ComplaintsforSabates Eye Centers P.C.

• Initial Complaint

  07/02/2024

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  I had cataract surgery with Sabates Eye Center with ** ******* and the charged me a copay that 2430.30 X2 first one on 10/25/23 and the second on 11/1423. Only to refund 238.42. Surgery was on **** Eye Center across the hall from them. Insurance paid and stated I should have not paid anything. **** was paid in the first Copay of 1474.19 and the second Copay of 971. refund of 503.19. They have told me that I will not be receiving anymore due to I had to pay for the upgrades on my lenses. Insurance said again that we should not have paid anything. The words they use is upgrade, however, insurance did pay what was charged and what was allowed they charged. **** charged 7,740.00 discount was 4,253. and paid 3,487. with me owing nothing per EOB. for both dates of service of 10/26/23 and 11/15/23. ** ******* Sabates Eye Center charged 1950. discount applied 1362.77 and paid 587.23 with me owing 0. for both dates of service 10/26/23 and 11/15/23. upgrades or not the insurance paid for what was billed and the discount is contract between Dr and insurance. I am paying on 4,621.58 for ** ******* office and **** ****. plus interest 20.24% on a credit card to pay for surgery and the insurance said I should not have paid anything, our family out of pocket had been met. I am frustrated that Insurance said and the EOB shows that they have been paid and that I owe nothing. The ****** lenses in the estimated bill shows it was 1550. charged per lens on the itemized statement. the charged me for the lenses 2430.30 per lens. I am paying interest on this as well.

  Business response

  07/29/2024

  I have attached the documents supporting the charges that we billed for ***** ******* surgeries on 10-26-23 and 11-15-23. The Good Faith Estimate (pg 2) indicates the amount the patient needs to pay for her portion of the estimated coinsurance and the upgrade professional fees for the physician's portion. In addition to the basic cataract surgery (which is billed to insurance and in this case, paid at 100%), the patient also chose an out of pocket upgraded lens. Of the upgrade, the only portion that Sabates Eye Centers charges the patient, is the professional fee to insert the upgraded lens. **** (the facility) charges and collects the for the lens. This was all explained to the patient prior to surgery and the patient signed consent forms (included in the packets attached to this response). The professional fee is not billable to insurance therefore, the patient is required to pay for this service up front. I have included the insurance explanation of benefits indicating that the insurance paid the basic cataract surgery at 100% and a copy of the patient's credit card refund slip where we refunded the overpayment of estimated coinsurance. There is no other refund due to the patient for the professional fees, as the patient paid up front for the upgraded service. The professional fees are not billed to insurance (per our contact with insurance companies), there were no insurance payments towards the upgrades. Premium upgrades are an out-of-pocket fee.  We do not bill insurances as it's a non-medically necessary procedure.  Our professional contracts do not include these services therefore they are deemed self-pay services.  We contractually cannot bill to any insurance.  Our contracts trump everything else, we are legally obligated to follow those unless otherwise notified of a change.

  As far as the patient calling ****; we are a separate company from the facility and should be treated as such. 

  Customer response

  07/30/2024

  
  Complaint: ********
  
  I am rejecting this response because: I feel this is double dipping into peoples pockets. From the older people that I see that have also had the same problems as I am stating. Yes, I do understand that **** Eye Surgery is a different in entity. However, you charge people prior to their surgery to not give them their refunds.  Stating it is a upgrade and then charge one price to the patient and send the charges to insurance with a lower amount.  Charged me 2430.30 times 2  and sent the insurance 1550.00 there is always a difference in what insurance allows part of what you do to get your money.  Insurance paid what they allowed and have told me that I should have not paid anything.  I should have went somewhere else and will not recommend you to any family or friends.  I still think that you should refund what is owed. I am still paying on my surgery and will be for awhile 4860.60 plus is not easy to come by these days.  You use the word upgrade and people walk away.  I am already having issues with my sight and  will go somewhere else. 
  
