Complaints

This profile includes complaints for Community Radiology Associates Inc.'s headquarters and its corporate-owned locations. To view all corporate locations, see Find Local Branches.

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  Community Radiology Associates Inc.

  PO Box 64939 Baltimore, MD 21264-4939

• 

  Community Radiology Associates Inc.

  67 Thomas Johnson Dr, Suite 4 Frederick, MD 21702

The complaint text that is displayed might not represent all complaints filed with BBB. 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.

• Initial Complaint

  Date:03/04/2025

  Type:Billing Issues
  Status:

  AnsweredMore info

  Complaint statuses

  Resolved:

  The complainant verified the issue was resolved to their satisfaction.

  Unresolved:

  The business responded to the dispute but failed to make a good faith effort to resolve it.

  Answered:

  The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.

  Unanswered:

  The business failed to respond to the dispute.

  Unpursuable:

  BBB is unable to locate the business.

  I received service from Community Radiology Associates (CRA) on Apr 23, 2024. On May 3, 2024 I received a copy of letter from my insurance company (****) that they sent to ***, stating that if they did not accept assignment from ******** for the claim in question, to disregard the notice. I do not have ********. On Aug 6, I received an invoice from *** for the service on Apr 23, which noted that I may have other insurance. I contacted *** to confirm their records were correct; **** was primary insurance and I did not have ********. I also contacted **** to confirm their records were correct in that I did not have ******** and they were my primary insurance. I requested **** to reprocess the claims as requested by ***. At the end of Aug, I received a letter from **** that the claim was pending receipt of requested information from ***. At the end of Sept, I received an invoice from ***. I contacted *** to explain that **** was reprocessing the claim and confirmed they had the correct insurance information (no ********** I also contacted **** confirming the claim reprocessing. On Sept 28 I received an *** from **** documenting their payment of the claim and my responsibility was $0. At the end of Nov, I received an invoice from ***. I contacted **** to confirm payment. I contacted *** and provided them the **** check # and amount of payment. *** stated they sent the claim back to ****. At the end of Dec, I received an *** from **** documenting the payment and my responsibility was $0. I received another invoice from *** for the claim. I contacted CRA on Jan 2, and they said they had the *** on file and that I owed nothing. On Feb 23, I received an invoice from ***. On Feb 28, I contacted *** and they stated they would have my bill reviewed. I called a second time in attempt to get a person who could finally resolve this issue. This time the person connected me to a resolution group. On Mar 1, I received a notice from a debt collector. The issue has not been resolved.

  Business Response

  Date: 03/07/2025

  This is to confirm that we have reviewed all aspects of Ms. ********** complaint.

  Ms. ******** was seen at Community Radiology Associates (CRA) on 04/23/24 for a bone density exam and screening mammogram. When the services were initially billed, unfortunately, the incorrect insurance plan was selected, ************************* The insurance responded asking for a primary Explanation of Benefits (EOB) because they did not believe they were the primary insurance, when typically that insurance is secondary to ********. Per Ms. ********* she mentioned that she contacted **** to let them know that she did not have ******** as her primary insurance. The claim was subsequently rebilled to the correct payer, GEHA-ASA. The insurance responded and paid the 04/23/24 date of service. 

  Ms. ********** account was thoroughly reviewed and concluded that her account was erroneously sent to collections in error. Ms. ********** account has been recalled from collections and the proper adjustments have been made on her account. At this time, Ms. ******** has a balance of $0.00 and does not owe any monies to CRA. On 03/06/25, a phone call was placed to Ms. ******** regarding the same.

  We apologize to Ms. ******** for any inconvenience this issue may have caused.
  
  We are committed to creating a seamless process that promptly escalates patient inquiries through the BBB to the appropriate management or executive levels within our company and tracking those inquiries through completion.
  
  We greatly appreciate your assistance and cooperation in achieving a resolution.

• Initial Complaint

  Date:02/26/2025

  Type:Facilities Issues
  Status:

  AnsweredMore info

  Complaint statuses

  Resolved:

  The complainant verified the issue was resolved to their satisfaction.

  Unresolved:

  The business responded to the dispute but failed to make a good faith effort to resolve it.

  Answered:

  The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.

  Unanswered:

  The business failed to respond to the dispute.

  Unpursuable:

  BBB is unable to locate the business.

