ComplaintsforMcNally Brothers Oral Surgery

• Initial Complaint

  02/21/2024

  Complaint Type:

  Order Issues

  Status:

  Resolved

  More info

  I'm filing a complaint due to a suspicious charge by McNally Brothers Oral Surgery, for which I want to be refunded $400. Regarding Account #******. On 12/4/23 I received medical treatment at their office in ****************, **. I was told to pay $400 at the appointment for an x-ray that would not be covered by my medical insurance company ******** ****. I thought this was strange, but I charged $400 on my ********** ****. The services rendered on 12/4/23 were $115 for Limited Oral Eval., and $400 for CT Maxillofacial w/o Dye. My insurance company processed the claim for this Preferred Provider, and according to the Explanation of Benefits (EOB) there was a Provider Discount of $27.07 for the $115 charge and $87.93 was Covered by Plan. After the $50 copay was deducted, the company paid $37.93. The $400 CT scan had a Provider Discount of $400 and the EOB indicated I only owed the $50 copay. Regarding the $400 charge, the message on EOB indicated "In-Network provider; Member is not responsible for any charges in excess of the maximum allowed for a participating provider". I called my insurance company on 3 occasions afterwards and was informed that I should not have paid the provider $400, and that legally the provider must refund me $400 since the claim was processed and a Provider Discount of $400 was given. On 2/20/24 I went to the provider's office and spoke to Medical Secretary Aimee **************. She refused to refund me $400 since she stated she had an EOB that indicated the insurance company denied the $400 charge. I showed her the EOB that I received but she would not accept it. I contacted my insurance company afterwards and they agreed that McNally Brothers Oral Surgery is violating the contractual agreement they have as a Preferred Provider by charging, and not reimbursing me, $400. I told Aimee that I will be filing a complaint with BBB. I'm unable to provide additional info here but please call me at ************** to discuss further.

  Business response

  03/04/2024

  At McNally Brothers Oral Surgery, we are committed to the best in patient care, which includes navigating the complexities of Insurance billing to the best of our ability.  However, insurance is subject to frequent updates making it challenging to guarantee what procedures will or will not be covered by the different insurances.  We contacted the claims department at this insurance company and they instructed us to re-bill with a modifier.  We have initiated a refund for $400.00 as requested.  If the re-billing renders a patient responsibility, we will retract the claim and write off the scan.  We strive for our patients to have positive experiences with all aspects of our office.  Should you need more information, please do not hesitate to reach out by phone, **************.  Thank you

  Customer response

  03/07/2024

   
  Better Business Bureau:
  
  I have reviewed the response made by the business in reference to complaint ID ********, and find that this resolution is satisfactory to me.
  
  Sincerely,
  
  *****************************

*Some consumers may elect to not publish the details of their complaints, some complaints may not meet BBB's standards for publication, or BBB may display a portion of complaints when a high volume is received for a particular business. ↩