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:09/11/2023

  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.

  On May ***** I had a Cancer Reconstruction surgery performed @ Florida Endoscopy & Surgery Center in *********** FLorida, due to having Stage 3 bilateral breast cancer. The surgeon performing the procedure was ******************************** of ****** ********* of ******* Surgery. This was all submitted to my insurance of BCBS of Fl. I had paid my out of pocket portion prior to procedure there fore leaving my responsibility $0 at time of service. I recently received a credit collections for $5800 dollars from this facility. I contacted my insurance to have them review my EOB for that year and they stated BCBS had already made payment to ** ********************************************* Center. for that claim. I had a BCBS representative ,***, contact their billing office on 3 way call with me and *************************. She explained to **************** per the contractual agreement , they received payment for the allowed amount billed on claim and patient responsibility should have *** $0. They used unapproved / inaccurate codes for procedure and that was fault of billing **** and not patient. Medical facilities have contracts with insurance that once they receive payment for billed amount they cannot collect difference from patient. Its double dipping an it against contract rules. They can submit any amount they desire, but BCBS will only pay what they deem appropriate. Any additional is to be written off. The representative informed **************** the proper way to submitting claims and they were advised to correct it. It has been filed with BCBS for investigation for fraudulent coding. I have disputed as well on my credit report, however it is still not been removed. Would appreciate complaint to be reviewed by BBB and look forward to hearing from your office . Feel free to contact me via email or phone, Any assistance is much appreciated.thank you *****************************

  Business Response

  Date: 09/18/2023

  When the patient came in at DOS they did not pay the total we expected them to owe, they were told about the $250 copay and paid $125, they then set up a payment plan for the remaining balance. 
  When BCBS processed this claim they applied $5,684.25 to the patient's deductible as shown on the attached EOB. This was billed to the patient. 
  We sent the patient statements about the balance and the payment plan that was in place and never heard back which resulted in us sending the account to collections. 
  When a representative from BCBS called Trixie with the patient on the line they reviewed the coding and BCBS agreed it was billed correctly. In addition, they discussed the deductible applied and how this would be due from the patient. 
  Per all of the documentation we have received from BCBS as well as the call that took place the patient is responsible for their deductible. ****** had noticed that the $125 patient payment made at time of service was not removed from the collection amount so this has been corrected with the collection agency to reflect the correct amount due of $5,559.25.
  
  
  Thank you,
  Business Office Director, FPO
  Credentialing Specialist

  Customer Answer

  Date: 10/03/2023

   
  Complaint: 20570776
  
  I am rejecting this response because:
  

  Thank you for responding back, I read the response from Florida Endoscopy Center and they told you a false statement. The whole conversation was recorded with **** and they were told by the **** representative they billed incorrectly with  incorrect and non approved codes, So they  LIED to BBB. I Will be taking this to court . I have already obtained a lawyer on this matter. I am not going to listen to anything they say, they are not utilizing the contractual agreement made with  insurance. They are already flagged with this claim with ****. They received payment ,regardless how much they got , they can not go after patient for any difference. 

  Thank you or your time

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