  Twice they have scheduled mri scans. I walked in the door and twice told they dont have a maxhine, didnt see the appt after just calling to conform, claiming a machine is down, sending me to another location to have a mri and *** to now be told another patient came (mind you i was sent her w an appt bc the other lovation claimed the machine broke as i walked in the door i told them i fainted and habe stabbing headaches ans my neurologist needs the images now *** the receptionist could care less saying they are too full even when I said its so serious ill wait. They need to be investigated bc this is routine, dangerous, and unprofessional. They literally obstructed my appt and responded w oh well we are too busy to see you when i had a **** appt! I am also losing an ENTIRE day of pay i cant get back as they did this to me walking in the door!!! I want my money back for the day i missed! I wamt my appt to be done as scheduled! They need to reimburse my insurance if charged!

  Business Response

  Date: 03/04/2025

  Due to an unexpected equipment issue at the original site, a patient scheduled for two exams on 02/26/2025 was rescheduled to the closest available location on the same day. However, one of the exams required prior authorization, which was still pending at the time of the appointment.
  Upon arrival, the patient was informed that the exam with the pending authorization could not be completed. The site manager provided documentation from the insurance company while the patient was in the office. The authorized exam was successfully completed on 02/26/2025.
  Once the authorization was obtained, the pending exam was rescheduled and completed on 03/01/2025. Please let me know if any further details are needed.
  

• Initial Complaint

  Date:01/21/2025

  Type:Billing Issues
  Status:

  ResolvedMore info

  Complaint statuses

  Resolved:

  The complainant verified the issue was resolved to their satisfaction.

  Unresolved:

  The business responded to the dispute but failed to make a good faith effort to resolve it.

  Answered:

  The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.

  Unanswered:

  The business failed to respond to the dispute.

  Unpursuable:

  BBB is unable to locate the business.

  On 11/15/23 and 11/24/23 I visited Community Radiology Associates (CRA) for x-rays related to a motor vehicle accident that occurred on 9/23/23. The visits were billed to my health insurance, rather than the motor vehicle insurance and I was charged a co-pay of $39.94 and $42.09, respectively. I paid the charges since the x-rays were medically necessary, and the merchant requires payment at the time of service. In both instances, I asked what needed to be done to properly bill these visits and was told to simply call the billing department to have it straightened out. I provided the x-ray charges as part of my claim to my motor vehicle insurance, Progressive (adjuster: *********** C ****** ************, claim: 238281073-A164275) and was told that he sent CRA the appropriate forms to have them submit the claims to Progressive for payment. Further, this correction should naturally cause the copays to be refunded.I called CRA several times between 4/14/24 and 1/16/25 to have the issue resolved. They are seemingly refusing to correct the billing or see the corrected billing through to completion and are content with the error going unresolved as their company has been compensated, though incorrectly.Details of the 6 conversations that occurred with Community Radiology representatives over the last ***** months are attached.

  Customer Answer

  Date: 01/24/2025

  The attachment that was not transmitted with the previous submission is attached.

• Initial Complaint

  Date:01/13/2025

  Type:Billing Issues
  Status:

  ResolvedMore info

  Complaint statuses

  Resolved:

  The complainant verified the issue was resolved to their satisfaction.

  Unresolved:

  The business responded to the dispute but failed to make a good faith effort to resolve it.

  Answered:

  The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.

  Unanswered:

  The business failed to respond to the dispute.

  Unpursuable:

  BBB is unable to locate the business.

  Community Radiology Associates (CRA) filed two idential claims with ******** for the idential date of service and identical procedure. When ******** (rightly) declined to pay the second claim, *** tried to collect from me and then turned the amount allegedly owed by me over to a collection agency.The date of service was 6/8/24 and the procedure was ***** MRI. ******** stated in their refusal to pay the second submittal "The information provided does not support the need for this many services or items within this period of time".The two claims submitted by *** were 1. in June 2024 right after procedure and 2. in September 2024 three months after the procedure.I believe CRA neglected to bill ******** for the entire amount the first time and found their error three months later. I don't believe I should have to pay for **** mistake whick resulted to the claim being denied.

  Business Response

  Date: 01/16/2025

  This is to confirm we have reviewed all aspects of Ms. ********* complaint.
  
