ComplaintsforSSM Health St. Louis

• Initial Complaint

  04/25/2024

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  I was looking for a different eye doctor for my family. We have been with our current provider for a number of years and was just looking for a routine eye exam and a new opinion on our prescriptions. I took my two children and myself to see ************** 9/19/23. My husband had an appointment scheduled for a future date but we canceled it after receiving our bill. We were charged for each person a Eye Exam, New Patient Comprehen $472 and refraction $80 for a total of $552 per person. Typically for the last 10 years, our eye exams are completely covered by our insurance. This time, it was not. I reached out to our insurance. They reviewed the claims and let me know that they were processed correctly and if I felt the charges were not correct, I should contact the provider and ask for a medical review. I reached out the *** Health and asked for a coding review. Their review stated the charged amounts were submitted correctly. I spoke with them to see what the $472 charge was for and was told it was a new patient fee. My one child, was already a patient at ***** ******************* but it was a different provider that saw him before. I called local optometrists and they do not charge a new patient fee and it is not normal practice. I chatted with *** health via their chat feature and inquired how they can charge over 400% of what the exam actually cost as an added fee without disclosure. Again I was told it was my responsibility to understand my insurance. I do understand my insurance coverage, what I wasn't prepared for was an additional undisclosed $1,416. I tried to report physician fraud through my insurance, UMR but because a service was performed, I was told it didn't qualify. I have submitted a claim to the ********** of ****** and ************ Services as i believe this practice is unethical but do not expect a response in the next 12 months.

  Business response

  05/06/2024

  This correspondence serves as SSM Healths response to Complaint #********.

  
  The complaint states SSM Health is billing a charge for a new patient fee. The "New Patient Fee" referred to is CPT code ***** Eye Exam ************ ****** visits fall into two categories - a new patient and an established patient. A new patient visit is always a slightly higher charge because the provider needs to obtain and document a patient history. It is not a separate fee for a new patient, it is the office visit charge for a new patient. All eye visits are billed the refraction (*****) and an office visit for either a new or established patient.
  
  Two claims were denied for Denial code 119 per the **** Denial code 119 means that the maximum benefit allowed for a specific time period or occurrence has been reached. This indicates that the insurance coverage or plan has a limit on the amount of money it will pay for a particular service or treatment within a given period. It is likely the visits were scheduled too soon and did not meet the criteria for coverage under the plan. If the member believes this to be incorrect, they will need to contact their insurance plan and review their benefits for this service.  The charge for the office visit for a new patient is correct as charged at $472.00. Billing is correct and the balances remain patient responsibility.

  Thank you for allowing us the opportunity to respond to this complaint.

  
  ***** SSM Health ***************** Services 

  Customer response

  05/10/2024

  Complaint: 21626010
  
  I am rejecting this response because: 1) *************************** was already a ***** ******************* customer and should not be charged the new customer fee. 2) I was not informed of a higher rate for a new customer. Our insurance has a *** $150 coverage for eye exams for 12 months. My insurance coverage is correct. It did not fail to cover the appointments. I was not charged more because I scheduled the appointment incorrectly. I think it is unethical for a company to charge a higher price without disclosing the dollar amount the customer would be charged prior. I scheduled the appointments, made it very clear what kind of appointment we were looking for, and told them my insurance information. I'm not sure what else I could have done to be aware of their ridiculous pricing schemes.
  
  Sincerely,
  
  *************************

• Initial Complaint

  04/21/2024

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  My name is ********************* and I am a student at ***. My SSM Health account number is: #************* was referred to PT services at ************ by a Student Health physician for TMJ disorder. I know my insurance card was on file because I have used it to pay for Student Health visits in the past. However, prior to receiving the services, I asked for a quote of how much the appointments would be. I told the staff at this time that I planned to Self-Pay and pay out of pocket rather than going through insurance. I had previously called my insurance and realized that under my plan, nothing was covered related to TMJ disorder. This was why I opted to Self-Pay instead. I was quoted about $230 for the initial visit and less for subsequent visits, which seemed affordable to me as a SLU student. I then underwent four total PT visits: Dec 6th and 13th in 2023 and Jan 3rd and 10th in 2024.I later received a bill from SSM Health of $2,168.00 for my PT visits. The bill showed the services had been run through my insurance (not self-pay) and, as I already knew it would, nothing was deducted by insurance. I would like SSM to correct this billing error.I have called the ******** Department several times since early March. Cases have been open over the phone since March 7th; however, I have not received any response in regard to whether the bill will be adjusted to Self-Pay, as I had requested. When i get a return call back at the return number they leave in the voicemail, I am redirected to a staff member who is unable to directly connect me to a supervisor. Most recently, I was told to email SSM Health but the automated replies tell me to put my bill on a payment play instead address their error. My mother (*******************) has also been helping me figure out this bill and is equally frustrated. We are filing a report to the Better Business Bureau as no one has reached out to help fix this issue. We'd greatly appreciate any help.********************* (she/her/hers)**************

  Business response

  04/23/2024

  This correspondence serves as SSM Health's response to Complaint # ********. 

