ComplaintsforProHealth Physicians, Inc

• Initial Complaint

  05/09/2024

  Complaint Type:

  Billing Issues

  Status:

  Resolved

  More info

  Many issues of unethical billing practices. The final straw was billing our insurance for services not provided, after much discussion with the practice, these charges were dropped. However, at that point we had decided to change doctors. We are now being being invoiced for charges that were not ever disclosed to us involving the transfer of paperwork to the new doctors office.

  Business response

  05/10/2024

  Patient experience has also spoken with this family and apologized for the inconvenience. We use a third party vendor for medical request release and there is a charge for this service. This complaint was documented and shared with the office for improved communication regarding this item in the future.

   

  Business response

  05/10/2024

  As an additional follow up, a refund request has been put forth for this charge.

  Thank you

  Customer response

  05/10/2024

  
  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

  03/28/2024

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  My husband and I were scheduled with ***** ****. We went in for our routine annual check up and had annual blood work done on 1/23/24. We were assured that as it's preventive blood work, it would be fully covered and we would not have to pay for it. However, the doctor's office sent the blood to ***** and now we're receiving bills from *****. I'm also being told by my insurance company that ***** **** coded the labs wrong and did not mark them as preventive. This has been so much stress trying to figure out why we've received these bills and how to rectify them. We have never had this issue in the past with annual blood work. After switching to this doctor's office, it seems to be nothing but issues. We received a bill for my husband's x-ray as well which was also apparently coded wrong. ***** **** made a bunch of errors on her end, it seems, and now we're expected to pay for it for some reason.

  Business response

  04/29/2024

  Good Afternoon,

   

  The patient experience has tried calling this patient 3 times. We have not heard back but this number is in ********** and we do not have a provider by this name. There is a provider with that name also in ********** so it appears this could be in error.

   

  Thank you

   

   

   

  Matt L*****
  Director, Patient Experience | ProHealth Physicians, part of *****

• Initial Complaint

  03/13/2024

  Complaint Type:

  Service or Repair Issues

  Status:

  Resolved

  More info

  My son takes an important medication for his ****. If he doesn't take it daily he suffers. His medication was accidentally thrown away with approx 60 days of the 90 day bottle still to be taken. I immediately reached out to Pro Health Pediatrics in ********** to get a new refill. My insurance requires the office to fill out a prior authorization in order to get an early refill. It has now been almost 1 month and the office has not successfully filled out the one document needed to get my son a new refill. I call every few days and get different answers from different people. Yet not one person in the office can fill out the form and send it to the insurance company successfully. The insurance said the would approve the refill within two hours once they have a prior authorization that specifically states why an early refill is needed (bottle thrown away accidentally). My son is suffering every day he is not on his medication. He is in trouble in school almost every day. To the point I will likely have to remove him from school this week until he is back on his medication. This is sad and embarrassing for a pediatricians office to be so inept. If it was easy to find a new provider I would be gone already! Do better please. No one should have to go almost a month without their daily medication.

  Business response

  04/22/2024

  Good Afternoon,

  In response to this patient concern that had previously been closed, patient experience was actively working through this concern. Patient has since received the ok for an early refill for the medication and was satisfied.

   

  Thank you

   

   

  Matt L*****
  Director, Patient Experience | ProHealth Physicians, part of *****

  Customer response

  04/23/2024

  
  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

  02/20/2024

  Complaint Type:

  Billing Issues

  Status:

