ComplaintsforJoshua Max Simon Primary Care Center
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Complaint Details
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Initial Complaint
04/09/2024
- Complaint Type:
- Billing Issues
- Status:
- Resolved
I had a doctor visit at the ************************ with ******************************** on 11/28/23 and my claim was sent incorrectly to my insurance UMR as if it was in a hospital setting which caused my claim to be applied to my deductible instead of my $20.00 copay for an office visit leaving me with two bills totaling over $179.00 which is clearly an error. I received two bills from ***************** for this office visit. I have repeatedly contacted their billing customer service, the doctor and a supervisor at ***************** Joshua Max Simon primary care center since January 2024 until today April 5th and this issue still has not been resolved. I need these claims re submitted correctly to my insurance so that I can receive a corrected bill. They have my insurance information and can clearly see that I should only pay a $20.00 copay per my insurance plan I do not owe these bills and I have disputed them since I received them but with no resolution to this issue. My insurance needs a corrected claim resubmitted so these bills can be paid. I was told that they were resubmitted but my insurance UMR has not received a corrected claim as of today.Customer response
04/16/2024
For some reason I was billed from the ************************ Center for one of these bills and no one has been able to explain why, I was never at the ***********************************************. I was told I was billed for a facility fee and the doctor visit which I do not know why. They also billed me under two different account numbers for the same date of service and I still have no explanation why. I went to this clinic for many years previously and have never been billed like this before.Business response
04/24/2024
April 24, 2024
Dear BBB Representative:
I reviewed the complaint from *************************** upon receipt yesterday and spoke with **************** today. **************** is frustrated about receiving two bills for her services received on November 28, 2023. Patients of The Joshua Max Simon Primary Care Center at Ascension ****************** ("***") is a teaching residency clinic and is a hospital outpatient department. As a result of being a department of the hospital, our patients receive two bills following their services here. One bill is for the physician professional services and one bill is for the facility fee or technical services. The billing statements associated with ******************** November 28, 2023 visit are accurate. Our supervisor recently spoke to **************** and had already written off the facility/technical services bill. I do appreciate the confusion and frustration **************** has experienced and as a good faith gesture, have approved 100% write-off of the second bill for professional services related to her November 28, 2023 visit at the ***. I have shared this action with **************** during our telephone conversation and explained that our designation as a hospital outpatient department cannot be changed and if she were to have future services at the *** she would receive two bills for services as described above.
Please let me know if you have any questions or additional comments.
Sincerely, *********************
****************************
************
Customer response
04/25/2024
Better Business Bureau:
I have reviewed the response made by the business in reference to complaint ID ********, and find that this response/resolution is satisfactory however I was a patient at this clinic for more than 20 years as well as my children and have always only paid a $20 copay according to my insurance plan. There had to be something in the coding when these claims were sent to my insurance for processing to make my insurance think my place of service was inside of a hospital. This is a residency clinic not a hospital so I should not have been billed a deductible for an office visit I was told several different answers as to why I was billed this way and none made sense. This is a free standing building separate from the hospital and my deductible only applies if I am in the actual hospital. That is where the frustration comes from, I am glad the bills were written off but there is still an issue that I received them in the first place. How can I go to a clinic for twenty plus years and this never happened before and I had the same insurance plan and same copay? I was told the claims would be resubmitted with doctors notes explaining that the place of service was not a hospital but that never happened, they never got a re submitted claim. I will never go to this clinic again so this wont happen again.
Regards,
***************************
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Customer Complaints Summary
1 total complaints in the last 3 years.
1 complaints closed in the last 12 months.