Complaints

• Initial Complaint

  05/14/2024

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  I went to Apollo for 14 therapy visits from 1/5/2024-4/8/2024. I was charged $85 for the 1/5 visit and $70 for the remaining 13 visits. I asked why they were charging more than my Cigna card that showed $50 for Specialist and was told thats what they were told to collect. In late March I viewed my claims online to find I owed $50 per claim. I called Cigna on 3/25 to ask how to handle the overcharge. The Representative said she would call them and advise of the overcharge and she gave them the option to refund me the $295 or allow me to go for treatments without a charge. At my next visit I was told by ******** that there would be no charge for the visit and Billing was reviewing the issue. At my next visit on 4/8 I was told there was $50 copay. I see they corrected the copay in their system but nothing about the overcharge! I told ***** that I would not pay as ******** said there would be no charge while under review. Apollo called a few days later to say it was still under review and there would be no charge for my next visits. I asked her to cancel all future visits. I called Cigna a few days later to place another complaint. Cignancalled them while I was on the line. ***** asked what the status of my refund was and was told Billing was still reviewing. To date I have not received a refund nor heard from Apollo. It has been 7 weeks and have decided to submit this complaint so no one else has to go through what I have. There are many elderly clients and wonder how often this elder abuse occurs.

  Business response

  05/14/2024

  Patient was notified via phone call that They are entitled to a refund however some claims were still pending from the insurance so we did not have the total amount. She was informed of the amount up-to-date and that she could either apply to her future visits or would issue a check. From that  moment she has not attended therapy and we have also attempted to call with no success in reaching or getting a call back. I have attached a picture of the email from our third party billing company showing our attempt to resolve the issue

  Business response

  05/21/2024

  All claims have been processed and a check was issued and mailed out May 18. Patient had a deductible that wasnt met it takes time for insurance to process the claims and submit the information to our billing office and then it takes some time for our billing office to process and close the month of all the claims so theres always a delay with claim processing in any medical field the patient was informed of this and we were waiting for three more claims to be finalized now that they are finalized and we were notified by the insurance we were able to break down the patient and submit a check. This was communicated to the patient and she was aware of how she needed to wait for her remaining claims to be finalized , we cannot The speed that an insurance takes to process a claim. I have attached the itemized ledger of the claim and what was paid by the insurance and the refund the patient was owed.

  Customer response

  05/21/2024

   
  Complaint: 21696845
  
  I am rejecting this response because:
  As usual Apollo has not a clue of how my *************** works.  ***** called them twice and explained that there is NO deductible. ***** further explained that they are to only charge me my $50 COPAY per visitvery simple.  I further explained to ******** that I am only to pay a co pay of $50 not $70 and she understood and said she would explain to Billing of my overpayment.  ***** also explained to her that the should refund me or give me 6 free visits. She said I would not have to pay for future visits until resolved. That lasted 1 visit but the next visit I was told I needed to pay $50. Of course no mention that they owed me $295.  I explained to ******** that I should not have to wait for future claims to be processed to receive my refund and asked for future visits to be canceled.  After waiting 2 months I received a check in the amount of $156.91 today which is far short what I overpaid!  They provide a balance sheet showing my 16 visits with their charges, adjustments & insurance payments and then the difference was the amount of the check!    I placed another complaint with ***** and they will be calling Apollo to explain I DO NOT need to meet a deductible for the 3rd time and I ONLY should have been charged a COPAY. This is either a scam or they are totally incompetent. Hopefully they are not targeting their elderly patients with this same abuse.
  Sincerely,
  
  *****************************

  Business response

  05/22/2024

  If you look at the prior message, there is an attachment with the explanation of benefits from the insurance and a whole ledger, breaking down what was billed what was paid and what is owed back
  

  it has nothing to do with elderly abuse. We have been around for over 10 years sorry take it as a personal offense, but this is how medical billing is and to be honest most facilities charge over 150 a session.

  unless youre able to attach your explanation of benefits from CIGNA and you could compare to the one I attached you will see they are both the same. CIGNA broke it down for us and thats what was provided and how the refund check was issued.

  Customer response

  05/22/2024

   
  Complaint: 21696845
  
  I am rejecting this response because:

  I already placed a complaint with Cigna again and will place another one now. They can for 3rd time explain that there is NO deductible and I am only to pay $50 per visit.  If they looked at my insurance card it clearly showed $50 for Specialist visit but no Apollo decides how much to charge the client instead - $85 for the 1st visit and then $70 per visit after that. Cigna will deal with them once  again.  Thank you for clarifying this is not elder abuse just incompetence.  
  
  Sincerely,
  
  *****************************

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