  The consumer states she was billed in error for services that were known to be non-covered by her insurance plan. She is requesting the self-pay rate be applied to her outstanding balances as she requested prior to receiving the services. 

  Two account balances are seen billed incorrectly. Both accounts are corrected and now reflect the true self-pay rate. The billing cycles have been reset to allow the consumer time to make payment arrangements. 

  SSM Health apologizes for the inconvenience this has caused our patient and appreciates the opportunity to respond to this complaint. 

  ************ SSM Health ***************** Serivces

• Initial Complaint

  04/18/2024

  Complaint Type:

  Billing Issues

  Status:

  Resolved

  More info

  I, ***********************, visited ******************************************************* (SSM Health neurosciences Dr. *** Pan) on September 8'2023. The receptionist took a copy of my health insurance card and I had written down my home address: *************************************************************************************************** my patient form. On March 14'2024, my husband ******************* received a voicemail from a credit collection service about SSM bill. I called SSM billing agency also on March 14'2024 and provided the customer service/** with my ********************** insurance card (BCBS). ** then mentioned that SSM health had sent a couple of bills to the wrong address (not to the correct home address I provided receptionist on September 8'2023), he also mentioned that SSM health didn't have any record of my health insurance even-though the receptionist took a copy of it during my visit. He promised to process the bill ($363) to the health insurance and that my name will be taken out of the credit collection service. The ** also promised that he would send me a copy of the bill that would have gone to BCBS to my email address but I never received it. On 4/5/2024, I received a credit collection services bill and I called SSM bill again on 4/5/2024 then I spoke with ******, she said she would escalate the processing of the my bill to BCBS and it should be processed by latest 4/9/2024. As per 4/18/2024, BCBS still hasn't received any claim from SSM health and my account is still with credit collection services. I would like for SSM Health to: 1. Process their bill through BCBS 2. Withdraw my account from credit collection services 3. Send me a copy of their bill AFTER it had gone through BCBS both to my home address as well as to my email address: ***************************** Thank you for your help.

  Business response

  04/25/2024

  This correspondence serves as SSM Health's response to Complaint # ********. 

  The complaint states the patient provided current demographic information and a current insurance card when registering for an office visit. SSM Health did not send claim to insurance and sent statements to a previous address resulting a balance being sent to collections. 

  SSM Health failed to update the guarantor demographics resulting in the statements being sent to an incorrect address. Insurance was received but never added and billed. Due to the age of the account, the balance has been recalled from collections with no negative reporting to the patient's credit and adjusted as a courtesy. The account balance is now $0.00. 

  We apologize for the inconvenience this has caused and hope to provide exceptional service in the future.

  ************** SSM Health Patient Financial Services 

  Customer response

  04/26/2024

  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,
  
  ***********************

• Initial Complaint

  04/17/2024

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  I was seeing a specialty provider at SSM, providers are great however the billing **** lacks care and understanding in regards to proper billing. *** spoke several time with champva for this. Also I was sent to collections due to their mistake of not billing my insurance provider and when I call them they tell they wont resubmit my claim nor remove the collections notice. This is stressful, unethical and I asking that they his be corrected immediately. Remove the collection and resubmit my claim to properly reflect my claim. I will never utilize this facility again. Shame.

  Business response

  04/16/2024

  This correspondence serves as SSM Health's response to Complaint ID: ********

  SSM Health submitted claims for services received after 6/30/2023 to the consumers primary insurance carrier. These claims were denied by the primary carrier for Coordination of Benefits (COB) update by the member. Currently the member has provided the updated COB information to her primary carrier. Outstanding balances have been removed from collections are pending processing. No balances are being billed to the consumer. 

  T**** you for allowing us the opportunity to respond to this complaint. 

   

  ************** SSM Health ***************** Services 

   

  Business response

  04/17/2024

  This correspondence serves as SSM Health's response to Complaint ID: ********

  
  SSM Health submitted claims for services received after 6/30/2023 to the consumers primary insurance carrier. These claims were denied by the primary carrier for Coordination of Benefits (COB) update by the member. Currently the member has provided the updated COB information to her primary carrier. Outstanding balances have been removed from collections are pending processing. No balances are being billed to the consumer. 
  Thank you for allowing us the opportunity to respond to this complaint. 
  
