ComplaintsforFacial Surgery Group

• Initial Complaint

  12/16/2022

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  On September 19th 2022 I had oral surgery to remove a cyst from my lower jaw. On that day I was under the impression they had done a pre qualification with my health insurance because they charged me $594.00 for what they said was my deductible. It is now December 16th and I received a claim denial from my insurance because they reached out to Facial Surgery Group on 10/20/2022 asking for more information and my insurance never received a response or follow up. I contacted the doctors office last month and again this month to ask them to follow up with ****** ****** **** about this claim. Facial surgery group has ignored me and has been completely unresponsive to me and to my insurance provider. It’s been three months and this needs to get figured out. The Facial Surgery Group location I am reaching out about is: Barry Road Office 7577 NW Barry Road, Suite B Kansas City, MO 64153 816.741.8999

  Business response

  12/28/2022

  My name is ******** with Facial Surgery Group. We received your letter of complaint by mail today, complaint number ********. Here is our response to complaint.

  Complaint ******** was seen in our office on September 19^th for a medical procedure. We sent a biopsy off for review to the oral pathology company we use same day. On notes of the pathology report they received it on September 20^th. We do not bill out any medical procedures if a path report is done until the path report comes back, path report came back on Friday September 30^th. Procedure was coded out to match the path findings on September 30^th.  Claim was submitted with clinical notes, patient information, and path report through our outsourced claim system on October 3^rd. Medical claims can take up to 60-90 days to be processed. On November 18^th complaint ******** sent an email to our x ray email at Barry road that UHC was requesting information, the front who spoke to complaint ******** asked if UHC could send the requested information over by email, UHC said they could not do that, to look online. Complaint ******** sent information from the call with our front our x-ray email. On December 16^th patient emailed again stating no follow-up was done. I was forwarded the email. That same day I talked UHC to figure out what information was needed, where to send it too, and I also tried to get ideas where they sent the requested additional information too. At this time, I have never received a phone call from complaint ********, no manager has received a phone call from complaint ********. Information can get lost in an email especially an email that gets 100s of x rays- referrals a day. On December 16^th was my first time receiving a forwarded email from complaint ******** which was by email, not my work email, and not by phone. During the times I spoke to UHC I have been told multiple different responses which is typical with UHC customer service. My findings where claim is still open and pending as path report was not fully attached. Path report has been attached to claim and is under review. I will put claim ref #s at the end. December 19^th, I emailed complaint ******** multiple times responding to email sent and giving updates on the claim, no response by complaint ******** either time left my phone number and information. Today is December 27^th, I have called UHC to follow up as stated above medical claims can take 60-90days, I spoke to a different UHC customer service representative that gave me an urgent fax number and stated claim would be processed in 24-48 hours. I sent complaint ******** an email with this follow-up information, still have never heard back from complaint ********. Complaint ******** has never called an asked for me or a manager directly to get help, so we can only help as fast as we hear. We have also not directly received by mail any letter from UHC. I handled the issue same day it was relayed to a manager and me by a forwarded email.  Again, our claims get submitted and followed up by our outsourced company, as well as I am helping. Almost all the time a patient will receive information from their insurance company before we do, we get calls, and we can handle them quickly. This claim is still opened and being processed per UHC claim will be paid.

  12.19.22 spoke to UHC claim number is ********** and clinical notes were faxed to ************ today. ref # ***** MB

   ********* *** ***** *** ***

  WAS GIVEN A NEW FAX NUMBER OF ************

  FOR URGENT REVIEW TO BE FIXED IN 24-48HOUR

  Thank you,

   

  ******** **

  Insurance Coordinator

  Facial Surgery Group

  816.741.8999

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