ComplaintsforGailey Eye Clinic. LTD

• Initial Complaint

  07/14/2023

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  I had gone for my annual eye exam and then decided on getting a new pair of glasses at Gailey. After a few weeks, I noticed the discoloration on the inside of the glasses. They were turning black and had me worried. I was concerned and I called to want to meet with the same lady who processed my purchase, but was told appointments for that wasn't necessary and I can just walk in. I went in, she was not available, but not a big deal. Another lady helped me and I explained the issue, she saw what the glasses looked like and she agreed that was odd and they are defective. She stepped away from the desk and came back with a new frame. I pleaded with her about getting another pair of a lesser value, but said no. I paid about $360 for this pair however, the fact that they were discoloring and defective, I wasn't interested in being given a newer of the same frame, rather I wanted something different even cheaper to just be done with it. She said no that's not possible (this was about 4 months after the initial purchase), but if they do show discoloration again, come back and we will figure out a long-term plan...meaning, I will either get an exchange or refund. The time that I went in for the initial issue was within my warranty period, and I was told that, since the issue wasn't me, the warranty will extend or start new from the time I got the second frame which was Sept or Oct of 2022. Unfortunately, the newer frame also have discoloration so I haven't worn them. The glasses from Gailey that I paid about $360 have been sitting around not being worn because they're defective and Gailey would not make an exchange or even give a partial refund. The original lady who sold me the glasses was short with me and not helpful at all when I called back about the glasses again earlier this week. I was told, a long-term plan will be implemented and now they don't want to assist me in correcting their mistake. I have lost $360 from all of this and it's totally not ok.

  Business response

  07/21/2023

  I feel that as a company we have been attentive to this patient and her requests, however I don’t feel comfortable issuing a refund to this patient.  Based to the below findings.
  The patient was unhappy with her frame after 5 months.  She felt the frame discoloration was a manufacture defect.  Patient wanted to choose a different cheaper frame, but we were not able to accommodate that request.  Prescription eyeglass lenses are custom designed and cut for each individual.  We would not be able to reinsert the current lens from the defective frame into a completely different frame.  However, we were able to replace the defective frame with another frame of the same shape and style under the 1-time manufacture warranty at no charge. 
  The patient returned 10 months later claiming that the warranty frame that we switched out was also defective.  At that time, I reached out to the manufacturer to see if this was a known issue.  The manufacturer shared with me that this was not a known issue and that in fact this frame was one of their best sellers.  I shared that information with the patient and explained how we had already used their 1-time manufacture warranty previously, but to help so that they could have a new frame I offered to sell them one at our cost.
  The manufacture warranty does not cover intentional damage, pet damage, loss or stolen frames, or normal wear on tear.   I feel that the discoloration that this patient is experiencing is from normal wear and tear of everyday use over the last 10 months.
  The patient has requested a refund of $360.  I am unsure where that total came from.  The frame, which is the part that they feel is defective, retails for $224.00.       Also commenting that we would not make and exchange, which we had previously done.

  Customer response

  07/27/2023

   I am rejecting this response because: the amount I mentioned is roughly what I paid for the glasses not just the frame. Also, when the business reached out to me via a phone call I didn't request a full refund, I asked for 50% refund from the total cost (of about $360) which is what I paid for the glasses not just the defective frames. 

  The business also called me to say I could get new glasses and only pay 50%...again, they want me to pay for the remaining cost of 50% for new glasses when I'm already out of lots of money from the previous pair. The representative from the business also agreed that the employee made a bad judgment call about the new warrant once I got the first frame replaced. For someone who doesn't wear makeup and has had numerous glasses, I can't believe they would try to argue that the discoloration was my fault (per the manufacturer response). I've never ever had frames that were defective or diclored. And I've to say that, I used to go to Gailey in Champaign and have always been happy with the services provided there. But this one time that I went to the Bloomington location, I had the worst service. Safe to say I'll not be returning to this business. And I'll not waste more money for something that should be corrected by the business. So unfair. 

  
  

• Initial Complaint

  04/20/2023

  Complaint Type:

  Billing Issues

  Status:

  Resolved

  More info

  I had an exam in the Galesburg office 11/1/22. I received an invoice for $45 in December. I paid that invoice with ck ***** on 12/18 and it cleared my bank on 12/22/22. I received another invoice for $45 in January but assumed my payment had not been processed so ignored it. I got another invoice on Feb 6,2023 for $45 dollars. I ended up speaking with ******** at Gailey and after she looked into the issue she said it was a billing error on their part and I did not owe anything. I get ANOTHER invoice for $45 on March 13,2023. I called again and this time spoke to ********* who told me ******** was not available. ********* said she would have to look into the matter and would call back. When she called, she said I didn't owe anything so I requested to get this in writing. She said she couldn't do that but would send me a $0 balance bill. That bill never came. I then received another invoice for $45 dated 4/07/23. I call again and speak with ********* who initially said "I don't see anything due, oh, but let me check the patient side". There she sees the balance and says it's from a *** ******* shortage back in 2020. I know that's not correct because *** has always paid in full. Again, she tells me she will have to look into it and will call back. That was 48 hours ago..no call back. So I just called and left a message on her voicemail. I do not have high hopes that she will return my call or get this problem resolved. My patience has run out with this issue and I have done everything I can to resolve it with no cooperation from their Bloomington business office. I have been a patient with Gailey since they opened their office in Galesburg. I have always been very satisfied with the exam and the customer service I receive during my appointment. But this issue with their business office has me shopping for another eye care provider.

