Complaints

The complaint text that is displayed might not represent all complaints filed with BBB. 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.

• Initial Complaint

  Date:05/01/2024

  Type:Customer Service Issues
  Status:

  AnsweredMore info

  Complaint statuses

  Resolved:

  The complainant verified the issue was resolved to their satisfaction.

  Unresolved:

  The business responded to the dispute but failed to make a good faith effort to resolve it.

  Answered:

  The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.

  Unanswered:

  The business failed to respond to the dispute.

  Unpursuable:

  BBB is unable to locate the business.

  Went to Dr E******* for about 20 years. He used to have his own practice until he joined Pro Health. Things changed. He didn’t have the time to listen to me. I had an accident at work. Someone by accident knocked me down. I called his office to ask for advice about what should I do for care. He never called but had his nurse call me back and the response was “if I can walk you should be fine”. Well turns out I had a fracture and took 3 months to heal. He was the most unhelpful for being my primary. Along with my type 2 diabetes he is not listening. I can’t take the medication Rybellis, we have over and over this. At this point I’m not taking anything. Also I found out the pain in my side is gallstones, after seeing another doctor in ******* was going to have a GI call me to make appointment for that. It’s been one month no call. Need to find another practice where they care about their patients.

  Business Response

  Date: 05/02/2024

  Patient experience has spoken with this patient.

  On 12/19/23, patient called her practice, as instructed to provide an update on her medication. It is documented that she said the medication, was working well and not causing symptoms that she previously reported. 

  Patient brought up that she had a fall and was hoping to get medical direction. It is documented that per Dr. E*******, it would be difficult to provide advice without examining her. She was offered, but declined, an appointment. She said she was walking fine and would call the office if anything changed. She did not call the office.

  On 1/9/24, patient went to the Hospital Emergency Room, to evaluate the fall. She also complained of nausea and abdominal pain. A CT scan was performed

  Patient was upset that a nurse called back instead of Dr. E******* himeself. Oftentimes, due to timing and access, it is medically necessary for a nurse to outreach instead of clinician.

  Patient finally complained about not having a GI referral. There has been no referral in place per what we can see so we are working with the practice to expedite this referral as quickly as possible. 

• Initial Complaint

  Date:02/26/2024

  Type:Billing Issues
  Status:

  AnsweredMore info

  Complaint statuses

  Resolved:

  The complainant verified the issue was resolved to their satisfaction.

  Unresolved:

  The business responded to the dispute but failed to make a good faith effort to resolve it.

  Answered:

  The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.

  Unanswered:

  The business failed to respond to the dispute.

  Unpursuable:

  BBB is unable to locate the business.

  This office dismissed a variety of medical concerns and only sent one diagnostic code to insurance. When coverage was denied, the patient called to have the code corrected. They agreed to amend the code, but months later a bill was received with no explanation. To date (4 months prior to the visit), the care team refused to update the diagnostic code to reflect the issues documented and discussed, as well as the extensive medical history of the patient. Additionally, calls to the office involve sitting on hold for 20-50 minutes before a human picks up the phone. When someone does pick up, they refer me to the "office manager" who has yet to return any calls or emails. This visit, and all following lab work are now completely out-of-pocket expenses, in excess of $1000.

  Customer Answer

  Date: 02/27/2024

  Attached EOB. I've had numerous conversations with our insurance and the medical office. The office has said the bill for 10/12 has been paid (we have not paid it) and I confirmed with an insurance agent that the bill is still outstanding and lab work (10/13) has not been covered. The office also reportedly has no record of the insurance reaching out to them on 2/5.

  Furthermore, an insurance agent reached out to the office yesterday (no answer) and this morning (the agent reported 50 minutes on hold before someone picked up) and was unable to receive clarification from the office. The agent has reached out via email as well, with no response.

  There is a major breakdown in communication and it is leading to an inability to resolve our issue. The issue was initiated by a diagnostic code that was hastily entered without necessary information regarding patient history, specifically that the patient was experiencing a symptom from years-long treatment for another medical condition, and she was worried it was due to a recent change in medication.

  The total out-of-pocket expenses due to this error are $1,134.84.

  Business Response

  Date: 02/29/2024

  Dear Client,

  
  Thank you for bringing your concerns to our attention. We are truly sorry to hear about your experience with our billing department. At ProHealth Physicians, we strive to ensure customer satisfaction and it is evident that in your case we have fallen short.

  After reviewing your complaint, we do want to advise that treatment options and testing will be ordered and performed based on the medical necessity of what the patient is seen and evaluated for.  Providers are not aware of the limitation of each patient in network benefits and patient should always contact their insurance carrier prior to being seen to ensure their coverage is active and what their plan will covers.  We understand that this concern has caused an inconvenience and for this we sincerely apologize. We are planning to contact the insurance carrier in an effort to determine what appeal options are available to resolve the denial and will update the patient on our findings.

  Your feedback is valuable to us as it helps us to improve. We hope to continue to serve you in the future. If you have any further questions or concerns, please feel free to contact us directly.

  Thank you for your patience and understanding,

  ProHealth Billing Department

• Initial Complaint

  Date:06/22/2022

  Type:Billing Issues
  Status:

  AnsweredMore info

  Complaint statuses

  Resolved:

  The complainant verified the issue was resolved to their satisfaction.

  Unresolved:

  The business responded to the dispute but failed to make a good faith effort to resolve it.

  Answered:

  The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.

  Unanswered:

  The business failed to respond to the dispute.

  Unpursuable:

  BBB is unable to locate the business.

  Date of transaction: 05/03/2022 Amount of bill/money owed: $83.48 Account number: unknown, ProHealth Physicians never sent a bill, I only saw it online in my health insurance company portal Nature of dispute: I went for my annual physical on 05/03/22. I signed a paper agreeing that the doctor's office could bill me for additional charges if anything outside of the physical is discussed. We did not discuss anything not related to the physical. After the physical, I had blood work done, the results were forwarded to the doctor's office. Subsequently, the doctor's office called to say results were good, cholesterol a little high. The doctor's office billed me for a separate office visit claiming it was to discuss high cholesterol. How could we have discussed cholesterol during the physical if I had not had blood work done yet? I have tried multiple times to resolve this with the billing office. I called Patient Experience. The person I spoke to said they were going to investigate and never called back. I had my health insurance company, *****, call them and they did and the doctor's office said they were not removing the charges. ***** said they would pursue a provider complaint on my behalf, but I have not seen any evidence that they did that. Everywhere I turn, no resolution. Called the doctor's office 06/21 to speak to an office manager. Spoke to someone who said they would pass along the message. No call back. AMA guidance for this scenario states the following: "Regulatory clarification" "The Current Procedural Terminology (CPT®) guidelines provide clarification. If an abnormality is encountered or a preexisting problem is addressed in the process of performing a preventive/wellness visit, and the problem or abnormal finding is significant enough to require additional work to perform the key components of a problem-focused evaluation and management service, then the appropriate office/outpatient E/M code should also be billed. Modifier-25 should be added to the o

  Business Response

  Date: 04/25/2024

  Good Morning,

  This was a complaint filed regarding a second service for date of service 5/3/2022. Patient reached out to the office on 6/6/2022 and the BBB complaint was filed on 6/22/2022. The amount in dispute was written off per the office request on 7/5/2022.

  Thank you

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