ComplaintsforFlorida Sports Injury & Orthopedic Institute

• Initial Complaint

  06/22/2022

  Complaint Type:

  Service or Repair Issues

  Status:

  Resolved

  More info

  Went to Physical therapy from 2/21/22 to 3/14/22. When paying for the sessions I was informed that the billing clerk did not have the proper program on her computer to file the claim directly to my insurance company, American Foreign Services Benefit Plan, *****, through the Federal Employee Health Benefits Program. Cayce, the billing clerk, informed me that I should pay using my credit card and then submit those charges to the insurance company for reimbursement. I submitted the charges. My insurance company informed me that I was overcharged by $48.06 per session. The Florida Sports Injury and Orthopedic Institute is an in-network provider and was at the time of my sessions. After numerous phone calls to the Institute leaving voicemails, I was able to contact someone in billing who said that the physical therapy department located in the same building was not in-network with my insurance company. I said the insurance company has confirmed they are in fact in-network and should have filed the claim directly with them. The insurance company left numerous phone messages and informed the Institute in writing of their in-network status. The Institute continues to play dumb and insist they are not an in-network provider for physical therapy. The Institute owes me a $192.24 refund. The amount of refund is small in itself. My concern is the fraud committed by this medical facility. The amount they charged me up front claiming they were unable to process the claim using their computers was much more than what the insurance company would have paid them as an in-network provider. If they tried to steal money from me through this fraud scheme, how many times have they done this to other medical patients? Imagine those patients with severe issues requiring more costly medical attention. How much stealing have they done through this fraud scheme?

  Business response

  07/20/2022

  Business Response /* (1000, 9, 2022/06/28) */ As we have told the patient numerous times while our doctors are contracted to take her insurance our PT department is not. I currently handle all contracts with her carrier and she was misinformed by her insurance company. We have never taken****** for PT patients and she signed a self pay statement when she started PT as we informed her that we do not take that insurance for that service. She was given the opportunity to seek a in network provider before starting services with us. We also informed her that it is out of the 90 day window to even submit claims if we could accept the insurance for that service. We cannot refund money as our PT's and company would be out the money for the services she was provided. So in conclusion she was both provided notice that we cannot take the insurance but wanted to be treated here at the self pay rates and was misinformed about our contract with her insurance company. We would be happy to provide a copy of the contract to show that we are not contracted to provide PT services for****** patients. Consumer Response /* (3000, 11, 2022/06/29) */ (The consumer indicated he/she DID NOT accept the response from the business.) As both my husband and I explained to Casey, the PT billing clerk before I started the PT sessions, my insurance is AFSPA - Foreign Services Benefit Plan. This is a special subgroup of******. It is a group of Federal employee insureds who have or are employed by the Federal Government and stationed overseas as diplomats and civilian employees of The Department of Defense. We do have additional benefits that may not be offered in the general****** plan. We called our insurance company and verified you are in network before beginning treatment. Casey heard us say that and insisted that she did not have the correct program on her computer to file our claim directly (she did not say that the PT department would reject any claims for in-network prices through******) and assured us that we could submit the receipts for our payments ourselves and would be reimbursed as other patients had done. Foreign Services Benefit Plan has tried numerous times to call you and has left voicemails and followed up with a letter explaining that under this specific plan you are considered in-network and should submit the claim and refund me the amount you overcharged me. You have refused to return the calls and acknowledge receipt of the written correspondence. Your refusal to honor your contract with all groups of****** one of which is Foreign Services Benefit Plan is very concerning. Is your refusal to return communications with my specialized Federal group of****** because you are avoiding giving me the refund you owe? Is it because you may have to reimburse other medical patients you have overcharged because you failed to check with their insurance to see if PT would be covered and made more money from them by charging them out of pocket? In the time it took you to write your response to BBB, you could have called the insurance company and had this all worked out. If you had returned the insurance company's voicemails and acknowledged their letter, the 90 day window to submit claims would not have passed. Please call the provider services phone number of Foreign Services Benefit Plan. Unlike your office, Foreign Services will answer your call without voicemail or call backs required. You have this info already from my billing info and insurance card on file, but here it is again: Provider Services: 1 202 833-5751 Member Services: 1 202 833-4910 If you continue to refuse to return correspondence to Foreign Services Benefit Plan, a special subgroup of******, I will have to file a fraud complaint with the Medical Board and the Attorney General"s office. Business Response /* (4000, 13, 2022/07/12) */ We issued a refund to the patient for the difference she felt entitled to without any clear answers or payments from her insurance provider. We can assure that her case was a single case and the normal procedure for patients that we are not contracted with. They are sent out to a in network provider. However, we are still waiting for****** to call and go over the contract as they could not confirm with us about the PT on the contract.****** only reached out to us for the first time last week and we never received a letter like the patient claims. In order to not come across this issue again we will no longer offer a self pay option to any patients that we do not accept the insurance for in PT. There is no scam or insurance fraud as the patient claims. We simply offered her an alternative to seeking outside care. As this claim stands we have no resolution with her insurance as they cannot confirm the details of the contract and I have left messages with no return calls. Consumer Response /* (2000, 15, 2022/07/14) */ (The consumer indicated he/she ACCEPTED the response from the business.) The Orthopedic Institute sent me a refund with no letter attached. Just a refund in an envelope. They are still claiming the insurance company did not contact them. This is a bold-face lie! 3 out of the numerous times they called the institute I was on hold with the insurance company on the other line. The insurance company has this documented. My insurance also wrote a letter to them.. The Institute refused to return calls to my insurance even after receiving a promise from the phone clerk at the Institute that they would get back to my insurance company. The energy they put into denying responsibility and avoidance makes me very concerned that the fraud was enacted upon other medical patients with unique insurance plans. Future patients of the Institute please be aware and perhaps look into taking your business to a more reputable honest Orthopedic facility.

*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. ↩