Business Profile

Hospital

SSM Health St. Louis

Headquarters

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Complaints

This profile includes complaints for SSM Health St. Louis's headquarters and its corporate-owned locations. To view all corporate locations, see

Customer Complaints Summary

121 total complaints in the last 3 years.
42 complaints closed in the last 12 months.

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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:03/02/2024
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 am writing on behalf of *********************. We are disputing a bill sent to us by SSM Health, from 1/30/24 for services provided on 1/23/24. We want an explanation of why the estimate total was do much lower than the bill. We understand the nature of an estimate, but would not have gone through with the study if given an accurate estimate. On 1/22/24 the estimate was provided with an estimated due of $3,149.25. The estimate has been included for you to review.The total charges were $6,175.00. An applicable discount is listed as -$2,470.00.The estimated out of pocket was therefore listed as $3,705.00 (the total charge minus the applicable discount). We are uncertain of the difference between the 2 estimates ($3,149.25 and $3,705.00), but expected to pay some amount close to it. Satisfied with the estimate, ****** went through with the study on 1/23/24. On 1/30/2024 we received the bill which was for the expected total charge of $6,175.00 but with only an early pay discount of $617.50 for a total due of $5,557.50. $5,557.50 is significantly higher than the estimate provided (at least $1,852.50 higher). The early payment discount has since been removed, so the total due is now $6,175.00.This is even higher than the estimate provided (at least $2,470.00 higher). The good faith estimate provided to us was a reasonable price for us to pay, but since SSM Health will not apply the applicable discount, we are disputing this bill. We understand the nature of a billing estimate, but to be billed 166% of what we were expecting is unreasonable.As of 3/1/2024, we have paid $3,705.00 of the now $6,175.00 bill - the amount we had expected to pay. Until this matter is resolved, we will continue to try to make contact with someone from SSM Health, but so far are only able to reach a frontline customer service representative.
Business Response
Date: 03/05/2024
This correspondence serves as SSM Health's response to Complaint # ********.
The consumer states the billed amount received is significantly higher than the good faith estimate provided prior to service and has not been able to resolve the balance after repeated calls to the billing office.
Due to an error at registration the account did not receive the self-pay discount indicated in the good faith estimate. As of 3/5/24 the account has been adjusted to reflect the self-pay discount. After receiving payment from the patient, the account balance is now $0.00. We apologize for the inconvenience this has caused and hope to provide exceptional customer service in the future.
Thank you for allowing us the opportunity to respond to this complaint.
************** SSM Health ***************** Services
Initial Complaint
Date:02/28/2024
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 received a letter from Arstrat, a collections agency for a bill of $88.27 on 2/8/24 for bills on my 18 year old from 5/23-7/23. I never received these bills. During this time, I brought her to countless appointments and procedures and not once was I told I had an outstanding balance. I called SSM billing and was told that I was turned over to collections and I never received a bill because on the portal it is marked "Paperless billing". This is my daughters portal. The portal that was recommended that she get at 18 for her privacy. We have received bills previously and she has logged in and I have paid these. I did not receive bills for the above dates. I asked to pay the total which was ****** and was told that they couldn't take it because it was already turned over to collections. I called collections and paid it. The very next week received a "final bill" for these dates. A few days later I received another bill for the same dates. I scanned the ** code which now shows an active balance with SSM of ******. I called again to SSM and was told that she didn't know what was going on with my account and would escalate it. I have placed 4 complaints, reached out on ******** messenger and have completed a survey poorly asking for a call back. I am looking for a resolution and an improvement in this process. I have never been sent to collections. It is unacceptable to send someone to collections before they ever receive a bill and I can't get a resolution for the matter.
Business Response
Date: 03/18/2024
This correspondence serves as SSM Health's response to Complaint No. 21362516.
The consumer states she did not receive billing statements prior to bad debt collection placement and at no time was she informed in person by staff of an outstanding balance. SSM Health MY Chart is the online portal for accessing and managing the patients care team, scheduling, billing, etc. The default setting for billing is paperless with notifications via phone, email or text message, based on the patients' preferences. Patient ********* Services implemented a process to better support the patient experience and adhere to fair collection practices wherein if the patient does not view statements in MyChart, they receive a paper statement prior to being sent to collections. The process failed in this instance. Four paperless statements were unviewed in My Chart; however, no paper statement was mailed prior bad debt placement. The process is currently under review.
The payment to the collection agency posted to the account which now has a $0.00 balance. SSM Health thanks you for your payment and apologizes for the inconvenience this has caused.
************** SSM Health Patient ********* Services
Customer Answer
Date: 03/20/2024
Complaint: 21362516

I am rejecting this response because:

I want to know that the problem that incurred will not happen to myself or anyone else. You say I have a zero balance however, when I have my last bill and I scanned the code, it still showed I had a bill. I want to know that you have a solution for this problem. What steps have you implemented to prevent this from happening again to myself and others?