  Unanswered

  More info

  My old cpap was malfunctioning. The West Hartford location where I had my sleep study in 2015 closed. On 6/28/23 I went to the Farmington sleep clinic. The Dr. was surprised the machine worked at all. To avoid a new sleepy study, she made a few adjustments and sent me home to try it for 30 days in hopes I would fulfill compliance for insurance to replace it. 8/4/23 I brought the machine back in and paid my $75 copay from the previous visit. The Dr. confirmed it was still broken. (This was not a consultation but a 5 minute conversation). She said she would exaggerate how broken it was to my insurance company so they would replace it and ordered me a new machine that would arrive in 3 weeks. It never arrived. On 8/31/23 I received a denial letter from my insurance. I left a message for the sleep clinic (no direct phone number). Receptionist called back and said they were being shut down and today is their last day. The Dr. wasn’t in so no one could help me! She suggested I request all my files online and find a new provider. I emailed a form to request my files and was told I would have to pay for every page. I agreed but they never responded. Then I was bombarded with bills saying I owed $75. Then came a letter and calls from Collections! Impossible to get a human on the phone so I complained through the Prohealth website. A customer service agent name Karen called me in November and agreed I shouldn’t have to pay and she would speak to billing on my behalf. I have followed up with her several times and there has been no resolve. It is now mid February. I find it infuriating and unprofessional how I was treated and I should NOT have to pay. Meanwhile I found an amazing new provider who followed the correct protocol by contacting the medical supply office and got me a new machine fast.

• Initial Complaint

  12/12/2023

  Complaint Type:

  Billing Issues

  Status:

  Unanswered

  More info

  Their billing office is fraudulent. A refund was owed to me and not returned for 30 days. They held money illegally of mine that was paid in error due to their billing error... They are now, after I've complained to them to get my money back, reporting fake amounts that I owe to collection agencies. Collection agency and pro health refuse to give me dates of service or itemized bills for the bills "in collections" the billing company ******* is horrible!

  Customer response

  12/12/2023

  I've noticed online other parents posting the same issues about prohealth and changing their doctor because of these issues 

• Initial Complaint

  08/01/2023

  Complaint Type:

  Billing Issues

  Status:

  Unanswered

  More info

  ProHealth Physicians has sent an erroneous bill to a debt collector agency for a health office visit I had in September, 2022. This bill was incorrectly coded as a workers compensation claim through the billing department in which my Cigna health insurance would decline the claim. I made several attempts through phone calls and emails to rectify the coding issue so that Cigna would approve the bill. On 4 occasions I was assured the coding issue would be resolved, but still no resolution. Due to their incompetence, they are also ruining my credit score by sending this bill to a debt collector. All that ProHealth has to do is correct the coding and Cigna will approve the claim, I am unable to get anyone to fix this issue and reaching to BBB as a last ditch effort for resolution. Please let me know if you need further information to assist.

• Initial Complaint

  01/18/2023

  Complaint Type:

  Customer Service Issues

  Status:

  Answered

  More info

  Re: ProHealth Physicians at *** ********** ******* *********** ** Doctor: Monika F***** and front desk office staff My mother has been visiting this office for quiet some time, ever, ever, and ever time she has a appointment, the front desk staff are extremely rude and condescending, a few examples are there tone of voice when speaking with me, it's nasty and unpleaseant, its every single front desk staff member, put on hold for an extermely long time, minimum of 15 minutes. Just recently, I called to find out why it was taking two days for the doctor to response to *** pharmarcy request for refill of my mother prescriptions, I was told by the staff member that I needed to be patience , unacceptable! I asked to speak with the doctor, and was told that a nurse would give me a call back, I did not ask to speak with a nurse, I ask to speak with her doctor, I did not receive a call, I guess speaking with my mom's doctor is out of the question, because I did not hear from her. And Monika F*****, I took my mother to see her for a follow up appointment, I asked Dr. F***** for sometime to review my mother medications to make sure that the meds where still needed and to assure it was safe, here exact words were "I DON'T HAVE TIME TO GO OVER EACH OF YOUR MOM'S MEDICATIONS", I was shock! This is a doctor who is in charge of my mom's health and she does not have time for her. I would appreciate it if you would address this behavior , it unprofessional.

  Business response

  04/22/2024

  Good Afternoon,

   

  Complaint # ********

   

  The Patient Experience department spoke with Olivia. It was explained and apologized that her complaint did not reach us untill now. She understood and was appreciative of the call and follow up.

   

  Her complaint was about disrespectful and rude front desk staff in the PHP ********** practice. She also didn’t feel that PA Monika F***** was attentive.