  Business response

  04/24/2023

  Our sincere apologies to this patient and their experience.  We strive to provide quality care to our patients.  We have reached out to the patient regarding their experience and the outcome was favorable.  

  Customer response

  04/28/2023

  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.

• Initial Complaint

  03/24/2023

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  I had a regular check up on March 1 and was given a laminated sheet with an option for additional imaging available for $35 and I was told not to pay that day because they would see if insurance would cover it. Then I received a bill in the mail for $145. I have explained this to them but they say I agreed to something else that was more expensive but I did not. I was not told there were other options. They said they would give me an answer in a couple of days but that was over a week ago and they said they called me on Monday which they did not. Lots of deception going on with this

  Business response

  03/27/2023

  We have heard back on the review of this account in which we were pending yet as of Friday when patient had contacted us.  Further, we have reached out to the patient with the outcome and believe a resolution has been reached on the situation at hand.

• Initial Complaint

  03/24/2023

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  I called to make an appointment for my son to be seen for a routine eye exam. My son had been seen by this eye care clinic before, as had many of my other children and my spouse. When I made the appointment I asked them if it was at least 11 months from his previous visit for insurance purposes. They told me over the phone that they looked up his previous appointment and that the new appointment would be over the 11 month requirement. After the appointment I received a bill from them that stated insurance refused to cover the routine eye exam. This was strange because two of his brothers had been seen at the same time and their eye exams were covered by insurance. When I called they assured me it was an insurance code issue on their end and that they would resubmit with the correct treatment code. I received another bill the following month showing that insurance denied the claim again. The second time I called they said they had no note from my previous call, and that there had been no resubmission to insurance. The individual on the phone from the billing department assured me they would resubmit to insurance. I received another bill in the mail with no insurance coverage. The third time I called they it was not a treatment code issue and that I would need to contact insurance to resolve the issue. When I contacted insurance they informed me that all appeals to denials must be submitted within 90 days. However, due to the clinic misleading me about it being a code issue for months, I was now outside the 90 days. When I explained that to the eye clinic and requested to be held harmless since they made two mistakes that lead to insurance not covering the charges, they denied my request. My family of eight have been a loyal customers for more than a decade, and after two mistakes made by the eye clinic they are refusing to excuse the charges of less than $250. This is horrific customer care and negligence from the billing and insurance department.

  Business response

  03/31/2023

  After looking into your situation, we have noted that everything was billed correctly.  We would be happy to provide you with clarification again, if you'd like to contact us.  We understand you would like us to adjust your balance yet everything was filed and processed correctly by insurance.

  Customer response

  03/31/2023

   I am rejecting this response because: I do not need clarification. Over a period of four months your billing and insurance staff assured me that the issue was with the billing code and that Gailley would rebill insurance. They lied, were woefully misinformed, or were incompetent and by the time they figured out that they had made a mistake it was too late for me to file an appeal with my insurance and get my insurance to pay the bill. My insurance has paid your office over $10,000 over the last 12 years. I have had numerous other billing issues with your clinic in which I had to inform your billing and insurance personnel of how to do their jobs in order to get insurance to pay you. This time, like the others, was your fault. You shirking blame off on me and calling me a liar is not resolving the issue.
  
  
  