Sincerely,

*************************************
Initial Complaint
Date:02/21/2024
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.
They are not processing my claims through my primary insurance and then my secondary insurance. This is causing a balance on my account that should not be there.
Business Response
Date: 04/15/2024
This correspondence serves as SSM Health's response to Complaint # ********.
The consumer states SSM Health failed to bill claims to her insurance in the correct order resulting in incorrect balances billed to the consumer.
One account is identified as having been billed incorrectly. This account has been recalled from collections and a courtesy adjustment posted for the full amount due to the age of the account. The patient payment received has been submitted for a refund review according to SSM Health's refund policy.
We apologize for the inconvenience this has caused and hope to provide exceptional service in the future.
************** SSM Health Patient Financial Services
Initial Complaint
Date:02/20/2024
Type:Service or Repair 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.
This is the second time this has happened. SSM Health at home will call and say that my health insurance has allowed me to recieve CPAP supplies that are covered under healthinsurqnce. They do not know which items are covered and they do not know what the over all cost (out of pocket) is. They tell me they will put together a list of items and the cost (if any) of all the items for my CPAP and call me back. They then never call back and send the list of items as an order to you. The last one cost me hundreds of dollars. I recieved this call for the 2nd time several months ago and they told me they will call me back and let me know the cost and they have not called back and if they did they never left a message. I just recieved a notice (email)I'm getting a package from SMM health that I did not ok. I made a call to them and of course no one answers the phone and I left a message. This is a fraudulent way to run a business. I want this to stop.
Business Response
Date: 02/22/2024
SSM representative had the opportunity to speak with the patient about his concerns. The incident and processes were discussed and the patient is satisfied. Staff have been re-educated.
Customer Answer
Date: 02/26/2024
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
Date:02/10/2024
Type:Product 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.
Last communication regarding this issue was February 6, 2024. A grievance was originally filed on 2021, and I was finally contacted via postal mail in March of 2022. I was overcharged on medical claims via deductibles and copayments. The letter indicated that I was due $485.44. To date I have not received the check. I advocated for myself and SSM Healthcare mailed the check to the insurance company (United Healthcare) and claim they didn't owe me. I am seeking repayment in the amount of $485.44.
Business Response
Date: 02/13/2024
This correspondence serves as SSM Health's response to Complaint # ********.
The consumer states she is due a refund from SSM Health due to being overcharged on medical claims. She refers to a letter dated March of 2022 indicating she was due a refund of $485.44.
The letter is addressed to the insurance carrier and not the patient and indicates the refund is due to an overpayment by her insurance carrier. SSM Health would not refund an insurance payment directly to a patient. Refunding the insurance carrier is the appropriate action. The consumer is not due a refund from SSM Health.
Thank you for allowing us the opportunity to respond to this complaint.
************** SSM Health ***************** Services
Customer Answer
Date: 02/13/2024
Complaint: 21275587

I am rejecting this response because:
The patient in which you refer to (me), overpaid in copayments and deductibles in 2021. I advocated for MYSELF. Why would I dispute claims on SSM's behalf when you all are worth millions? The action (reimbursement to UHC) was rather inappropriate since I am the one that paid these funds out of pocket. It is evident that you all are going to stand strong on your fallacies. I don't do business with crooks. SSM Healthcare is an unethical organization that robs patients.
Best Regards,
************************;
************************