   

  Her mom left the practice and ProHealth because of this experience. We would have investigated, offered retraining and addressed at the time of the concern if we would have been made aware of it.

   

   

   

  Thank you,

   

   

   

  Matt L*****
  Director, Patient Experience | ProHealth Physicians, part of *****

• Initial Complaint

  01/12/2023

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  Prohealth in *** ************ *** ******* ** ***** charged me for office visit during an annual physical exam ( 12/13/22). When brought it up with office manager (Susan), she said there was a discussion about your specific health issue. I told her that doctor had asked me how am I doing with those ongoing health issue. Those issue were not brought it up and/or wanted to have doctor look at it. The doctor enquired about the issues as part of checking history which is covered in annual physical exam, and I should not be charged for it. This is complaint is that Prohealth charged for health issues discussion that doctors brought up to check on how am I doing during annual physcial. Prohealth has charged $210 to insurance company resutling $85 for me as out of pocket expense.

  Business response

  04/17/2024

  Good Afternoon,

  Here is the first response to one of the BBB complaints that you forwarded along. Patient Experience conducted outreach to this patient today in response to BBB complaint that we hadn’t previously received. Here was the finding (response is kept vague to protect patient privacy):

   

   

  Patient disputed a 2^nd service charge that stemmed from a visit on 12/13/2022 which was a complete physical exam appointment. There is documentation that patient spoke with the office manager regarding this issue. A coding review supported the charge, and patient did sign the waiver. The patient had complained of new pain. The condition was assessed and patient was referred to a specialist.

   

  The patient appreciated the call and accepted that his BBB complaint went unnoticed by our team; however, he still feels that the 2^nd service charge is unfair.

   

   

   

  Matt L*****
  Director, Patient Experience | ProHealth Physicians, part of Optum

• Initial Complaint

  12/02/2022

  Complaint Type:

  Customer Service Issues

  Status:

  Answered

  More info

  Been trying to get my kids' medical records transferred. On 11/7/22 we went to our new doctor's office, ********** ********** ** ********. We filled out a records transfer request and they faxed it to Pro Health/********* **********. They never received anything so we followed up with Pro Health and were told they never received anything. On 11/28, my wife ****** spoke to Karen J**** at patient experience who said it was all taken care of. We followed up again with our new pediatrician who said they never received anything. They even refaxed the request. Karen also said my wife would hear back from a manager twice and never did. I left a message again today. We need the records sent so my kids can get their appropriate shots and care. This is holding up their appointments unnecessarily. We also received mail on 12/1 with forms for us to fill out to release records to us directly from pro health which we never asked for. Please help resolve this.

  Business response

  04/22/2024

  Hello,

  The patients father had faxed a release of medical records request to ********* ********** on 11/7/22 because his daughter was transferring outside of ProHealth. On 11/28/22, the records had not been received so the patients father called. The faxed release form was never received. The request to expedite the request was completed and on 12/9/22, the records were mailed to the new practice. The guideline is a 30 day turnaround and the BBB complaint was filed on 12/2/2022. The records were sent short of the 30 day threshold.

  Thank you

  Matt L*****
  Director, Patient Experience | ProHealth Physicians, part of *****

  Customer response

  04/22/2024

  
  Complaint: ********
  
  I am rejecting this response because: your timeline is inaccurate and you are responding over a year after the complaint was filed. 
  
