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:02/03/2023

  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.

  I currently have 2 retroactive reimbursement cases I am handling with my insurer. The Provider refused to provide itemized receipts for monies I paid for treatment which occurred on 1/13/23 so that I can seek authorization through my health insurance. I requested copies of the 1/13/23 receipt, they promised to provide same the very same day. However, said receipt was not made available that day. My representative arrived, in person, the following day and requested the receipt again and was made to wait over an hour for something that was supposed to have received yesterday. I finally received a receipt in addition to an unprofessional and passive aggressive letter from the provider informing me I had waived my rights to seek authorization through him for a portion of my 1/26/23 date of service charges. However, that was not the issue, I am aware I consensually waived my rights for him to seek that reimbursement and never requested he do so. Because my carrier is more difficult than most, my legal representative is handling that process for me instead through a retroactive reimbursement pursuant to my policy. This method saves everyone’s time. I had no need for his services in that regard nor his passive aggressive letter regarding that matter which may now become a part of my insurance file and may adversely effect my right to seek reimbursement due to his unsolicited meddling. I only wanted a receipt for my 1/13/23 date of service and for my provider to cease any action regarding the previously denied portion of my 1/26/23 date of service, since I am content to handle that personally with my own insurance company. However, I am concerned continuing and non-consensual involvement in the process by this Provider, who purports to act on my behalf, may adversely affect the outcome of my retroactive authorization application. I would like the provider to cease seeking authorization or submitting any documents on my behalf for code ***** and allow my attorney to do so.

  Business Response

  Date: 02/11/2023

  We have gone out of our way to help and provide excellent care to this patient. And will not go into all the details of the significant time and efforts we have expended to help this patient. We indeed spared no cost to help this patient. Throughout the process, we have had numerous repetitive phone calls from patient's significant other, and numerous contacts which at this time we are regarding as highly abusive. We do take each of our patient's care very seriously, and do spend as much time as needed to help each and everyone of our patients. When any patient makes payment for any service, they are issued a receipt at the time of payment, which happened in this case. So suggestions otherwise is inaccurate. 

   

  We do have team members dealing with various active patient care issues for patients receiving care at every given time at our facility. It is imperative and medically necessary for them to do so at every given time. Typically when items are requested relating to a patient's medical records, office protocols and policies are such that time of up to 5 days are required to have such records available. And record charges apply depending on the number of pages of such requested records.  This applies to billing and account balance records. The significant other of the patient (also patient's attorney), have continually caused team members at our office to be increasingly stressed, she has condescending to team members, she has insulted team members on their grammar, she has made frivolous legal threats, some team members are almost brought to tears after speaking with her. She would show up to the office unannounced. She would repeatedly give team members just doing their jobs a difficult time. She would call into multiple different queues and to multiple different extensions all because her phone call was not returned within a 10-minute timeframe. 

   

  Regarding this complaint, there was request for billing statement (not receipt, as receipt was provided at time of payment) which can take up to 5 days to be ready. Patient's representative showed up at our office in person to get billing statement, we were trying to help her get it in as less time as possible, and waived the charge for it.  When patient's significant other (also his attorney) showed up to our office, those who were handling the billing statement processing were not notified of any specific timing of when she would be coming to get it. Those team members were in the middle of other things, and quickly did their best to get the billing statement ready. Including trying to see if they can have it fully current, including charges from the recently performed surgery. It was then finally deemed that more time was needed to have charges from most recently performed surgeries included in the billing statement.  As that would be most helpful to patient. The billing statement could have been faxed over to any provided fax number to avoid any wait times.
  

   

  Additionally, patient's significant other (also his attorney) requested something in writing pertaining to insurance related denials of elective surgery received. While patient's significant other was in office, to help her, explanation was quickly typed up (to save her time so she does not have to come back to the office for the letter) and provided to her solely to get her something in writing as she asked for. It seems there was inadvertent misunderstanding of what the requested letter was to cover. This prompted an email from the patient's significant other full of insults, in which she made numerous frivolous threats, and made inaccurate statements. 

   

  It is very unfortunate that after we spent so much time to help in this patient's care, including dealing with a very difficult insurance, going out of our way at every turn to make exceptions and help patient. This is what we get in return. Very unfortunate. 