Sincerely,

*************************
Business Response
Date: 02/15/2024
This correspondence serves as SSM Health's second response to Complaint # ********.
The refund letter is specific to six dates of service from April 2021 to September 2021 where payments were received from the insurance company, not the patient. The claims in questions were rebilled as a global package due to the member's maternity benefit. Again, we will not refund an insurance payment to a patient, but back to the original payer, and in this instance that was the insurance carrier.
The refund is correct as processed and the patients not due a refund.
Thank you,
************** Patient Fianacial Services SSM Health
Initial Complaint
Date:02/06/2024
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.
My wife ********************************* was diagnosed with Lyme disease last year. After being treated by a nurse practitioner it was recommended that she see a specialist. After calling around she was connected with the *********************** at ********* in **********, **. who assured that **************************** would be able to help her. After waiting multiple months she finally had her appointment on August 21st. After reviewing her file ************* stated "I am not sure why they sent you to me as I do not specialize in ****. I deal with auto immune disorders." He asked if she would like him to check for those and she declined. Then we got a bill for $564.12. We called to dispute the bill on 9/27/23 because no services were rendered and we did not feel that we should owe anything, and we were told that we would need to send a letter. We sent the requested letter the next day. After not hearing from them we received another bill and called again to check on the status on 1/9/24. We were told that the letter was received on 10/11/23, but there was no further comments. They said they would resubmit it and call us within 7-10 days. They did not call, so we called back on 1/26/24 after giving us more run around they said they would submit it to a supervisor and we would hear back in 24-48hrs. They did not call back, so we called again on 2/1/24. This time the person on the other line said he was just taking messages and ****** would call us back later today or tomorrow. She did not. I called again on 2/5/24 and asked to be connected to a supervisor who couled help with this billing issue. After much more run around was connected with a "floor supervisor" who would not give me a name other than *******************. After trying to get me off the phone for ********************************************************************** so I asked to speak to someone who could. She stated that she could not connect me. I asked for a phone number and she said she is not allowed to give it.
Business Response
Date: 03/01/2024
This correspondence serves as SSM Health's response to Complaint # ********.
**** Patient Relations has received this complaint and is conducting a review of the stated patient concerns. Due to HIPAA and privacy laws the details of the review cannot be shared on this platform. **** Patient Relations will communicate directly with the patient and share the outcome of their investigation.
Thank you for allowing us the opportunity to respond to this compliant
************** SSM Health ***************** Services
Customer Answer
Date: 03/04/2024
Complaint: 21256302

I am rejecting this response because: They told us they were reviewing the situation. They have told us the same thing from the beginning. They have only called us on one occasion, on 2/15/2024. We missed the call, and when we called back ten minutes later, they were too busy to accommodate us. They said they would call us back later, and they never did. The only communication we have with them is when we call them.

Sincerely,

*********************************
Business Response
Date: 03/08/2024
This correspondence serves as SSM Health's second response to Complaint # ********
**** Patient Relations is in the process of reviewing the stated complaint and will send a formal response with the outcome once the review is completed. A letter acknowledging receipt of their formal complaint has been mailed to the consumer and states they will receive another correspondence within 30 days. We would request the consumer allow time for the review to be competed and the response received. Again, due to HIPAA and privacy laws the details of the review cannot be shared on this platform.
Thank you,
************** SSM Health ***************** Services

Customer Answer
Date: 03/15/2024
Release form for *****************************;
Customer Answer
Date: 03/15/2024
Release for *****************************;
Customer Answer
Date: 03/15/2024
Release for *****************************;
Business Response
Date: 03/19/2024
This correspondence serves as SSM Health's third response to complaint # ********.
**** Patient Relations and the provider of service completed their review and mailed a letter of response directly to the patient today, 3/19/2024. Please allow time for receipt of this letter and outcome.
************** SSM Health ***************** Serivces
Initial Complaint
Date:02/01/2024
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 ribs that are not just broken are clearly misplaced if you put a hand over each side you can tell with this injury occurring November 20th 2023 (2 months ago) that they are not healing on their own.I initially saw *************************** January 18th 2024 thinking I just had a lumbar hernia. She said I do not have any hernia.(NY surgeon just confirmed I have 3 hernias and I'm only 34 years old) and she says that 'most lumbar hernias usually go away on their own) She orders xrays of my ************* I go back the next day on January 19th and the person taking my X rays (******) acted deliberately in not taking an image of the section where the most pain is at. She did the other side and the machine lit up and made a sound each time she went back to the room to press the button while I stood against the board. When it came to doing the side that's in the most pain at a 45 degree angle with half my back against the board (left oblique) she walked back real fast the MACHINE DID NOT EVEN GO OFF IT CLEARLY DID NOT TAKE AN IMAGE. I addressed this to her and she said it did take an image and said "It's overheating it does that sometimes".Dr. ******** office upon calling back and letting each new staff member that got on the phone I am recording the call, individual by the name of '*******' schedules me an appointment with Vascular orthopedic surgeon ************** for Friday Feb 2nd 2024 Yesterday January 31st I receive a call from '*******************' who is a 'nurse Navigator' I explained that the most important image was not taken and she completely ignored it on a recorded line that she was informed of being recorded and said '************** has your images and will figure out what needs to happen then.' SSM Healths Administration hangs up any time I call. SSM health does not have a phone number to a customer relations department or a patient care advocate that comes up at this time on google.I have a print out of an X ray at urgent care showing my ribs completely dangling.
Business Response
Date: 02/12/2024
Thank you for providing SSM Health-St. Louis with the concerns you received regarding our organization. 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.
Initial Complaint
Date:01/29/2024
Type:Customer Service Issues
Status:
UnresolvedMore 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 am reaching out for help to resolve a dispute I have with *** *** ***** ******* ** ******** **. I do not have a computer to send this online, so am having someone type this letter for me.

