollars which is my responsibility. A few months later I received a bill from the Temecula Billing Department stating that I owe them $******** because my medical insurance Anthem Blue Cross PPO is refusing to pay any of it. I immediately filed my first appeal and it was denied. I filed a second appeal and that also was denied. Anthem Blue Cross has come up with multiple excuses to why they are refusing to pay the bill. Their first excuse was that the doctor I saw that day in the ER was "out-of-network" and the second excuse was that Temecula ER filed the bill using the wrong procedure code (refer to Case number ***************) however the emergency room physician that treated me determined I needed Level 5 complex care. Anthem does not agree with this and is refusing to pay ANY part of this bill. By refusing to pay this medical bill (Account #********) they are in violation of their own Evidence of Coverage page 136 (City of Long Beach, 2020) where it states that Anthem should get another doctor with appropriate training to review the medical records. According to Temecula ER, Anthem is in violation of federal law, California law and their own provider manual. Also according to the California Department of Managed Health Care, my health plan MUST cover emergency care, I filed a complaint with the DMHC on September 24, 2021 however they could not help me with this matter because "I have a self-funded health plan and these plans are out of their jurisdiction". I also contacted the Health Consumer Alliance of Los Angeles County and they advised me to do several things including filing a complaint with the BBB. Temecula Billing Department is holding me responsible for this unpaid bill and is threatening to send my bill to Collections.
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Customer Complaints Summary
1 total complaints in the last 3 years.
0 complaints closed in the last 12 months.