  Ms. ******* was seen at Community Radiology Associates (CRA) on 06/08/24 for an MRI of the Lumbar spine. The claim was initially billed to *********************** ********, on 06/12/24. The claim was paid on 6/27/24, however, it was identified later that the amount billed to ******** was incorrect. On 9/12/24, the claim was refiled to ******** as a corrected claim with the correct charge amount, however ******** subsequently denied that claim on 9/18/24.
  
  ******** does not accept corrected claims and the change should have been corrected with ******** using their ************ Tools which includes updating and resubmitting via portal,IVR, or reopening gateway. Education was provided to the user to follow ******** Claim Corrections process.  
  
  As of 1/16/25, the claim has been corrected through the ******** portal, by which the claim will be reprocessed. Please allow up to ***** days for ******** to reprocess the ******** this time, we have moved the outstanding balance out of collections and put it back into insurance responsibility while we wait for insurance adjudication.We will additionally place a hold on Ms. ********* account.
  
  We sincerely apologize to ********** for the delay in resolving this inquiry and the inconvenience this issue may have caused.
  
  We are committed to creating a seamless process that promptly escalates patient inquiries through the BBB to the appropriate management or executive levels within our company and tracking those inquiries through completion.
  
  We greatly appreciate your assistance and cooperation in achieving a resolution.
  

  Customer Answer

  Date: 01/16/2025

   
  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,
  
  ***** *******

• Initial Complaint

  Date:01/02/2025

  Type:Billing Issues
  Status:

  ResolvedMore info

  Complaint statuses

  Resolved:

  The complainant verified the issue was resolved to their satisfaction.

  Unresolved:

  The business responded to the dispute but failed to make a good faith effort to resolve it.

  Answered:

  The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.

  Unanswered:

  The business failed to respond to the dispute.

  Unpursuable:

  BBB is unable to locate the business.

  On January 25, 2025 I received services with Community Radiology. The bill was to go to insurance (all information was given to Community Radiology at that time) due to an accident at which I was not at fault. The attached letter details the numerous interactions with Community Radiology over the following months. Ultimately, though I am not liable for this bill (and Community Radiology acknowledged this) they sent me to collections. I had hoped that my response to ************************ (the collection agency) would have resolved this issue. However, I received another bill from Community Radiology for this service on January 1, 2025. This is harassment at this point and must stop.

  Business Response

  Date: 01/08/2025

  This is to confirm we have reviewed all aspects of Ms. ******** complaint.

  
  Ms. ****** was seen at Community Radiology Associates (CRA) on 01/25/22. The claim was initially sent to Ms.******* private insurance, and the claim denied. On 03/03/22, the claim was thereafter sent to Ms. ******* auto insurance, which was the correct insurance. Unfortunately, the claim went unresponded for many months and *** was unable to contact with Ms. ******* auto insurance after many attempts. Due to the unresponded status, the claim was moved to patient responsibility.

  
  On 05/23/24, Ms. ****** contacted CRA regarding the balance of $69.41 and the representative advised Ms. ****** the balance was due to a deductible, however, that information was incorrect. This has been escalated to the appropriate department leadership team for education.

  
  On 05/30/24, Ms. ****** contacted *** to provide updated auto accident information and asked that her claim be resubmitted. On 06/25/24, Ms. ****** contacted *** and spoke to a manager and Ms. ****** was told the outstanding balance would be adjusted off. The account was noted that it was being sent for adjustment however it never was sent the adjustment queue. This has been escalated as well.

  
  As of 01/03/2025, the balance of $69.41 has been adjusted off Ms. ******* account and now shows a $0.00 balance. Ms. ****** will no longer receive statements for the *** referenced in this grievance.

  
  We sincerely apologize to Ms. ****** for the delay in resolving this inquiry and the inconvenience this issue may have caused.

  
  We are committed to creating a seamless process that promptly escalates patient inquiries through the BBB to the appropriate management or executive levels within our company and tracking those inquiries through completion.

  
  We greatly appreciate your assistance and cooperation in achieving a resolution.

  Customer Answer

  Date: 01/11/2025

   
  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,
  
  ****** R ******

• Initial Complaint

  Date:11/07/2024

  Type:Customer Service Issues
  Status:

  AnsweredMore info

  Complaint statuses

  Resolved:

  The complainant verified the issue was resolved to their satisfaction.

