ComplaintsforTotal Rehab Physical Therapy

• Initial Complaint

  04/24/2023

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  Sept. 1, 2022 - Oct. 5, 2022. I was sent by my doctor to this establishment for physical therapy. When I presented them with my ******************************* information, they assured me that my out-of-pocket costs for these sessions would be $25/session because they were "in network." This was what I would have been charged at my local hospital. I had six sessions, and after these concluded, I paid them $150. on 10/17/2022. Several months later, I received a bill saying I owed $329.67 because, contrary to what I was informed, they were not "in network" with my insurance company. This is unfair, and I would have never gone to this establishment if I was told that they were out-of-network. They made the mistake, and they should take responsibility and cover the balance of what they say I owe.

  Business response

  05/08/2023

  A referral to our facility does not require services to be rendered at our facility.  Where this customer chose to receive care was a choice of the consumer.  On 9/1/23, ****************** filled out intake paperwork, provided her insurance card, and signed an assignment of benefits and liability of payment.  When a third party such as a ******** Supplement plan is provided, Total Rehab is happy to file the claim on behalf of our consumers.  Sending a claim to a third party is done as a service to our consumers.  Insurance coverage varies greatly by the insurance company, the parent company, and the particular plan.  Total Rehab is filing the claim, but we are not the carrier nor would we communicate what the absolute patient responsibility will be.  In this case, when claims were received on 10/17/22, the claims processed to the client's deductible.  

  On 9/27/22, ****************** called our office.  Stated she was going to ****** in January for 8 months and wants to be sure her balance is paid before leaving so once we know how much she'll be owing for her visits inform her so she can stay on top of her balance. 

  On 11/7/22, *********************** contacted our company and stated he thought it was communicated that the patient responsibility would be $30 per session.  It was explained to him that per the explanation of benefits (which the client also received), the claims went to the deductible.  It was suggested he call the insurance company if he believed the claim processed incorrectly.  

  On 11/10/22, Total Rehab refiled the claim to the ******** Supplement plan as a courtesy to the client.  

  On 12/23/22, dates of service 9/1/22-10/5/22 rebilled claims denied as duplicate. Total Rehab contacted United Healthcare (who manages the AARP ******** Supplement plan) to verify the claims were processed out of network and were applied to the client deductible. Total Rehab again moved the patient balance to bill the patient for the claims that applied to the client deductible.

  Patient received statements from Total Rehab on 10/31/22 for $124.50, on 12/31/22 for $******, on 1/31/23 for $******, and on 2/28/23 for $******.  On 10/17/22, the client paid $150 which has been applied to the account.

  On 2/13/23, *********************** called ***** called and stated that he keeps getting statements.  Stated he had paid $150 on 10/17/22. He also stated that he was told that it would be a $30 copay per visit. Statement amount is $ ******. They are currently in ****** and he provided a new email address. ****************************************.

  On 2/13/23 an email was received from ****************** stating,  "This is not acceptable. When **** had her first session, she was told it would cost ?? 30. If that was not the case, she would have gone to GRMC. We will not pay this bill. You have told us on several occasions that the cost per session would be $30. That is what we paid and that is all we will pay. It's on Total Rehab to figure this out and make it right. ****"

  I emailed ****************** on 2/13/23 stating "******************, I can understand your frustration over insurance coverage. I assure you that we feel the same way in our frustration in dealing with insurance. Total Rehab processes your insurance as a courtesy. The ultimate responsibility in the account is the consumer."

  On 2/14/23, an email from ****************** stating, "Thank you for clarifying the situation. However, this current situation is unacceptable to **. When **** first went to Total Rehab, she showed her ******** Advantage card to people who signed her up for PT sessions. She was assured that the cost of her sessions would be covered as In-Network by those who filed her paperwork, and when she asked about this for her second appointment, she was assured again that the cost for each session would be $30. This was again confirmed to me on the phone when I authorized the $150. charge to our credit card on 10/17/2022, and was confirmed again to me by ****** when I inquired about the first bill we received that informed us that we had a balance due of $******, back in November 2022. Your office misinformed both **** and myself numerous times that her treatments would be covered with a charge of $30/session. She would NEVER have agreed to be seen by your therapists if she had been told that Total Rehab was not an In-Network provider, because she could have easily scheduled her PT sessions at GRMC, where they would be covered at $30 per session. The above mistakes are totally the responsibility of Total Rehab and it is your responsibility to make the situation right by absorbing the balance due. We will do whatever is necessary file a complaint with the Better Business Bureau, bring the matter to the attention of the **** ******** office, etc to make sure that we do not have to pay this balance and that our credit rating, which is flawless, is not affected by the failure to pay this bill. Thank you for taking care of and finalizing this matter. ***********************"

