ComplaintsforOral-Facial Surgery Associates, P.S.C.

• Initial Complaint

  09/22/2022

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  On 9/22/2022 my wife took my daughters for an evaluation. We chose Dr. K***** because he was in-network. His office is 1 hr and 3 minutes away from our home (roughly 43 miles). We have to pass several other surgeons' to get to his facility in Florence, KY. We were notified after services that we owed $470.00 because we were out of network. My wife was informed that they ended their contract with ****** 3 weeks ago and she needed to pay for the entire amount before being allowed to leave. The office DID NOT NOTIFY US THEY WERE OUT OF NETWORK UNTIL AFTER THEY PERFORMED SERVICES AND DEMANDED IMMEDIATE PAYMENT. We would have never came to this doctor if we would have even thought they were out of our insurance network. This is clearly an unfair business practice. Almost a bait and switch. I attempted to speak to the office manager, Yvonne, and got the run around. She was not present during the visit but informed me that my wife "was aware that we are now out of network." This is 100% lie. We would have left the facility immediately without having completed any services. WE WERE NOT INFORMED WE WERE NOW OUT OF NETWORK OR A POTENTIAL COST OF THESE SERVICES! I asked the office manager for the payment to be reduced to what it would have cost in-network due to their unfair billing practices. She declined and said that we can be put on a billing plan. Yvonne had no intention of helping the situation. She stated that there may be a reimbursement from ****** and the claim was already processed. I asked if they could process one claim and know the amount then why weren't we at least informed of cost at that time. Also ,I spoke to my insurance and was informed that there is no pending claim at this time (but, it may take a few days..I receive an email when a claim come through, its not instant). I did state I would consider disputing the charges due to improper billing practices and she stated that was fine as they did services they could show completed. No excuse for this..

  Business response

  10/13/2022

  Hello BBB Representative, 
  
  RE: Complaint #******** 
  
  First of all patient care and experience in our office is always our top priority. *** ******* is correct we are newly out of the Anthem network so we have tried to be very diligent in informing every patient before their appointment that we are out of network. Our front staff employee remembers speaking to **** ******* the day before the appointment to confirm and reiterate to her we were out of network and she would pay the charges for the day and we would file the claim and anything paid by insurance would be paid to them. 
  
  We have been told many times by Anthem all out of network payments go directly to the insured, however since terminating our contract we have found out through Anthem that some employers do allow payment to out of network providers. We did receive payments for ***** and ***** on October 12'". The payments received were $94.50 per patient and were processed on October 13th. Two checks have been issued in the amount of $94.50 on October 13". 

  There is never a bait and switch at our office as alleged and there is never an attempt to mislead anyone. Everything was done correctly at our office in regards to these patients. 
  
  Regards, 
   
  Yvonne R********* Office Manager Oral Facial Surgery Associates 1481 Cavalry Drive, Suite 200 Florence, KY 41042 Ph: ###-###-#### 

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