  Unresolved:

  The business responded to the dispute but failed to make a good faith effort to resolve it.

  Answered:

  The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.

  Unanswered:

  The business failed to respond to the dispute.

  Unpursuable:

  BBB is unable to locate the business.

  My physician's staff scheduled an x-ray on or about September *****, 2024. I was also given a generic order for the same test at my request because I specifically wanted to use a Radiology Service that was NOT Community Radiology.I had that test done and thought that was the end of it. However, apparently the order was also sent to Community Radiology. Since that time I have received both texts and emails from Community Radiology reminding me of this order. I have repeatedly tried to stop this by email and by calling, all to no avail. When I call I never get to speak with an actual person but just keep getting prompts. There is apparently no way to contact a real person. I want this harassment to STOP immediately

  Business Response

  Date: 11/11/2024

  We have cancelled the order in our system to stop the text communication to schedule.  I have submitted a request to not contact patient moving forward on any ordered exams .  We will share the concern with our contact center regarding her inability to connect with anyone to contact a Live person.  When a patient enters STOP on a text message, it will stop further messaging for that particular encounter.

• Initial Complaint

  Date:10/24/2024

  Type:Service or Repair Issues
  Status:

  AnsweredMore info

  Complaint statuses

  Resolved:

  The complainant verified the issue was resolved to their satisfaction.

  Unresolved:

  The business responded to the dispute but failed to make a good faith effort to resolve it.

  Answered:

  The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.

  Unanswered:

  The business failed to respond to the dispute.

  Unpursuable:

  BBB is unable to locate the business.

  I have a neurostimulator model that is permitted to be used with a ** MRI and provided documentation that proved that the device is allowed, and sent the model number in through a secured image, and the appointment had been cancelled over and over and over again because they have refused to contact the MRI specialist, and only demanded he can be contacted by email, and even if I had the exact model and the exact pdf that demonstrates that it is possible to use it in a 3 T machine they refused to provide any recourse. While this happens there have been more urgency to get the brain MRI done and it is frankly irresponsible to delay such a matter over a concern that doesn't exist.

  Business Response

  Date: 10/29/2024

  Out of concern for patient safety, we air on the side of caution and only scan patients with neurostimulators on a 1.5T scanner.  There is always concern of the 3T scanners heating up these devices.

• Initial Complaint

  Date:10/01/2024

  Type:Billing Issues
  Status:

  AnsweredMore info

  Complaint statuses

  Resolved:

  The complainant verified the issue was resolved to their satisfaction.

  Unresolved:

  The business responded to the dispute but failed to make a good faith effort to resolve it.

  Answered:

  The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.

  Unanswered:

  The business failed to respond to the dispute.

  Unpursuable:

  BBB is unable to locate the business.

  I have had problems with Community Radiology Associates' billing. They were supposed to have sent a bill for my mammogram to *********** date of service March 22, 2023. They did not send adequate information to ******** so ******** did not pay the claim and asked for more information. I did not get the bill for $546 until this spring of 2024. After trying repeatedly to community with Community Radiology that they had made the billing error, and not hearing from them except for sending a bill I do not owe, they turned me over to a collection agency! I have written to the agency and Community Radiology Associates.

  Business Response

  Date: 10/02/2024

  This is to confirm that we have fully reviewed and responded to all aspects of Ms. ******* complaint.

  
  On 03/22/23, we attempted to ************* MD and received an electronic rejection from ********* through our clearinghouse, which advised us that ********************** (BCBS) was the primary insurance and ******** was secondary. This rejection would not allow us to submit a claim to ******** MD.

  
  Subsequently, the claim was sent to **** two separate times and also sent to ******** MD again. Upon further research,it was determined that Ms. ******* ******** insurance is ******** DC and not ******** MD, as well as, incorrect BCBS plans being selected. These missteps in choosing the incorrect insurance plans are what caused the claims to not make it to the appropriate payers. Many unsuccessful attempts were made to get a claim to ******** or ****, therefore, resulting in our office sending a statement to Ms. ****** to obtain coordination of benefit information.  

  
  As of 10/01/24, Ms. ******* account has been removed from collections. Our office has rebilled the 03/22/23 claim to ********. ******** will most likely deny the claim for Timely Filing,however, a rebill was necessary in order for our office to receive an Explanation of Benefits (EOB). As such, after ******** processes the claim, Ms. ****** will not be responsible for any balance for the 03/22/23 date of service.

