ComplaintsforProHealth Physicians, Inc

• Initial Complaint

  10/03/2022

  Complaint Type:

  Customer Service Issues

  Status:

  Answered

  More info

  On numerous occasions, we have called the doctor’s office outside of normal business hours with health-related questions for my 6 year-old daughter and 8 month-old son. The call rings and we are never directed to the after hours service and are never able to reach the on-call service despite waiting on the phone for over 30 minutes. We have noted our concerns with our pediatrician’s office and our concerns have gone unanswered. Today I was told it was out of their control as it was up to corporate. We are being denied patient care access and have been forced to resort to ER visits due to this.

  Business response

  04/26/2024

  Good Morning,

   

  The patient experience department has left two voicemail messages for this complainant to call back regarding this complaint. We have not heard back yet. The children are still active patients with ProHealth. The organization is actively working on recruitment and hiring to alleviate similar situations to this stemming from staffing.

   

  Thank you

   

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

• Initial Complaint

  09/09/2022

  Complaint Type:

  Billing Issues

  Status:

  Unanswered

  More info

  I went to have a sleep study done on 2/6/21 at *** ********** ***, in *********** *** With provider Dr. James O******. I confirm with ****** insurance company before that said the procedure, provider and facility are all in network. Pro Health has been sending Bills to me starting April of 2022 and continues to bill me $543.26 for date of service 2/6/21. Pro Health is constantly sending claims to ****** with incorrect information so the claim will be out of network with me owing $543.26. I believe this term is called upcoding. With each call to pro health the correct information was given so Pro health can resubmit the claim with the correct in network information. However to no eval Pro Health continues to omit the provider name and use the wrong address-NPI number. -First bill of $775.98: begin of April 2022 from Pro Health. I called ****** spoke to Liz-confirm I am in network and Pro Heath did not put provider name so ****** assumed I went out of network. Liz will ask to resubmit. --April 21/2022 Got another bill. I called ****** same day and spoke to Julian. Julian said Pro Heath mail claim to a PO Box-use wrong ****** address and no provider name. Julian said will ask to resubmit. --Bill $543.26 Pro Health. On June 14, 2022 I spoke with Abby at ******. Abby –no provider name and assume its I went out of network. Abby said will call Pro Health inform correct information and to submit. I called Pro Health spoke with Monica–explained issue and gave her correct information to send bill again. –Pro Health ticket number *********. --June 16, 2022–Sandy from Pro Health called and her tone was aggressive, bully and attempt to intimidate with saying I do not know my health insurance benefits and need to call ******. Sandy said putting facility and provider name on claim does not matter. I owe them money. I immediately called ****** and spoke to Tommy whom said will request Pro Health to resubmit claim. --Got another bill $543.26. I called Pro Health 8/1,202

• Initial Complaint

  08/01/2022

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  Prohealth Physicians submitted my claim for an office visit to my primary care doctor as named on my insurance card and on file in their system INCORRECTLY as a specialist visit with a $30 copay. I do not have a copay ($0 - primary care visit) to see my primary care doctor (on 3/14/22) . I brought this error to their attention at my next visit. It was acknowledged but she did not want to take the time to correct it. I then called the billing office and explained. She told me they would review and correct the error, provided a case number (*********) and was told it would take 2 weeks. I explained to her that there had been errors before and that I'd be very upset if I was to continue to receive bills or threats when it's a clear acknowledged error that they seem to like to avoid and let it go to where the patient is burdened with the problem. I said promise me I won't see a bill again while you're fixing this. She promised and said I would NOT. Well, I got 3 more including a collections notice. Further, when I went to another ProHealth office for a consult, they demanded to collect the $30 from me as "they are all connected." I explained the situation and the employee was rude as usual. She handed me a print out and my doctor's name was spelled incorrectly. Then I had to take time to contact my insurance company. I filed a ckaim/billing error with them and they sent it to the claims department to be resubmitted as a PCP visit with no cooay, however, this takes up to a month. So I've not only done my part, I'm now doing their job and being treated badly. They have poor reviews about billing issues all over the internet. They do nothing to fix their problems and create them for patients to deal with. I saw my primary care doctor on this date and as stated on my insurance info on file, my copay is $0. I owe ZERO. They've failed to correct this error in a timely manner and now I have a collections notice. Fix the error, redo the claim properly, notify collections.

  Business response

  09/21/2022

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

   

  I received a notice of a complaint that was previously sent to Tracy dated 8/23/2022.

   

   

  This item was sent back to the insurance company for review and after additional investigation on the claim and co-pay that was originally charged, this amount was credited and the patient now has a $0 balance.

