Complaints

• Initial Complaint

  08/10/2022

  Complaint Type:

  Billing Issues

  Status:

  Resolved

  More info

  My child started receiving ABA therapy at Spectrum House in Niceville, FL in 2018. In 03/21, Spectrum House merged with Proud Moments. My child continued to receive services until we moved out of state in 07/21. On 07/07/22, I received an invoice stating that Proud Moments had submitted claims to my insurance carrier for services provided from 04/20/21 to 06/04/2021, that my insurance had processed the claims, and that I was responsible for paying the remaining balance (almost $900). I immediately contacted Proud Moments asking for verification that the services had been billed both to my child's primary insurance (***** and secondary insurance ******* **********). On 07/21/22, I received an email from Natalie Lyle ***** stating that Proud Moments did not have my child's secondary insurance information on file. I provided copies of my child's insurance card to her on 07/25/22. On 07/26/22, Ms. Lyle ***** contacted me via email stating that my child's "Medicaid is showing as inactive on the Medicaid portal. There appears to be no secondary insurance through Medicaid at this time so billing to the secondary insurance as Medicaid is not possible at this time." I informed Ms. Lyle ***** that my child's Medicaid is inactive now because we moved out of state last year. I reminded her that "we obviously were in-state when (my child) was receiving services, and the medicaid account was active at that time. You should be able to verify it was active at time of service and bill accordingly." She let me know she would pass this information along to the authorizations/cost sharing team. On 08/05/22, I received a second invoice requesting the same amount for the services provided from 04-20-21 to 06-04-2021. At time of service, my child was a recipient of the Gardiner Scholarship. Had we received the invoice, showing appropriate insurance billing, earlier, we would have gladly used the scholarship to pay the balance. At this point we are too late to submit to Gardiner.

  Business response

  09/22/2022

  
  Thank you for submitting your inquiry. We truly apologize for the inconvenience this has caused you and your family. After a thorough review of the events, we did not submit the secondary claim to your Medicaid plan in a timely manner, and as such we have written off the amount due. There is currently no outstanding balance on your account. In addition, we have reviewed our processes and controls to ensure that this does not occur in the future. Thank you again for your inquiry and please let us know if we can assist you in any way in the future.
  
  Best,
  
  Joe *****
  Vice President, Revenue Cycle Management
  

  Customer response

  09/24/2022

  (The consumer indicated he/she ACCEPTED the response from the business.)
  Thank you for your attention to this matter. I appreciate that you not only addressed my complaint but also are taking steps to ensure this situation does not occur again in the future for me or other clients.

• Initial Complaint

  07/05/2022

  Complaint Type:

  Billing Issues

  Status:

  Resolved

  More info

  In June 2021 I enrolled my daughter, ****** ******** in Proud Moments ABA in Pensacola, Florida. She started out at the Highway 29 location then she transferred to the Davis Highway location. Her primary insurance was ******* for retirees. Her secondary insurance was ******** ********* I also applied for indigency in June 2021. In the agreement it states Proud Moments will absorb any extra costs insurance won't cover due to us being low income. In December 2021 we moved out of state to New Orleans, Louisiana. In March 2022 I received a bill in the excess of $4,000 in ABA therapy for ******* It appears this company's billing department dropped the ball in billing correctly. Proud moments called me sometime in April 2021 to let me know ********* ******* insurance lapsed and she needed to stop therapy until her insurance was in place again. Judy ******* assured me in May 2021 ********* insurance information was up to date. Now several months later I'm getting a large bill. It's not right. It's not my fault the billing person did not bill appropriately. It's not fair to send me an outrageous bill several months later after my daughter has discontinued therapy.

  Business response

  07/21/2022

  Business Response /* (1000, 5, 2022/07/08) */ I am responding to this complaint that came to your office in relationship to being billed for services. I reviewed with our billing team lead and after review, we have this client as qualifying for a payment waiver meaning they will not have to pay an co-pay, co-insurance balance etc. On June 15th, we had a glitch in our billing system that sent her a bill for the total amount that we have waived accidentally. Our team has confirmed that she does not have a balance and will not have to make any payment on that bill she received. Our team is calling her today to explain what happened and assure her she does not have any payment required. Consumer Response /* (2000, 7, 2022/07/08) */ (The consumer indicated he/she ACCEPTED the response from the business.) I would like to thank Proud Moments for their prompt attention to this matter. I'm satisfied with the outcome.

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