  Sincerely,
  
  ******* ******

• Initial Complaint

  11/01/2022

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  8/16 Account (#*******) sent to collections only 19 days after most recent bill for balance of account, showing account in good standing with no past due balance. Date and action was preceded by 2 on-time monthly payments, and I was out of the country from 8/1-8/30, unable to retrieve physical mail, which included a single "Final Warning" letter dated 8/16, only 5 days after most recent bill/statement showing account current, in good standing, and WITH NO PAST DUE BALANCE. Contacted: 8/31, spoke w/ "Edward I", Billing supervisor, promised resolution within 14 days No Reply Contacted: via email Sent: Thursday, September 15, 2022 2:41 PM To: ********************************** <**********************************> Subject: **** **** Formal Complaint documentation No Reply Contacted: by phone 9/16 spoke with "Edward I #2", Assistant supervisor, promised resolution in 48 hrs No Reply Contacted: by phone 9/29 spoke with "Edwardo I #2", Assistant supervisor, offered disputed (with documentation) resolution that "account was 90 days past due" despite their own bills to the contrary. Promised further resolution with "Edwardo I. #1" within 48 Hours. No Reply Contacted : by phone 10/16? would not be put through to previous billing supervisors, and was promised call-back from new billing supervisor "Don", within 48 hours. No Reply Contacted: by phone 11/1, told that since the bill had been paid, they could no longer share information on it, and referred me to the previously contacted email address, regardless of whether or not it was being responded to.

  Business response

  05/02/2024

  Good Afternoon,

   

  • DOS 12/3/21 claim was filed to **** and per the EOB insurance assigned $320 to the patient responsibility.
  • Between March -August 2022 patient mailed in two partial payments. Records show that four statements were mailed and after 120 days the remaining balance of $164.00 was referred to collections on 8/30/2022.
  • Account was retracted from collections on 11/2/2022 after full payment was received.
  • Follow up emails were sent to pt to confirm status of account.
  • The patient can attempt to appeal the denial with the insurance carrier, but we will be unable to authorize a refund.

   

   

  Matt L*****
  Director, Patient Experience | ProHealth Physicians, **** ** *****

  Customer response

  05/02/2024

  
  Complaint: ********
  
  I am rejecting this response because:

  every statement you sent me showed the account in good standing with no balance 30 days, 60 days or 90 days past due. I made two monthly payments and was scheduled to make two more for full payment. you sent it to collections before I even had the opportunity to make the third payment and every statement you sent showed the account in good standing never showed any past due amount at all. 
  
  Sincerely,
  
  **** ****

  Customer response

  05/20/2024

  
  Complaint: ********
  
  I am rejecting this response because:

  information provided does not address the complaint at all. The four statements that were sent during the 120 days before you sent it to collections all show the account in good standing with no payments overdue at 30 days, 60 days, 90 days or 120 days. That is the basis of complaint and you will not find a way around it because you don’t have the truth on your side. and there is a paper trail to prove my complaint. And you have it. And I have it. And it was attached to the original complaint.

  An acknowledgment of your mishandling of this billing situation, and an apology for sending an account that was indicated in good standing to collections with no warning is all I’m asking for.

  
  
  Sincerely,
  
  **** ****

  Business response

  05/28/2024

  Upon reviewing this matter with our billing department, the following detailed response from billing was created. Patient experience also spoke with the patient and if further questions arise, can assist further as well.

   

  Dear Mr. ****,
  
  I am writing in response to the consumer complaint correspondence submitted to our offices on behalf of Mr. **** ****.  The letter we received references Mr. ****’s allegations that on August 16, 2022 his account balance was referred to collections “only 19 days after most recent bill for balance of account, showing account in good standing with no past due balance.” 
  
  We have investigated this matter and records show the following. The first invoice date for the open balance of $302.00 for date of service 12/3/2021 was mailed on April 17, 2022, subsequently four (4) additional consecutive monthly statements (May, June, July and August 2022) were mailed to Mr. ****’s attention.  Each invoice statement included the notification advising Mr. **** that the open balance was DUE DATE:  UPON RECEIPT.
  
  Payment records show that two check payments were received.  The first check amount of $52.00 was received and posted on June 6, 2022 and the second check amount of $50.00 was received and posted on July 14, 2022 leaving an open balance of $200.00.
  
  As referenced by Mr. **** in his complaint description, records confirm that a pre-collections letter was also mailed to his attention on August 16, 2022 advising him of the past due balance of $200.00 with his provider from ProHealth Physicians.  If payment is not received, all or part of your self-pay balance may be turned over to a collection  agency that reports to the credit bureaus.
  
  No additional payments were made to resolve the open outstanding balance for the date of service in question after the July 14, 2022 payment and on August 30, 2022 the invoice balance was turned over to a collection agency.  

*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. ↩