   

  We do genuinely care about this patient's best medical interest. We are very happy to take care of patient, and will always provide the best medical care for patient. However, the ongoing abusive/harassing actions of her significant other is no longer welcome. 

   

  The complaint also suggests preposterously that our office is engaging in continued "involvement" in some process with patient's insurance. Not sure what that is supposed to mean. One of the things that was clearly emphasized repeatedly prior to surgery, was that after surgery is performed, our office will NOT continue seeking prior authorization for any codes that were previously denied. Our policy is to get all planned procedure codes approved prior to surgery before proceeding with surgery.   In this case, after surgery was performed, we do not work on getting authorization for any other codes, as surgery is completed. Patient pre-paid for the denied component of performed surgery at a discounted rate. After surgery, we simply submit performed codes to insurance for reimbursement, less the code(s) relating to the procedure(s) that the patient pre-paid. So suggesting that we are either working on retro-authorization of a pre-paid portion of the surgery is preposterous, and suggesting that we are sending any letter(s) to any insurance company is absurd. 

   

  Regarding the desired settlement on the complaint, it is ambiguous. And especially in light of a prior misunderstanding regarding what was being requested in a written letter. This desired settlement of "no further contact by the business," is not clear. Patient had recent surgery, and was in our office voluntarily yesterday for routine post-operative care. It is medically necessary for him to have recommend post-operative care following a surgery of the nature that he underwent. Of course, he has the right to choose another medical practice for future care if that is what he is wanting. If he wishes that we do not call him again, and if he wishes to no longer receive care from our office, he should simply call our office on Monday morning and notify us that he no longer wants our office to call him, as he is going to resume his medically necessary care elsewhere. 

   

   

  Customer Answer

  Date: 02/13/2023

  
  Complaint: ********
  
  I am rejecting this response because:

  The attached document I received on 1/31/23 is the true reason for the complaint, in addition to the receipt I was missing.  I want to make the business aware this is what is going on in their office as well as make this letter part of the BBB's Complaint file.  This business has staff members authoring unauthorized, unsigned, and insulting documents, on the business letterhead, directed in an unsolicited fashion at patients and their family members.  If an authorized signer and shareholder of the business can tell me they actually endorse these statements (grammatical errors and all) and authorized their authorship, perhaps I would reconsider.  However, it is my understanding that an office staff member, who is not an officer of the business and was in no way requested to draft this document by any person, authored this attached statement for the sole purpose of insulting me (not helping me as they claim) and created a document that is discoverable in any pending insurance litigation I may have to initiate to compel the payment of my retroactive reimbursement.

  This business claims the attached statement is a "letter of medical necessity" they prepared for me at my request, free of charge, when ordinarily such a statement could cost a patient upwards of $800.  However, it is clear from a review of the document that this is not a letter of medical necessity at all.  The attached document cannot legally qualify as a "letter of medical necessity" because is neither a letter nor signed by a medical provider.  It is merely some type of encounter note authored by office staff and never endorsed by a medical provider.  While one paragraph may have been relevant the remainder is an insulting and inaccurate rant.

  I had my attorney advise them if this is ever added to my chart or sent to my insurer, I will sue.  It is bad enough they created this document, however, they continue to threaten to send this document to my insurer and to add it to my chart. 

   

  My desired remedy:

  I want this attached document retracted. 

  I want a written apology from the attached document's author.

  I want them to cease contacting my insurer with/regarding this document.  The "no further contact" box was selected because that was the most applicable of the few available BBB remedy options. The business can continue my medical care, but I want no further contact with this document's author and I want that person excluded from access to my chart/patient file so that they can create no further unauthorized and inaccurate records which may harm my insurance case.

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

  Business Response

  Date: 02/23/2023

  We will respectfully not go back and forth on this any longer. The only one passing around this letter written in response to your request was you. 
  