  Sincerely,
  
  ***** *****

  Business response

  07/31/2024

  The service that was billed to insurance was not the same service that the patient paid in for in advance, therefore it was not "double dipping". The professional fee was for only pertaining to the upgraded lens that the patient chose in addition to the basic cataract surgery. If the patient had not chosen to receive an upgraded lens, there would not be an additional charge for that service. This was all explained to the patient prior to the surgery. 

• Initial Complaint

  08/16/2023

  Complaint Type:

  Service or Repair Issues

  Status:

  Unanswered

  More info

  MY WIFE HAD CATARACT EYE SURGERIES ON MAY FIRST, AND MAY22ND OF THIS YEAR. WE WERE REQUIRED TO PAY FOR EACH SURGERY IN ADVANCE WHICH WE DID FAITHFULLY. WE WERE TOLD THAT ANY MONEYS PAID BY MEDICARE OR OUR INSURANCE WOULD BE REFUNDED TO US. ACCORDING TO OUR INSURANCE DOCUMENTS (ATTACHED), $4802.07 WAS PAID BY ****** FOR THESE SURGERIES, IN ADDITION TO THE $3300.00 PER EYE THAT WE WERE REQUIRED TO PAY, UP FRONT, BEFORE THE SURGERIES COULD PROCEED.. THE BILLING DEPARTMENT OF SABATES NOW SAYS THAT THE MONEY THAT WAS REFUNDED TO SABATES WAS FOR PORTIONS OF THE SURGERY THAT WE DID NOT PAY FOR. THAT IS ABSURD!!! WE WERE REPEATEDLY TOLD THAT THE ENTIRE SURGERY WAS TO BE PAID FOR IN ADVANCE BEFORE THE SURGERY TO PROCEED. IN ADDITION, THE SURGEON, DR. KEVIN PIKEY DETAILED WHAT THE SURGERY ENTAILED. I HAVE SENT TWO LETTERS TO THE SURGEON; AND SEVERAL EMAILS TO HIS BILLING DEPPARTMENT TO NO AVAIL. THIS IS CLEARLY A CASE OF 1) DECEITFUL PRACTICES; AND 2) OUTRIGHT FRAUD. MANY OF SABATES CUSTOMERS ARE ELDERLY AND RETIRED, AS ARE MYSELF AND MY WIFE. IF THEY ARE ALLOWED TO PERPETRATE THIS FRAUD ON ALL THEIR PATIENTS, I WOULD HAVE TO SAY THAT THIS IS NOTHING MORE THAN A SCAM PERPETRATED ON THE ELDERLY. CAN YOU HELP???

  Customer response

  09/23/2023

  I HAVE NOT HEARD ANYTHING FROM SABATES EYE, AND SUSPECT I NEVER WILL. JUST FOR YOUR INFORMATION, I HAVE SPENT LITERALLY ABOUT 40 - 50 HOURS FILING COMPLAINTS WITH ****** INSURANCE; THE MISSOURI ATTORNEY GENERAL'S OFFICE; THE MISSOURI DEPARTMENT OF COMMERCE & INSURANCE,  AND THE BBB. SABATES HAS ACTUALLY VIOLATED BOTH STATE AND FEDERAL LAWS CONCERNING : "BALANCE BILLING" a/k/a "SURPRISE BILLING" YET NO ONE SEEMS TO WANT TO ENFORCE THE LAW.

  
  

• Initial Complaint

  03/19/2023

  Complaint Type:

  Service or Repair Issues

  Status:

  Unanswered

  More info

  I went to Sabates to have cataracts removed from both eyes. I was presented three options: the standard (to be near-sided or far-sided) lens replacement or a more advanced lens. Insurance would cover the standard lens procedure. I would have to pay out of pocket expenses (nearly $6000) for the advance lenses. I decided to pay for the advanced lenses because I was told I would NOT have to wear glasses after the procedure. A few months have passed, and I still have blurred vision. The doctor told me I'd need glasses to fix my blurred vision. Another option would be to have surgery again, making one eye far-sided and the other eye near-sided. I do not want another surgery or want to wear glasses. I would like a full refund of my out of pocket expenses.

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