ComplaintsforGold Coast Surgicenter

• Initial Complaint

  03/31/2022

  Complaint Type:

  Billing Issues

  Status:

  Unresolved

  More info

  On Wednesday 24th *************************** was given surgery to repair a torn ACL. The business, in violation of the No Surprises Act of 2022 failed to provide 30 days after the operation to enroll us in a payment plan. Instead they informed us that we must enroll in an autopay prior to the operation in an amount greater than the deductible. After the insurance company paid out the claim to the insurance company, we were billed ****** over the amount explanation of benefits provided by the insurance company.****** from the center refused to allow us to pay one installment of the payment plan and reevaluate after the claim was processed. *************************** refused to reimburse the overbill.All other companies we have dealt with were able to correct the overpayment in a timely manner; however, Gold Coast ************** has refused to repay us for another month at the earliest. If you look at the reviews of this center, you will see almost every review states that they -overbilled despite being aware of the overbilling -required payment upfront despite being required by law to offer up to 30 days after service to enroll in a payment plan AFTER proper billing has been accounted for.-refused to pay back the overbilled amount in a timely manner after acknowledging the overbilling.These are practices that other participants in the health care system have been able to reconcile with us. This is the only company we have dealt with that billed us incorrectly AND refused to work with us to resolve.We are requesting either:reimburse the overbilled amount within the 14 days of this complaint being filed void the transaction from 3/23 for $614.98, and a paper **** be sent for the remainder ($93.31) to our address on file.We also plan on filing a complaint with the Centers for ******** and ******** regarding the specific infractions of the No Surprises Act, but that body does not have a way of requesting payment in the interim. The BBB is our best bet to resolve.

  Business response

  04/07/2022

  Good afternoon ******************,

   

   

  Our facility is contracted and IN-Network with **** of IL. Gold Coast participates in the **** *** voucher program. I have attached some information regarding this program so you can understand our billing practice. I understand your claim status states the claim processed on 03/01/2022 ,however, Gold Coast will receive the payment within 60 days from the date of process. You will receive your refund once the **** payment has been posted to your account, which will be the last week of April. You will receive a refund in the amount of $521.67. The No surprises act pertains to OUT of Network billing please see attachment. In your case you are not out of network. The patient was provided an Estimate which comes directly from our contract with the provided CPT codes from the physicians office (see attached) this was provided on 02/17/2022. The patient had surgery on 02/23/2022 and at this time the automated payment plan was set up by the patient see promissory note. The payment plan was stopped on 03/24/2022 when the claim status was checked by Rosette the billing specialist. As soon as **** deposits the monthly voucher you will receive your credit back on your credit card. We are not withholding your credit. We have not received payment from the insurance company as of yet due to the *** **** voucher program. Please let me know if additional information is needed.

   

   

  Thank you

  ****************************

  Business Office Lead

  Customer response

  04/12/2022

   
  Complaint: 16970672
  
  I am rejecting this response because:

  I inquired on the specific date they will reverse the transaction and the root cause of the overbilling. This was 5 days ago and they will not respond. I am pasting the email here to get the business to give me a date and reason for the overbilling. The email is also attached.

  ---------------------------------------------------------------------------------------------

  Good Afternoon,

  
  I understand what the *** voucher program is. There is nothing in these documents that state that you HAVE to hold our payment while waiting for repayment from insurance. You have stated yourself that BCBS will pay your company back within 60 days. 
  
  What is the expected date that the reversal will be submitted by your group? Is it April 25th?
  
  The claim was finalized 3/1. Why were we charged 3/23/2022? Why was the plan cancelled 3/24/2022, one day after the overcharge and over 2 weeks after the claim was finalized?

  Sincerely,
  
  *************************

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