  On 2/14/23, I responded with the following email:  "******************, Thank you for expressing your opinion, and I understand your frustration. I have reviewed the notes associated with ****'s account. The balance due is what your insurance has communicated was due. You should also have received the same explanation of benefits from your insurance company. I hope **** is doing well and your travels are safe. Sincerely, ***************************"

  Another email from ****************** was received on 3/14/23, "Dear ******, Weve received another bill from Total Rehab in **********, now with what appears to be an additional service charge of $4.87, making our balance now $329.67. As Ive told you before, this charge is entirely the result of misinformation **** was given by you and others on staff at Total Rehab in ********. This is your responsibility to fix, as we will not pay this bill. If we continue to receive this bill for another month, I will report the issue to the Better Business Bureau in ****. Thank you for dealing with this. ***********************"

  On 3/14/23, another email from ****************** was received stating, "******************, You have not responded to the original mistake: your office and I believe it was in fact ****** -- misinformed my wife about what the cost of the treatments would be. We have paid what we were told the costs would be. We will not pay any more than this. You can take up the problem with your billing office. As far as we are concerned, this bill has been paid. ***********************"

  My response to ****************** on 3/14/23, "******************, I have reviewed this case and have reviewed the communications. I have responded to all of your questions. I understand it is not the response that you would like to hear. Financial obligations for services received is the responsibility of the consumer. Unless further documentation is provided that is not subjective in nature, this case is considered closed. The account balance is what is owed at this time. Respectfully, ***************************, PT, MPT"

  I understand that insurance is challenging to understand and the nuances to coverage.  However, the consumer has to take responsibility for understanding their coverage.  I believe Total Rehab did the best we could to advocate for the best coverage for our client.  The charges are reasonable for the services received.  I have responded to the consumer in a timely manner on all occasions.  Because the client did not agree with the company decision, he chose to go to the Better Business Bureau.  The client did not contact his insurance carrier to the best of my knowledge as was suggested.  

   

  Customer response

  05/08/2023

   
  Complaint: 19967765
  
  I am rejecting this response because:  I was assured by Total Rehab that they were "In Network" with my ******** Advantage plan when I first went to their facility, and that the cost would be $25 per session.  If they had doubts that they were "In Network" with my ******** Advantage plan, they should have communicated this to me.  They expressed absolutely NO doubt; they assured me that their cost would be identical to the cost were I to receive treatment at ********************************.  They made the mistake; they misinformed me about my coverage; it is their responsibility to know what networks they belong to and what networks they don't belong to.  If they cannot guarantee that their services will be covered by the insurance companies covering their patients, they should post on their door:  "Have treatment at your own risk:  We cannot confirm that what will tell you about your insurance coverage at our establishment is true.  You are on your own and if we misinform you, that's your fault, not ours."  Their billing of me is not right; they should admit they made a mistake and they should take financial responsibility for their mistake. If I had the slightest doubt that my treatments would be covered, I would have tried to confirm this with my insurance company or would have gone elsewhere.  Once again: the assured me that my treatment would be covered.
  
  Sincerely,
  
  ***********************

  Business response

  06/13/2023

  We understand Mr. and ******************* are unhappy about the bill they received from Total Rehab.  We understand they believe Total Rehab should have communicated their insurance benefits.  Total Rehab is a provider for Physical Therapy and Occupational Therapy services.  The insurance plan the consumer choose is the consumer's responsibility to understand their plan benefits.  In this case, this consumer did not take any steps to contact their insurance carrier to validate their benefits.  Total Rehab was engaged for services by this consumer.  The consumer signed paperwork which allowed Total Rehab to bill the insurance they provided, and then we administered our service.  Our providers have not been paid for the hard work and care they provided to this consumer. 

  Business response

  06/14/2023

  We understand Mr. and ******************* are unhappy about the bill they received from Total Rehab.  We understand they believe Total Rehab should have communicated their insurance benefits.  Total Rehab is a provider for Physical Therapy and Occupational Therapy services.  ************* plan the consumer choose is the consumer's responsibility to understand their plan benefits.  In this case, this consumer did not take any steps to contact their insurance carrier to validate their benefits.  Total Rehab was engaged for services by this consumer.  The consumer signed paperwork which allowed Total Rehab to bill the insurance they provided, and then we administered our service.  Our providers have not been paid for the hard work and care they provided to this consumer. 
  

  
  

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