   

   

  Thank you,

  Matt

• Initial Complaint

  06/20/2022

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  I had gotten a physical at the end of March. At that time, I asked the doctor no questions about any other issues. In April, I get a bill from ProHealth stating that I owe $30 for the office visit. I called them and inquired why. I was told that it was because I have a pre-existing condition and that insurance does not cover physicals with pre-exisiting conditions. I said that I had the pre-existing condition for about 13 years and never have I ever in those 13 years been charged for a physical. They said that I had talked to the doctor about an issue. I said I hadn't. They then stated, well, you signed paperwork stating that you would pay for any out-of-pocket expenses. I told them, yes I did, but I also expected them to code this correctly, which they did not. I have talked to billing at ProHealth and most recently Patient Experience. Patient Experience told me that they would look into this and get this changed. I have left several messages for them since that time and have received only one phonecall back, despite being told I would hear back. I was also told that it would take 2 weeks for the review to take place. When I called billing again, they said, 'oh no, it's a month'. Now at the end of June, I am still waiting to hear from them.

  Business response

  04/17/2024

  Hello,

  The patient was disputing a second service charge that stemmed from a complete physical exam. The ongoing treatment of a diagnosis was re-evaluated, patient had signed second service form and the charge was deemed valid. Patient has since transferred out of ProHealth.

   

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

   

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

  Customer response

  04/17/2024

  ProHealth gives this form with other mandatory forms during a visit. They do not tell their patients that it is optional to sign it. So yes, I did sign in, but they force the patients to sign.

  I find it interesting that this was over 2 years ago and they are just getting around to answering now. This is unprofessional of them.

   

  You can close my case. I just needed to mention this piece of the puzzle. I still believe they are not a trustworthy organization to work with and their practices are unethical.
  

• Initial Complaint

  05/24/2022

  Complaint Type:

  Billing Issues

  Status:

  Unanswered

  More info

  ProHealth Physicians has engaged in what I consider unfair business practices. I have called numerous times to their Billing Department with unresolved issue of collections. 1. 8/31/21 I received notification from ProHealth that I owed 129.82 from a date of service of 3/1/21 for my son. This notice was received late as I had moved, and I had just received the notification (marked 8/17/21) from mail forwarding. I had received no other notifications otherwise. 2. I called the day I received the notification, and paid the $129.82 in full, and confirmed I owned no further money, and provided my updated address. 3. I received a notification dated 91/21 on 9/14/21 from a collection agency (who had my correct address) that the balance of $129.82 had gone to collections and that I owed it. 4. I called ProHealth Physicians on 9/14/21, where I lodged a complaint, and again provided my new address. I was assured the issue was resolved. 5. On 4/18/22 I received another notice from *** that I now owed $49.86 as apparently the insurance company had rebilled the service in December of 2021, a full three months after I had already "paid in full." 6. I called ProHealth on 4/18/22, 5/11/22, 5/17/22, and 5/23/22 without resolution. ProHealth claims it has no documentation of me requesting and address change, when I did multiple times, but because they don't have it, I can't do anything apparently. They are unwilling to retract the collections. They are also not willing to address the unfair billing practice of having paid a claim in full and 3 months later have it be rebilled, and due to the incorrect address, never notified of this, and had it sent to collections again (who again had my proper address). ProHealth's unwillingness to address to these issues is completely unacceptable.

• Initial Complaint

  04/22/2022

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  ProHealth Physicians Billing department is depositing check payments I have made but not applying them to my account. I have called and sent multiple letters but they are not responding with correct processing and the contact center keeps asking for the same info again and again but taking no action. I have detailed history of communications including images of checks they have deposited but not applied to my account.

  Business response

  05/02/2024

  Good Afternoon,

   

  The patient mailed the payment to the incorrect lockbox. Once payments were received, the balances were retracted from collections.

   

  Thanks,

   

   

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

• Initial Complaint

  11/01/2021

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  Payments in the amount of $8400 have been made to prohealth in error from my bank account. Several attempts have been made to contact prohealth to point out the error information has been supplied to confirm payments have been made from my account at **** ** ******* to prohealth account in error. Three additional points of contact have been made to prohealth with no resolve and in fact with error of information today a representative from my bank also verified the payments that have been made and once again I have had no resolve has been made. On the calls the Pro Health Rep advised that there is a credit of $1547 on my account but no mention of confirmation of the additional $8400 paid. Please investigate and contact me directly

  Business response

  11/16/2021

  Many members of the organization and billing team/vendor have been working to resolve the concern. Refund of the mis-allocated funds is in process. Customer has the number of the Patient Experience Department to contact if there are any additional delays or concerns.

  Customer response

  11/16/2021

  
  Complaint: ********
  
  I am rejecting this response because:  They have had weeks to resolve this and people who have called are not knowledgeable, although they claim to record calls, make notes etc  
  it is not noticeable.  I have asked for "senior" decision makers to contact me and weeks past before being forwarded to ***** *****.  Refunds have arrived in part still waiting on the full refunded amounts.

  
  Sincerely,
  
  *** ********

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