ComplaintsforMedical Consultants Management, LLC

• Initial Complaint

  03/12/2024

  Complaint Type:

  Customer Service Issues

  Status:

  Answered

  More info

  In February I requested my medical records, and a letter from the clinic documenting that my insurance was denied at the clinic on 9/27/2023 and that the clinic did not conduct a pap smear in the office. The request was refused and I was referred to *******************, **** stated that their will be no letter because i switched providers which i did not. He is refusing the letter and release of my full medical records. I have attached the appointment card for the appointment in question and the medical record that does indeed read i was referred to an OBGYN.I am requesting the FULL medical file to include forms signed and completed in office. I am requesting in writing, a statement that med fl clinic in 2023 did not conduct pap smears and that i was referred outside of the office. I also need the insurance denial information for the appointment on 9/27/2023.

  Business response

  04/01/2024

  The patient has the facts and her copies attached confused.

  1st - in February the patient did not initially request medical records. In the emails between myself and her (which she supplied) she asks for 2 items: 1. a statement that at her visit to our office in 2023 we did not conduct a papsmear and referred her outside the office and 2. the insurance denial for the 2023 appointment.The patient called in February to make a follow up appointment and was told her insurance was not valid and that she had switched to another primary care provider, not us. she stated verbally and in her email that this was a lie.The eligibility that was run on that day, 2/23/24, is attached.

  2nd - records cannot be requested verbally. per HIPAA, there must be a written request, which we do not have in our records.

  3rd - she includes an appointment card for 9/27/23. That was her 6 week follow up appointment given to her when she was in our office on 8/10/2023.That appointment was to review lab results. We sent her a reminder message. Apparently she called back, but the appt. was cancelled because she had a different PCP. We offered to assist her to help change back to us if she wanted, but she declined.

  4th - she had one (1) appointment in our office on 8/10/2023. The visit was due to her concerns about her blood pressure ***** which she felt was elevated. Her blood pressure was NOT elevated at the time of the visit. Further, she brought her own ** monitor to the office that day. The memory was reviewed and showed 80% normal readings  It was sporadically mildly elevated on days she indicated were "most stressful". The visit note refers to her "anxiety" several times, including her being anxious "for the past decade", that she currently takes "Lexapro daily and Lorazepam as needed, which help her feel better" and "she expressed that she would like to withdraw from medications within the next two months before traveling to *****". I am more than willing to provide her a copy of that office visit note, and all her records, inclding the lab results. those can be provided directly to her or to the BBB, but must be sent via encrypted email, fax or mail.

  5th - she includes part of a note from 7/7/2023, but that is not our from our office. That is from a provider named ****************************, APRN. We do not know who that is, but it is not our provider or our office.

  6th - at her appointment with us on 8/10/2023 she was referred to an OBGYN for cervical screening. She was also referred to have a mammogram for breast cancer screening. She was also advised "that she needs to follow up with mental health specialist for proper evaluation, treatment, and help with her medication withdrawal". To the best of our knowledge, she has not followed up with any of these referrals/requests.

  When the matter began, she was referred from the office manager tome (via emails from the area manager and the assistant medical director).

  I received a phone message from our call center manager stating I had 30 minutes to call the pt. back. The pt. states this is not true.

  I called her and she answered the phone "feed seeds and other needs" in a fast, almost incomprehensible manner. She had stated at her appointment that she owned 3 pre-school offices, so I was confused. I asked for her by name 3 times but she would not confirm her name, which I needed to do before proceeding, again due to HIPAA requirements. She then cursed at me and hung up. I emailed her and wrote this (see attached) but she denies her phone message, that she cursed or that she hung up in her response and instead she told me how I should have handled the phone call. (se attached)

  Please advise how you would prefer I proceed regarding the records. 

  Either way, I need a signed HIPAA release to place in the chart.

  Please advise if you require any further information.

   

  Thank you,

  *******************,

  Director of Corporate Compliance.

   

  Business response

  04/01/2024

  see attached, accidently not included.

  Business response

  04/04/2024

  ***see attached business response and supporting documentation***

  Customer response

  04/04/2024

   
  Complaint: 21423917
  
  I am rejecting this response because: I am not confused. The *** was never changed, the insurance card printed to date is not what was requested. That insurance policy was cancelled as a result of the issues with this office and Ambetter in 2023. I am asking for the documentation that the insurance was denied (I was not told the *** changed at the time), in September not current.  Correct, I did not originally ask you for the medical record, the circled information in the complaint is directly from the record I picked up at your office! Additionally, the same information is in your medical portal. The medical records are incomplete! You are correct, as I stated I did not see *******************, I saw *******************, she referred me to a OBGYN, NOT AN IN OFFICE PAP! It was repeatedly stated by your office that you did not conduct pap smears. Not sure what is happening here, but this statement substantiates my points, "That is from a provider named ****************************, APRN. We do not know who that is, but it is not our provider or our office," this is copied directly from my medical records I received. My medical notes or personal appointment information is of no importance here, I requested that you write a letter that I was referred to an OBGYN, however you now state that I was not referred to an OBGYN. All of that is indeed false and recorded in the medical record I received from YOUR OFFICE!

  I signed the ***** forms to access electronic records, the complete medical (remember I was already at your office to gather my records, I was refused all parts and received only a partial record) file including all bloodwork, forms signed, accurate doctor notes! (noting correct Dr seen), and should be uploaded to the portal and or available to be picked up in the office. 

  Again, I am requesting the letter to state I was referred to an OBGYN as stated in my medical record and in person at your office! 

  Again, I am requesting a letter stating the insurance was denied for the sept 27th office appointment, whether you want to make up the *** issue is on you, this is also going to Ambetter either way it substantiates my complaint.
  
  Sincerely,
  
  *********************

  Business response

  04/15/2024

  The insurance companys online verification of benefits is where we got the printout previously included that stated she had a different ***. It clearly shows that the *** is Primary Medical Bay ********************** If their information is wrong then she has a miscommunication with her insurance company. that has nothing to do with us. It also shows that the premium she paid was only paid through September 30, 2023. So apparently it was cancelled as of October 1, 2024, or possibly retroactively to that day as effective. And I strongly deny that is was cancelled due to issues with our office, as she states. This document shows it was cancelled because the premiums for October 1, 2023, and later were not paid. Of course, it does not show the reason why it was unpaid, and it may be simply because she cancelled it, as she states.
  I never said the patient was not referred to an ob/gyn by our office. I said that the proof she included was from some other office she went to before she went to us. That provider, ****************************** currently works for Community Medical Group in ********, ******* but he may have worked for Primary Medical Bay ********************* previously,and when she saw him on July 7, 2023. In any event he does not now nor did he ever work for us. She either gave us that document or that group sent it directly to us when we requested prior records.
  As far as her request for a letter stating that we referred her to an OBGYN, it is in her medical records from us, and that visit note is self-explanatory. We will not provide a letter stating the same.
  As far as a letter stating the insurance was denied for September 27th, that is something the insurance company will have to provide. This was her follow up appointment, and the only notation in our internal system states the appointment was cancelled due to a change in ***.
  Finally, if she sends me an email from ******************* giving me permission to send her records to her via reply email, to ******************* I will send her all her records immediately, within no more than 24 hours, via return (encrypted)email.

  This would be the quickest way to provide her her entire medical record.

  Thank you,

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

*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. ↩