  
  We apologize to Ms. ****** for any confusion and inconvenience this issue may have caused.

  
  We are committed to creating a seamless process that promptly escalates patient inquiries through the BBB to the appropriate management or executive levels within our company and tracking those inquiries through completion.

  
  We greatly appreciate your assistance and cooperation in achieving a resolution.

  Customer Answer

  Date: 10/15/2024

  Please see attached.

  Business Response

  Date: 10/15/2024

  As stated in our original response - We refiled claim to ******** insurance as part of a billing requirement on our end to ensure we have received proper adjudication. There were billing missteps on our end that we have acknowledged, educated on, and made an attempt to resolve. This is of no-fault of Ms. ******* Due to the amount of time that has passed, ******** will likely deny due to timely filing, which falls on the provider, not the patient. Additionally, as stated, we removed Ms. ****** from collections, and once the denial is received from ******** which is needed on our end, we will adjust the balance to $0.00 with no patient responsibility. There is no action for Ms. ****** to take on her account. 

• Initial Complaint

  Date:09/23/2024

  Type:Billing Issues
  Status:

  ResolvedMore info

  Complaint statuses

  Resolved:

  The complainant verified the issue was resolved to their satisfaction.

  Unresolved:

  The business responded to the dispute but failed to make a good faith effort to resolve it.

  Answered:

  The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.

  Unanswered:

  The business failed to respond to the dispute.

  Unpursuable:

  BBB is unable to locate the business.

  I have been trying to pay an outstanding balance since 7/26/2024. A credit of $60.93 was to be applied to my outstanding balance of $133.03 per the 7/18 statement. The gentleman that I spoke with on 7/26 assured me that I only owed $34.25 rather than the $72.10 that basic math would yield. I paid the $34.25 on 7/26 and was assured the next statement would be a $0 balance. I received the 8/17 statement still showing the $60.93 credit with now a balance due of $98.78. I called and spoke to both a representative and a supervisor on 8/26 assuring me they were looking into it and would call me back that day. I called on 8/27 and spoke with yet another representative that said the supervisor was looking into it and would call back. No calls.I called again on 8/29 and spoke with yet another representative who said billing needed to apply the credit and adjust the amount due to $37.85 (the outstanding amount I knew I had owed in July--basic math tells one that the $34.25 I paid and the $37.85 I am attempting to pay yields the $72.10 due in July). He further indicated that next month's statement (September) would be adjusted and not to worry they were not sending me to collections. I called one more time on 9/3 and that representative said the issue was in fact never sent back to billing to adjust and that she would get it fixed, apologized that I had to call so many times, and elevated this to her supervisor. I just received the 9/16 statement with the credit of $60.93 still unapplied and a balance due of $98.78. I have called five times, this has been elevated to two supervisors, and now the statement is RED and says if I do not pay I will be sent to collections. I have been trying to pay the $37.85 owed since July. Credits should always be applied to balances due, particularly CRA who routinely overcharges for the radiology fees. Last year I had to call multiple times over at least two billing cycles to get them to cut a check for my overpayment at that time.

  Business Response

  Date: 09/30/2024

  This is to confirm that we have fully reviewed and responded to all aspects of Ms. ********* complaint.
  
  After a thorough review of Ms. ********* multiple dates of service with Community Radiology Associates(CRA), it was identified that the incorrect amount owed was communicated to her when speaking with our customer service team.
  
  To fully understand the amount Ms. ********* truly owes, we had to evaluate her previous dates of service with CRA and the Explanation of Benefits with her Insurance.
  
  Ms. ******** had visits on the following dates with associated Time of service payments:
  3/25/2024 MRI Patient paid $126.70 at the time of service Claim is still pending with Insurance
  4/26/2024 MRI Patient paid $185.38 at the time of service Patient responsibility owed per Insurance adjudication is $155.86 Leaving a credit of $29.52
  4/29/2024 MRI No time-of-service payment collected Patient responsibility owed per Insurance adjudication is $95.29 The credit balance of $29.52 from 4/26/2024 date of service was applied and $65.77 from her 3/25/2024 DOS was applied to cover the $95.29 balance owed. This left $60.93 remaining on her 3/25/2024 date of service..
  7/5/2024 MRA No time-of-service payment collected Patient responsibility owed per Insurance adjudication is $133.03  - This is the amount that was sent on the statement in addition to the $60.93 credit showing on 3/25/2024 Date of service.
  