  
  If it did not provide the explanation we thought you sought, then our apologies. It was never meant to upset you, and was never provided to disrespect you. It was something that never would have been written had it not been for the sole reason we thought you were asking for explanation. Explanation to you and not to your chart or to anyone else. No one will waste time that can be used for valuable things to write a letter if it was not requested. The letter was then written hastily to minimize wait since your representative was already in the office, as we were simultaneously  making attempts to see if we can get all current charges on the billing statement for your benefit. 
  I do believe the letter/email you spouse sent in response to the letter was meant to be maximally disrespectful ( in my opinion) and did not make the situation any better with regards to resolution, not to mention it included numerous frivolous legal threats- typically not the best way to get to best address concerns. A request to speak with Dr. O***** could have been (in our opinion) a better way to address the matter.  You likely would have noticed you were over-thinking things, for something done without bad intent, something done thinking that it was explanation that would be helpful to you. Something done to hand to you and to you only. But since then, you have been passing around the letter to people/organizations that you do not have knowledge of what protocols they may have relating to documents provided to them.  If you are aiming for one reason or another to not have anyone or your insurance see a letter written only for you, you and you only have gone around disseminating this letter. For example, you gave a PA-C (medical provider) seeing you for medical care the letter that he had no business seeing; he could have inadvertently placed it with your medical paperwork he takes from patients and scanned it into your chart. As it was only noticed he had a copy of it when it was placed with paperwork that the scanner team could have scanned if they got to it. It was not meant for your chart and was NEVER placed in your chart at anytime. But if you keep dropping it off to random people/organizations, then you have to blame yourself for any actions those you hand it to may take with it. The PA-C didn’t even know why he was being given the letter when he was just their to provide you needed medical care. Had it been inadvertently scanned, it would be due to you sharing a letter meant for you to others (which is your right) but you cannot blame anyone if it is misused by those who get it. Again, the letter was only meant to be handed to you and not even emailed or faxed. 
  
  
  So please beware that if your goal is to prevent the insurance from knowing your elective  surgery was already canceled so that codes could be fixed; something that your insurance would have fixed if given the customary time for such code adjustments. As the code in question was related to a procedure that was already approved; but code adjustments was needed given the approval of only part of one of the needed procedures. That way you did not have to pay for anything out of pocket. But you insisted on paying knowing full well that we advised that the insurance company would have  automatically fixed it within a day or so, given the surgery was already approved. That would have avoided you from self-paying for the missing piece in the approval, and so the insurance would not have been responsible for reimbursement plus attorney fees for say a bad faith claim. Say insurance was given the day or 2 recommended to make code correction and they failed to do so, then doing the self-pay may have been something needed if further wasted time was not desired. As in such a case, the insurance was then given reasonable opportunity to correct the partial authorization and failed to. But it would have been highly unlikely they would not have made the needed code adjustment for the approved surgery. But also you may have other things or other approaches you like to use in discussing/disclosing matters to your insurance - which is the way it should be. Our office will never share letters meant for you to any other party. This have explained multiple times before  

  
  And again to clarify, I am not saying or suggesting that you did not provide your insurance all the needed information in seeking retroactive reimbursement as your spouse as an attorney knows the importance of providing to insurance all needed/relevant information relating to such request. It seems you are just suggesting you want her to be the one providing such information to the insurance and not us; and we 120% agree. What she submits to insurance is up to her as an attorney she knows what is required by law to be provided, and that is and will never be our role.
  
  
  If that is your goal of making sure your insurance company doesn’t hear it from us; we
  want to clarify again that we have had ZERO interest in speaking with your insurance about anything already paid by you. You have the responsibility (not us) to provide them whatever information you need to provide them. We have no part in that. We solely submit pre-approved codes to your insurance, and codes relating any procedures performed not already paid for by yourself. That’s all we do. 
  
  You mentioned that we continue to threaten to send this document to your insurance. A statement you know is categorically FALSE; but yet you seem to like making it. No need to continually make an issue of something that should not be an issue with better ways to handle it. We have NEVER threatened you of anything. You are the one through your spouse that has continually made frivolous threats for something that there is better way of handling.
  

  So that we don’t continue going back and forth with this matter that seems to come from what appears to be an honest misunderstanding; I will be having Dr. O***** reach out to you/your spouse as we have her on you list of approved individuals to discuss your care with. He will hear your concerns and will be able to provide any help. He is in the operating room all day today but will reach out later this evening or tomorrow morning. Again, we never meant any disrespect. But this will be the last response to any further entries as it is counterproductive. Our goal is to see what is needed to help you; and ensure we do so. And that while you are our patient, that we always provide you with the BEST medical care. 
  
  
  Have a great day. 
  
  
  Thank you, and God bless.