ComplaintsforBeautiful Beginnings

• Initial Complaint

  05/18/2023

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  I have paid for my full maternity services including delivery and postpartum care completely as of January 16th, 2023. The claims for this care were submitted to my insurance soon after my 6 weeks postpartum visit, concluding my contracted care under Beautiful Beginnings Midwifery and Birth Center. My insurance provider finished processing the first claim and sent the check for my reimbursement to Beautiful Beginnings Midwifery and Birth Center. When I was told that Beautiful Beginnings Midwifery and Birth Center was sent the check on April 13th, 2023 and this was not told to me, nor was I given my check. I went in person to Beautiful Beginnings Midwifery and Birth Center to collect my check. I did this on May 1st, 2023. I was told by Christopher P***** at the office that Beautiful Beginnings Midwifery and Birth Center has a policy of keeping its clients' insurance reimbursements for 30 days after Beautiful Beginnings Midwifery and Birth Center receives their reimbursement checks. 5 days for check clearance is reasonable. 30 days are not. Christopher told me the money goes into a bank account specifically for holding reimbursements so it isn't used for any business expenses, but this is of no concern to me. It should be in my bank account instead. I was also told there were three claims submitted for my care, which makes it more likely for insurance to be late in processing some of them. I am now apparently waiting for one to process. I paid for one service, so it is odd to me that they were submitted as multiple claims and didn't tell me they would do that until I went in person to collect. When I went in person, I was told there were two claims submitted and that was confirmed by my insurance care coordinator. This information is contradictory. I repeat that I have paid Beautiful Beginnings Midwifery and Birth Center in full and have been owed thousands of dollars longer than reasonable check clearance.

  Business response

  05/24/2023

  On November 7th, 2022 the client began care with Beautiful Beginnings Midwifery.  On this day the client took part in her intake where she met with Mina Q****, our Billing Coordinator, and reviewed and signed several documents, including our financial contract.  The client delivered February 7th, 2023 and attended 3 more visits with the last postpartum visit on Wednesday, March 22, 2023.
  In accordance with our financial contract, a claim was filed 2 business days later (our office is open Monday through Thursday) on Monday, March 27, 2023.  Two claims were filed.  The first claim consisted of two line items for provider services: ***** for 6+ antepartum visits and  ***** for delivery & postpartum care global (bundled). The second claim was ******* form for facility fees.  The insurance company prepared and dated a check on April 13, 2023, paying on the first described claim.  The Explanation of Benefits (EOB) and check for part one (provider services) arrived sometime between Friday, April 22 and Monday, April 24 through our mail slot (again, we are closed on Fridays) and was deposited on April 24, 2023.
  The  check was written to Beautiful Beginnings Midwifery, LLC as the payee.  These are reimbursements to our facility for healthcare services and reported to our 1099 by the insurance companies, not reimbursements issued directly to the patient. As per our financial contract (Please see attached signed document) that was reviewed and signed by the client, in paragraph 5, line 5, which states “We will determine how much refund is due to you, and we will send you a refund along with the Explanation of Benefits from your insurance provider within 30 days,” the check was deposited into our reimbursement holding account.  The reason for the 30 day policy is due to the fact that insurance companies will, at times, make adjustments to claims and request money back due to overpayment on a claim.  Payments are deposited into a reimbursement holding account for 30 days to add a buffer for this as we would be responsible to repay any overpayment, not the client.  This policy was instituted because in the past we have lost thousands of dollars when reimbursements are made to clients based on insurance payments received by us and the insurance company makes adjustments afterwards, with clients being unwilling to return the money to us.
  On or about  May 2, 2023, Christopher took a call from the insurance company inquiring about the reimbursement to the client and he explained our policy as stated above as to why we were holding the payment. The representative stated she understood and acknowledged that we were within our rights to do so. During this call the representative also stated that part two of the claim was still processing. This was communicated to the client. On May 17, 2023, further contact was made with the insurance company by Mina to verify the second claim was still processing. It was confirmed the claim was still processing and would be expedited. (See attached correspondence)
  Please also note that a check cannot just be written and issued in a matter of minutes.  Once a reimbursement check is received it is scanned into the appropriate file prior to being deposited. Next the EOB is reviewed by our billing coordinator. This process includes, and is not limited to, entering the EOB into the clients billing, insurance, and payments files, adjustments in accounting files, completing a thorough review of the claim and EOB to be sure the claim was processed correctly, and is reviewed for proper reimbursement to clients based on insurance claim laws.  
  On May 1, 2023, when the client came to our office and requested a reimbursement check she was reminded by Christopher P*****, Office Manager, of the 30 day policy and as to why we hold the payment never stipulating it was a period for the “check to clear”.  On May 16, 2023 the client then began correspondence with our office administrative assistant demanding payment and threatening to sue if reimbursement was not delivered within 10 days. She was reminded again in a response dated May 17th, 2023 of the policy and given a copy of her financial contract.  She also stated that she understood that she signed the contract,  but felt the agreed to policy is “flawed.” (please see attached correspondence).  Also of note, per the financial contract the reimbursement would be scheduled prior to 10 days, no later than May 24, 2023. 
  On May 23, 2023 we received a formal complaint report from the BBB which had been filed on May 17, 2023. The client picked up the check in person on May 24, 2023 for the first claim and payments that were received from the insurance company.
  Due to the fact that we have suffered loss of income due to previous overpayment issues in the past we have had to institute this policy to protect us.  Understanding that our clients need to be made aware of this policy of holding insurance payments/reimbursements, we added this policy in writing to our Financial Contract which was revised in 2017.  We are saddened by the client’s remarks that we have been unfair to her by not reimbursing her sooner.  We feel we have not acted unfairly nor out of malice, nor have treated the client any differently than other clients in our practice, and have abided by our contracts.  Again, the policy was reviewed with the client when she came into care and the client signed the financial contract agreeing to this policy.
  
  

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