  Business response

  04/03/2023

  We received our first call from the father on 11/30/2022 inquiring about the August 2022 date of service for his child, 4 statements had been sent out at this point.  The Patient Accounts Representative documented the conversation stating she mentioned the charges appeared to be possibly coded incorrectly and that she would send the claim over for review to the appropriate department. The father then called Patient Accounts again on 02/24/2023 and spoke with another Patient Accounts Representative who conveyed the same information as above.  Upon review we found the coding to be accurate.  The claim was billed with the same vision diagnosis codes used on previous dates of service for this patient and those claims processed and were paid by the insurance company. Additionally, on 2/24/2023, another Patient Accounts Representative then called the insurance company to research deeper as to why the claim denied, the insurance stated it was because the patient had 2 vision exams within a one-year timeframe. They went on to state they would only pay for one vision exam within a 12-month period. 03/15/23 We did receive a letter from the insurance company stating they must receive a reconsideration no later than 90 days from the date of denial and ours was beyond that timeframe.  We never did submit a reconsideration to the insurance company, we simply called on 02/24/2023 questioning/asking for clarification on the denial reason as noted above.  No reconsideration was ever submitted as it was not necessary because the claim did process correctly based on the above evidence. When the father called back on 3/24/2023, the Patient Accounts Representative shared the details received from the insurance company.  The father stated this was not true and that we had billed incorrectly.  The Patient Accounts Representative attempted to explain to the father and recommended he contact his insurance company; additionally offered the father the reference number we received from our phone call with the insurance company, but the father hung up on the Patient Account Representative.
  Patient Accounts Team Lead then spoke with the father and shared the same information as above.  The father stated that his insurance paid for his other children’s visits on the same day. Patient Accounts Lead reviewed the other children’s accounts and found they only had one vision exam within that year.  This was why their claims had paid and why this other child’s exam had not been covered.
  

  Customer response

  04/03/2023

   I am rejecting this response because: I called more time than is mentioned. I told one of the representatives this and they said that the previous personnel must not have made any notes. Gailey never made it known to me that they contacted the insurance company. Each and every time I called they indicated that it was a coding error and that they would resubmit. One of the representatives was confused why it had not already been resent based on the notes. If at any time Gailey had notified me that the claim was being denied due to it only being 11 months from the previous appointment, I could have easily appealed the insurance denial, and likely would have had it paid out because it was within days of the 11 month allowance by my insurance. However, Gailey repeatedly told me it was a coding issue, until it was too late for me to file an appeal with insurance.
  
  
  

• Initial Complaint

  08/08/2022

  Complaint Type:

  Billing Issues

  Status:

  Resolved

  More info

  I called around December 4th of last year to check if my insurance would be covered. They assured me it would be covered and I have my eye exam on the 27th. After taking too long to give me eye glasses I went elsewhere with no problem. 9 months later I get a 400 dollar bill and they're telling me insurance doesn't apply. In addition the free eye exam promo just doesn't apply and they can't tell me why. This is ******** practice to price gouge, if they'd just waive the eye exam I'd pay the rest but no they can't even do that right.

  Business response

  08/08/2022

  Upon review of the patients account this afternoon, I did see a few discrepancies.  The BCBS card for the primary insurance we had on file for this patient, after closer review by my Patient Accounts Team in early July of this year, due to the balance still outstanding with them, we investigated and found this policy to be inactive on the DOS.  At this point, we proceeded with billing the patients secondary insurance we had on file, Aetna insurance through the college of Illinois State University.  Upon receipt of response from Aetna on 07/22/2022, we received the EOB (explanation of benefits) stating patient was not eligible due to patients age, reason code N129.  At this point, we had balance billed the patient, once we heard from the insurance since they stated they would not cover services rendered.  This statement was sent to the address we had on file which matched the patients ID card presented. Yet the address patient provided at time of service on the New Patient Questionnaire Form is the local Bloomington Address as noted on this complaint.  Being the Date of Service was within one year of the response from insurance, we can legally balance bill the patient for anything insurance did not cover.  I believe there may have been miscommunications in our services to the patient as he was under the impression that the insurance would cover his balance in full.  The insurances provided are plans we are in network with, yet the BCBS card through his mother is showing inactive and the Aetna denied as mentioned above unfortunately.  Due to the extreme dissatisfaction the patient is experiencing, I am willing to absorb the charges billed to the patient for a patient satisfaction outcome.  The amount I will adjust off today is the balance in full, of $390.00.  I have spoken with the patient and he is very pleased with this outcome.  Please touch base with this patient as he is willing to rescind this complaint.

  Customer response

  08/08/2022

   Better Business Bureau:
  
  I have reviewed the response made by the business in reference to complaint ID 1*******, and find that this resolution is satisfactory to me.

• Initial Complaint

  09/26/2021

  Complaint Type:

  Service or Repair Issues

  Status:

  Unanswered

  More info

  I had an eye exam with Gailey Eye Center in August 2021 and took that prescription to another provider to actually buy the glasses. The prescription was for tri-focal glasses, which I had never worn. I had the glasses made, and wore them for a few weeks before returning them because tri-focal lenses just don't work for me. This provider was happy to swap out the lenses with standard "reader" lenses, which was what I requested. However, in order to put new lenses in, they asked me to call Gailey to write a new prescription with only the reader portion completed. I did that on 9/13 and was told they would try to have it completed that day, but it may be tomorrow. Long story short; it has been two weeks, I have called about every other day. Each time I call, I have to start over. They don't seem to have any recollection or records of prior calls, and several times have transferred me to someone else on the same call, only to have to start all over again.

*Some consumers may elect to not publish the details of their complaints, some complaints may not meet BBB's standards for publication, or BBB may display a portion of complaints when a high volume is received for a particular business. ↩