  ************** SSM Health ***************** Services 

• Initial Complaint

  04/08/2024

  Complaint Type:

  Billing Issues

  Status:

  Resolved

  More info

  On 5/18/2023 *********************************** with SSM Health provided pathology services and billed the incorrect insurance company, using out of date information. I attempted to fix the situation on several occasions, each time I was told the information had been updated and to wait 30 days. 30 days later I would get yet another late bill, would call them, provide them the information AGAIN, would be told to wait 30 days, AGAIN, and then 30 days would AGAIN get a late ****. I repeatedly called them, and started taking notes in February. From February forward I talked with:2-6- ********* 2-23 - **** and ******* (who told me ******** hadn't done what she was supposed to do)3-8 ***** ********* (who told me ******* hadn't done what she was supposed to do)3-11 Radiah - who told me ******* hadn't done the right thing 3-15 - **** - told me NO ONE had ever updated ANY information 3-15 - FINALLY was able to get a hold of a supervisor (after multiple calls), *****. ***** then told me it was too late to submit my claim to the insurance company but he would see if the *** would be forgiven as he felt I shouldn't have to pay as it was SSM's fault. 3-22 - Called ****** - at this point ***** refused to get on the phone 3-25 - Called at got ******* - he talked to ********************** again refused to get on the phone but informed me the ***t would not be forgiven. So I have paid the ***t. My concern is not the amount, my concern is their poor customer service and antiquated billing systems that force people into paying bills they don't owe. I can only imagine what this must be like for people with bills more than a few hundred dollars.I hope SOMEONE with the power to make change at SSM will review my record and ask themselves what they need to change to prevent this criminally bad customer service from happening again, and yes, I feel they own me 165 dollars.

  Business response

  04/29/2024

  This correspondence serves as SSM Health's response to Complaint # ********. 

  The complaint states SSM failed to bill to the correct insurance carrier and repeated attempts by the patient to correct the account with the billing office failed. 

  The balance on the account has been recalled from collections and adjusted as a courtesy in this instance. 

  We apologize for the inconvenience this has caused our patient. Then you for allowing us the opportunity to respond to this complaint.

  ************** SSM Health ***************** Services 

  Customer response

  05/08/2024

  I appreciate the follow-up;however, I had already paid AR street as they were saying it would go to collections. Is SSM going to refund me what I paid?

  Thanks,

  ********

  Business response

  05/13/2024

  A refund request was submitted for the amount paid to the collection agency. Please allow ***** business days for the refund to process. 

  ************** SSM Health ***************** Services 

  Customer response

  05/13/2024

  Complaint: 21548366
  
  I am rejecting this response because:

  The refund has not been received yet. Ill accept once the refund has been received.
  

  I appreciate SSMs help getting this resolved, although it does seem unfortunate that I had to get the BBB involved to get traction on this issue. 
  
  Sincerely,
  
  ***********************************

• Initial Complaint

  03/31/2024

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  I was in the hospital after surgery from November 27th,2023-November 30th,2023. During the discharge process on November 30th,2023 I was told by the social worker and at least one other staff member, that even though I had family there that could take me home, I would have to take an ambulance home due to their safety concerns of me getting into my house. I explained to them that I am on disability and could not afford an ambulance, they told me they would make sure my insurance covered the transportation home. A few weeks later I received a bill for $1605.00 from the ambulance company. I called my insurance and they said not only was it out-of-network, it was not covered because it was not an emergency. I left several emails and messages with multiple departments at both ************************* and SSM main offices. I finally received a callback from ************************* in ******, ** stating that they were unable to help me and that I would be responsible for the bill. If they werent going to make sure my insurance covered it then they should have allowed me to leave with my family. I feel they need to make this right and cover the bill, and train their social workers that this needs to be better taken care of upon discharging patients.

  Business response

  04/01/2024

  This correspondence serves as SSM Healths response to Complaint # ********.

  
  The consumer received a statement for the ambulance transport at discharge and states he was informed by staff insurance would cover the cost.
  SSM Health provided a Letter for Medical Necessity for Non-Emergent Ambulance Transport at time of discharge. When scheduling ambulance transfers the medical team will utilize this form to help determine the appropriateness of the transport. While used as a guide, it does not determine or authorize or payment for the trip, which is determined by the insurance carrier and the member benefits for this service.
  SSM Health previously reviewed this request in January and discussed the findings with the consumer in January and February. SSM will not assume financial responsibility for the ambulance transport bill.
  