  Based on our review, we determined that the amount of $34.25 that Ms. ******** was advised was not the amount owed for that date of service.We sent this complaint to the appropriate leadership to review the account in depth and provide education as needed. After their review, they confirmed that it was a human error that provided the incorrect amount to Ms. ********* Due to this error, we have adjusted off the remaining balance for her 7/5/2024 date of service.
  
  Ms. ******** should be aware that her 3/25/2024 is still pending with her insurance and there may be a future amount owed as her original payment made for this date of service was applied to other visits to reconcile any outstanding balances.
  
  We apologize to Ms. ******** for the delay in resolving this inquiry and the inconvenience this issue may have caused.
  
  We are committed to creating a seamless process that promptly escalates patient inquiries through the BBB to the appropriate management or executive levels within our company and tracking those inquiries through completion.
  
  We greatly appreciate your assistance and cooperation in achieving a resolution.

  Customer Answer

  Date: 10/02/2024

   
  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, assuming that the zero balance for the 7.5.2024 MRV will also obviate sending me to collections per the 9.16.2024 CRA statement.

  I understand the *** from 3.25.2024 is still being processed by ****. However, I have already met my catastrophic out-of-pocket maximum for the year. Thus, any amount due to CRA will be paid by *****
  
  Sincerely,
  
  ******* ********

• Initial Complaint

  Date:06/17/2024

  Type:Billing Issues
  Status:

  AnsweredMore info

  Complaint statuses

  Resolved:

  The complainant verified the issue was resolved to their satisfaction.

  Unresolved:

  The business responded to the dispute but failed to make a good faith effort to resolve it.

  Answered:

  The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.

  Unanswered:

  The business failed to respond to the dispute.

  Unpursuable:

  BBB is unable to locate the business.

  Community Radiology of ********* has acknowledged that they did overcharge me and owe me a refund. I have been trying to get a refund from them since January 2024. Im not sure what else I can do. Is there anyway you can help resolve this matter. Community Radiology has many unlawful billing practices. This is just one example. I would like my refund that they owe me for overcharging. And the same as they are incurring interest on monies that they have not refunded I would like the interest paid to me.

  Business Response

  Date: 06/18/2024

  Please be advised that it is our policy to collect an estimated cost share for procedures at the time of service.  Patient benefits are confirmed via an ******************** Interchange) process. The cost share information is requested at the time of scheduling and/or at the time of service through a 270 real-time connection to the insurance.  A 271 response is received from the insurance which provides patient eligibility and any out-of-pocket costs for which the patient would be responsible- including ***payment, ***Insurance,and/or Deductible. If the insurance returns the 271 in a timely fashion,patients are notified of their estimated cost share when contacting the site to schedule services.
  
  After services are complete and the radiology report is finalized, services are coded (CPT/ICD10) and submitted to the insurance carrier.  After processing the claim, the insurance issues an Explanation of Benefits (EOB) which is the most accurate source for providing the patient and provider with information on how the services were adjudicated.  

  After a thorough review of the patient's account and complaint, it has been identified that the 271 response received from the insurance showed a patient responsibility of $2,626.50. After the claim was processed, we received an EOB from the payer showing a patient responsibility of $2,500.00. Customarily, the system automatically refunds any overpayment but, in this instance, it did not occur. We received one call from the patient on 6/3/24 in which she advised of the overpayment. It was immediately sent for payment research and a refund of $126.50 was sent to the patient's credit card on 6/6/24. 

  We apologize to Ms. ****** for the delay in submitting her refund and for any inconvenience it may have caused. We have notified management in our ****************** so that they may investigate this further to determine the root cause as to why the system did not automatically generate this refund and ensure that system errors of this type do not occur moving forward. 

  We are committed to creating a seamless process that promptly escalates patient inquiries through the BBB to the appropriate management or executive levels within our company and tracking those inquiries through completion.
  
  We greatly appreciate your assistance and cooperation in achieving a resolution.

  Customer Answer

  Date: 06/28/2024

  Not sure why this is closed? There has been no resolution? Please advise.