ComplaintsforSouthern Gastroenterology Associates

• Initial Complaint

  06/17/2024

  Complaint Type:

  Sales and Advertising Issues

  Status:

  Resolved

  More info

  I went to Dr ***************************** for a colonoscopy on 10/10/2022 I gave them my insurance card they did a presurgery visit before my colonoscopy. When it came to billing they broke the billing up into sections billing everything separately. My insurance doesnt allow that and wrote them telling them so. They were in network so I wasnt suppose to be charged the full amount as if I had no insurance. But because the insurance disallowed their billing practice theyre trying to bill me. Now that years have passed I feel its unfair of them to charge me for incorrectly billing the insurance properly.

  Business response

  06/25/2024

  Date of service for above patient was 10-10-2022.  Our billing department worked with GEHA (Insurance carrier), see information below:
  
  1.   12-12-2022 Insurance carrier denied 2 of the 3 procedures for both the facility and the physician claims stating bundling issue
  

        a.   Per CMS guidelines, the billing department utilized correct modifiers (59) to identify that they were completely separate procedures performed on the same day.
  

        b.   Insurance requested that we send in an appeal to for reconsideration.
  

        c.   The billing department utilized GEHA appeal form and sent in.
  

        d.   Insurance did come back and reimburse for the 2nd procedure, but not the 3rd.

        e.   We then sent medical records with a second level of appeal.

        f.    We did not hear back from insurance so we sent numerous statements and a personal letter from the Billing Manager, to which the patient never responded to (had this happened timely it would have been resolved). 
  

  2.   At this time, it is now a question of timely filing and due to the frustration of the patient (as well as the billing department) we will agree to do a one time courtesy adjustment.
  

  3.  We hope in the future the patient will respond timely and we can attain correct reimbursement from insurance carrier.

  Customer response

  06/28/2024

   
  Better Business Bureau:
  
  I have reviewed the response made by the business in reference to complaint ID ********, and find that this resolution is satisfactory to me.
  
  Sincerely,
  
  *************************

• Initial Complaint

  05/22/2024

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  I had a preventative procedure done on 03/01/2023. Since then they billed me after what insurance covered. I talked to them and explained this was a preventive procedure and 100% should be covered. We got in a 3 way call with provider, *************** and myself and resolved the matter and provider received their payment. Since then I received another invoice and I called the provider. They asked me to ignore as these are routine system generated invoices. So, I started ignoring those letters. Yesterday, I received a letter from collection agency saying I owe the provider balance. I was shocked. This morning I talked to the provider and now they are saying it's for pathology charges which ***** did not cover. I asked them did you try to contact me? Their response was 'we have lot going on and we cannot reach individual customer'. Their response was 'you should have seen it's different Billing Code and pay' where they asked me to ignore those system generated mails. Now they are asking me to pay 30% extra for collection fee. First, I'm really upset I have been put on collection when my credit history is excellent (820+) with zero late payments in last 30 years. They need to waive the collection fee of extra 30%. Also, they need to train their people on how to manage this kind of situation and not cause unnecessary headache for others or ruin their credit history or reputation. Very unprofessional.

  Business response

  05/29/2024

  May 29th, 2024
  
  Below is an outline of discussion had with *********************************:
  

  A)  On March 1st 2023 **************** came to our facility Southern Endoscopy Suite, LLC for a Colonoscopy.  His insurance was Aetna.
  

  B)  The facility claim was paid in full on March 7th 2023.
  

  C)  **************** was the performing physician and the claim was originally processed incorrectly by ***** on March 7th applying $791.64 to patient responsibility.  The Billing Team did appeal this decision and was told by ***** on March 27th, 2023 that they were reprocessing for payment. During that time, the patient reached out to us and we explained that insurance would reconsider the charges and pay in full.  The statement he received for the physician ($791.64) we explained to disregard and wait for Aetna to apply payment.  Aetna paid for claim on April 11th 2023.
  

  D)  Pathology (the specimens removed during procedure) was the last claim to be filed = file completion was March 15th 2023.  Aetna processed claim and allotted $616.38 to patient responsibility.  This statement is completely separate than the Physician fee for ****************.  We then had a discussion with **************** on June 23rd, 2023 regarding this bill stating that it is not part of the wellness benefit and would hit his deductible.  Patient stated he was call us back when he returned from his trip to resolve this issue.  We never heard back from the patient.  Therefore, our collection process is to send to our 3rd party agency for further collection options of funds.
  

  E)   On May 22nd 2024 (a little over a year later) **************** called and threatened that he was going to file a claim against us.  We explained that we completed all processing of claims correctly.  

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