  Thank you for allowing us the opportunity to respond to this complaint.

  
  ************** SSM Health ***************** Services 

  Customer response

  04/02/2024

  Complaint: 21511408
  
  I am rejecting this response because:
  
  I had multiple family members, one of which was there in the room, that could have safely transported me home.  It was hospital staffs decision to make me take an ambulance.  If they couldnt secure an ambulance that was within my insurance benefits, they should have told me and allowed me to go home with my family.  They could have asked me to sign a waiver stating that I refused an ambulance or something.  
  
  Also no one contacted me in January or February other than to tell me they needed more time to look in to my complaint. The letters did state that someone from the hospital may call me if the had questions, but no one ever did. Obviously your staff has problems communicating with patients while at the hospital and once they are at home.  
  
  Sincerely,
  
  ***************************

• Initial Complaint

  03/28/2024

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  My concern is with the billing practices of SSM in so far as their double billing. Not only do I receive a bill for services from SSM, they also turned the same accounts balance due to a collection service.Is this not considered double billing on their part? If I was an elderly individual I would most likely pay both! This is not the first occasion this has happened to my family, my husband had surgery and 10 months later we received the FIRST Bill. I made arrangements to pay ***** per month at our clinic. After 3 months, the clinic's patient account department could not apply my payment to this bill, as it had been turned over to collections, by corporate accounts in StLouis. For failure of not having a "signed agreement"! Although I had an agreement with our local clinic.So based on my previous encounters with SSM billing practices, I wanted to delay any payments, until I received my ******** Quarterly Statement which I received on Feb 6, 2024. My first collection letter was sent on 1/30/24! As well as continued bills from SSM.This situation is very concerning to me, not only myself but others who unknowingly are placed in a similar position, and pay both!

  Business response

  04/12/2024

  This correspondence serves as SSM Healths response to complaint # ********.

  
  The consumer states she is concerned SSM Health is double billing for accounts placed with outside collections. She states she had a payment arrangement and, but SSM Health placed the balance with collections despite making monthly payments.
  SSM Health ***************** Services offers options for patients to repay their account balances. These are structured payment arrangements with defined parameters and are based on the outstanding balance. The payments made by the consumer were outside the parameters for a structured payment plan. The account balance progressed to collections accurately according to SSM Healths billing policy. Once a balance is placed with collections, SSM billing office ceases to bill or collect on balances, eliminating the possibility of double billing. As a new balance comes due new statements will generate and SSM will collect on those balances that are not in collections.
  The billing and collections are correct according to SSM Health billing policy.
  
  Thank you for allowing us the opportunity to respond to this complaint.
  
  ************** SSM Health ***************** Services

• Initial Complaint

  03/28/2024

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  My issue is my lawyer sent them a check for ******* and ask them to apply to my account ************. In reference to the car accident bills *******. Someone apply the money to the wrong treatment. It been in collections because they sat on the check. Now Im getting bills from the collection agency because they were not paid.

  Customer response

  04/09/2024

  if you look on this document you will see how long they sit on the check that was sent out to them before March, but they did not deposit it until on March 14 2023. 

  Business response

  04/12/2024

  This correspondence serves as SSM Healths response to Complaint # ********. 

  The consumer states her attorney send a check in the amount of $2073 for payment of services related to a motor vehicle accident. The payment was not posted in a timely manner and the balance was sent to collections in error.
  Payment in the amount of $2027.00 was received and posted to the consumers account on 3/13/2023. The balance in collections is for a date of service unrelated to the motor vehicle accident. 

  A separate correspondence is being sent to the consumer with details of that claim and denial.

  Thank you for allowing us the opportunity to respond to this complaint.

  ************** SSM Health ***************** Services 

  Customer response

  04/16/2024

  This we they fixed the bill for ******* with the payment of ******* and applied to the following below.   6/21/2022-$325.00, 6/22/2022-$316.00, 7/6/2022-$93.00, 7/6/2022-$299.00, 7/13/2022-$93.00, 7/13/2022-$89.00, 7/28/2022-$93.00, 7/28/2022-$89.00, total *******-*******=******
  today I received bill for May 2, 2023 and May 9,2023. This is the bill they applied the ******* to the problem is they should have sent the bill to the VA to pay. I had a representative call them today from the VA with the information they need to get it paid. SSM needs to get that **** paid from the VA  send me a check for ****** and make sure my credit report is clear on this issue. They have messed up for the second time. 

