ComplaintsforRiver Ridge Surgical Suites, LLC

• Initial Complaint

  10/10/2023

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  My wife had surgery scheduled at this center. Upon arrival, they demanded that we pay $368.69 saying it was our deductible and was owed. I tried to explain to the billing person that the surgery was covered at 100%, and had nothing to do with our deductible or copay since it was covered at 100%. I even called my medical provider and had her call as well to verify this which she did. But still refused to do my wife's surgery unless we paid. They basically held us hostage in order to get the procedure performed. Once the bill was paid, we contacted them to get our refund as we are on a fixed income and desperately needed this money. They are abusing patients by making us pay up front money we don't owe them, and we were forced to put it on a credit card and pay interest for something we never should have been billed for in the first place. I am demanding that they change their policy immediately! I tried to reason with them but they insisted on taking our money or no procedure. This is extortion! I expect an apology and an immediate change in their policy, as the billing department obviously doesn't know how to do their job and are hurting innocent people.

  Business response

  10/20/2023

  Good afternoon.

  We have reviewed the account involved in complaint.  This patient was scheduled for surgery 8/31/2023.  Patient benefits were checked 8/08/2023 through ******** benefit verification service.  It was confirmed the patient had 0% coinsurance, $400 deductible with $31.31 met, and an out-of-pocket maximum of $3,400 which $476.31 had been met.  This did calculate a $368.69 estimated patient responsibility.  ****** processed the claim, and we received the Explanation of Benefits along with payment 9/25/2023.  The claim was processed in our billing department 9/26/2023.  A refund was mailed to patient 10/04/2023.  River Ridge Surgical Suites is not aware of a complaint or a request to recheck benefits on the date of service or any time prior to date of service.  However, our billing department was contacted by patient's husband 10/03/2023 to request a refund.  He was advised at that time the refund process had already been initiated.

  Prior to surgery, we check patient benefits and review estimated financial responsibility with every patient.  Our insurance verification team spoke with the patient on 8/08/2023 and the patient did not express concern with the estimate.  River Ridge Surgical Suites does recheck the patient benefits at their request.  We do make every effort to work with all patients with financial hardship.  Our center also does participate with **** ****** which offers a no interest 6 month option as well as long term options.  It is customary to advise all patients of this option when discussing estimated patient responsibility.

  Thank you for allowing us the opportunity to respond.
  

  Customer response

  10/22/2023

  
  Complaint: ********  
  I am rejecting this response because:

  We already had other medical bills being processed that we actually owed parts of what River Ridge charged us up front. Had they followed SOP protocol and billed insurance without demanding payment up front, as other providers have been doing for years, we never would have had to pay money we didn't owe up front only to have them refund our money in full. This is bad business practice and extortion in order to get the medical care needed. Just because a balance due shows up on the day they check doesn't mean it is owed to them, and it wasn't as our insurance plan paid them in full as I told them it would be as I had already confirmed benefits prior to procedure. They need to change their policy.

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

  Business response

  11/03/2023

  Good afternoon.
  

  Thank you for the opportunity to respond.  River Ridge Surgical Suites has followed our Standard Operations Procedure according to the patient's Acknowledgement of Financial Responsibility which was signed by patient and is attached.  It states, "the following is an estimation what you will be billed for services provided.  Final bill may be higher or lower depending on the procedures actually provided on your date of service.  Any amounts paid prior to the procedure will be applied to the total patient responsibility; a refund will be issued for any overpayment amounts."   **** ******* was contacted 8/8/2023 and instructed what the estimated responsibility would be and offered and option to help with payment should she not be able to provide payment on her own.  At that time, **** ******* did verbalize understanding.  As soon as an overpayment was recognized, a refund was mailed within 6 business days.  River Ridge Surgical Suites does appreciate all patient feedback but do feel SOP was followed and **** ******* was treated fairly and justly.

  River Ridge Surgical Suites follows the same process with all surgical patients.  

  Again, thank you for the opportunity to respond.

  Customer response

  11/06/2023

  
  Complaint: ********
  
  I am rejecting this response because:

   

  They need to change their standard operating procedures! MY standard operating procedure is to NOT pay a bill prior to it being submitted to the insurance company first so they can't hold my money (and our medical procedure hostage), which they had to pay ALL of it back because as I stated and proved, we did NOT owe them any of that money and should NOT have to pay ANYTHING up front as I have already proved to them. They MUST change their SOP in order for me to be fully satisfied so future patients are not forced to pay money up front that they do not owe...PERIOD!
  
  Sincerely,
  
  **** *******

  Business response

  11/17/2023

  Thank you for the response.  Our procedures are in line with business and insurance industry standards.  Per our insurance contract, we are allowed to collect estimated allowances due.  These estimates provided are per the patient's insurance company representative.   We do not hold a procedure "hostage" due to estimated allowables but do provide a **** ****** option if needed.  Our standard operating procedure is to always work with our patients if we are made aware of an issue.  If a refund is due patient, we do ensure these are processed in timely fashion as indicated by our turn-around time with this case.

  Customer response

  11/18/2023

  I absolutely do NOT accept this response as normal business practices as NO other medical facility has EVER pre-charged me for ANYTHING!!! I absolutely and formally REJECT their excuse and demand change or leave this complaint on their record so others can see exactly how they will be treated and take their business elsewhere.

   

  
  Complaint: ********
  
  I am rejecting this response because:
  
  Sincerely,
  
  **** *******

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