• Initial Complaint

  03/08/2024

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  I received a bill for $160.00 from SSM Health. The charges were for my glasses. I paid $253.00 for half down for the glasses and then I paid $252.00 for the remaining balance of the glasses. I paid in full. I called the eye doctor's ****** regarding the bill on 02-13-24 in the morning. They told me they would have someone call me back because it showed I paid in full. No one called back. I called again in the afternoon and again was told someone would call me back. No one called. I called the billing department on 02-16-24 and spoke with ****. He couldn't figure it out and told me someone from billing would be calling me but no one called me back. I called the doctor's ****** again on 02-19-24 I was told ***** was on the phone will billing and someone would call me back. No one will call me back and no one can figure out why the system is charging me this amount when I don't owe anything. I ordered contacts and instead of showing I paid my contacts in full it applied to the balance that isn't correct. I need someone to help me get this fixed and the amount taken off my account. SSM is a terrible customer service and not responsive. I don't want to me sent to a collect agency because of SSM incompetent billing. I want this taken off my records. Thanks, ******************************

  Business response

  04/22/2024

  The consumer states she is receiving a statement for $160 for services have already been paid in full. The statement for $160 was mailed on 2/8/24. Payment posted to the visit on 2/12/24. The statement crossed in the mail with the payment. The balance on the visit referenced in the complaint is paid in full. The consumer can disregard the statement for this date of service.

   

  Thank you for allowing us the opportunity to respond to this complaint.

  Business response

  04/22/2024

  The consumer states she is receiving a statement for $160 for services have already been paid in full. The statement for $160 was mailed on 2/8/24. Payment posted to the visit on 2/12/24. The statement crossed in the mail with the payment. The balance on the visit referenced in the complaint is paid in full. The consumer can disregard the statement for this date of service.

   

  Thank you for allowing us the opportunity to respond to this complaint.

• Initial Complaint

  03/07/2024

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  On 10/9/23 I called St ********* in Mustang at 6:42pm to ask if they conducted SANE exams. I was told yes. I got there at 7:39pm, they checked me in, took my vitals, and put me in a room. After waiting for about ***************************** explaining how involved a SANE exam is and asking if I really wanted to do it. I said yes, that's why I came in. Then he proceeded to tell me that they don't do them at this hospital so they would have to transfer me to *****************. I said okay. He left the room and we waited another 30 minutes before we inquired what was taking so long for them to discharge me. They said something was wrong with the system. We waited another 30 minutes and inquired again, then they finally discharged me at 9:14pm. They did not give me any medication or medical care. I then went to ***************** in *** for the actual SANE exam. A few months go by and now St ********* is sending me a bill for $2, 275 when I didn't even receive the care I went in for that they said on the phone that they could provide. I should not be paying for services I did not receive. They are trying to financially take advantage of someone who has already gone through a very traumatic experience and I think that is very unprofessional and inappropriate. I called to try and discuss a dispute but they said I would have to send it in writing to the address on my bill, which I will do.

  Business response

  03/12/2024

  March 12, 2024

   

   

   

  Better Business Bureau

  *************************************************************************

  Case #: 21401690

   

   

  To Whom It May ********************* style="color: rgb(36, 36, 36); background-color: rgb(255, 255, 255); margin: 0in; font-size: 11pt; font-family: Calibri, sans-serif; font-weight: 400; font-style: normal; text-align: start; letter-spacing: normal; line-height: 12pt; text-indent: 0px;"> 

  Thank you for providing SSM Health *************************** with the concerns you received regarding our organization from Ms. ********************** SSM Health takes all customer concerns very seriously. Upon receipt of this notification, we began to review all aspects of the concern and will follow up on any potential opportunities for improvement necessary as part of our complaint and grievance process.  We are actively working to resolve the concerns with the customer directly but are unable to share any details with the BBB regarding our review and response due to patient privacy laws.

   

  Sincerely,

   

  Morgan K.

  Opportunity for Improvement Specialist

  SSM Health

  **************

  Customer response

  03/18/2024

  Please see attachment for HIPPA release.

  Business response

  03/25/2024

  Better Business Bureau
  *************************************************************************
  Case #:21401690
  
  
  To Whom It May ********************* you for providing SSM Health *************************** with the concerns you received regarding our organization from Ms. ********************** SSM Health takes all customer concerns very seriously. Upon receipt of this notification, we began to review all aspects of the concern and will follow up on any potential opportunities for improvement necessary as part of our complaint and grievance process.  We are actively working to resolve the concerns with the customer directly but are unable to share any details with the BBB regarding our review and response due to patient privacy laws.
  
  Sincerely,
  
  ****************
  Opportunity for Improvement Specialist
  SSM Health
  **************

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