In a nutshell, I feel that I was overcharged for my husband's most recent stay at *** ***** *******. He came in under hospice care and we were told his death was eminent. He was only there for about 2 ½ days before we pulled him out for a reevaluation and retrieved his belongings the same day. They are charging me for a bed hold that I never authorized and are saying that hospice is not covered under Medicare in nursing homes. Based on some research, I have found that costs associated with room fees in nursing homes is covered for hospice patients that are experiencing a medical crisis due to symptom exacerbation and are staying in an inpatient unit for the short term. I would say that a stroke and heart failure along with internal bleeding and being there for only 2 ½ days should fit this category.

Please see the enclosed copies of letters regarding this matter. Thank you in advance for your time and assistance.
Initial Complaint
Date:01/11/2024
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.
The *ur*ose of my com*laint was to layout the details and summarize the encounter with SSM Urgent Care, Florissant MO, and how my misdiagnosis has im*acted my life and the life of my family. Went to SSM Urgent care in Florissant MO on 11/25/23 with sym*toms of COVID, congestion, headache, funny nose, sore throat, body aches, chest tightness, and coughing s*ells at night and during the day. I was diagnosed with Acute cough and Viral URI with cough. I requested a COVID test and was refused by the nurse *ractitioner stating my sym*toms has gone on for a long time and if I had COVID test would not ca*ture the sym*toms. Well, I was refused the COVID test and I did not get any better. In addition, I had another added sym*tom, *ain in my right leg. So in addition to my medical sym*toms with cough, cold, congestion, chest *ain and tightening, my u**er right leg was giving me issues. 12/21/23 I was 1st seen by the nurse. I gave her my sym*toms. She stated, we are going to do a COVID and other test to determine while I was still having the cold sym*toms. After being seen by the nurse *ractitioner she checked my leg and said I could have s*asms but she *refer that I go to the emergency room and get it checked out. She said my test came back and was negative for COVID. She said it did come back *ositive for Stre* throat and gave me a *rescri*tion. My sym*toms for my leg s*asms as well as the intense coughing, fever, chils, dry cough, shortness of breath, body aching and feeling very fatigued had intensified. 12/23/23, I went to the ******** ******* Medical Center Emergency Room I was diagnosed with muscle s*asms, COVID and RSV. According to the doctors, I have had COVID for some time. Because I was not diagnosed *ro*erly, my entire family including my husband, my children and my grandson develo*ed COVID as a result of SSM Urgent Care telling me I did not have COVID when I did.
Business Response
Date: 01/16/2024
Thank you for *roviding SSM Health Urgent Care with the concerns you received regarding our organization.&nbs*; SSM Health takes all customer concerns very seriously.&nbs*; U*on recei*t of this notification, we began to review all as*ects of the concern and will follow u* on any *otential o**ortunities for im*rovement necessary as *art of our com*laint and grievance *rocess.&nbs*; 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 res*onse due to *atient *rivacy laws.”
Customer Answer
Date: 01/16/2024
Com*laint: ********

I am rejecting this res*onse because:

The res*onse seems to me like they are trying to justify the events that trans*ired without taking any accountability.&nbs*; I would like this com*laint to stay onfile and the com*any to receive a rating of B or below.&nbs*; Not only was I treated rudely and was refused medical attention at that time when I was clearly in distressed, I was misdiagnosed stating I had did not have COVID when I was *ro*erly diagnosed 2 days later by *** ******** ******* ********.&nbs*; I infected my family including my 2 year old grandson with asthma who has not clearly recovered.&nbs*; I was quarantined u* til the time SSM Urgent Care told me I was negative for COVID. Once they told me on a Thursday I did not have it and went among my family, they incurred sym*toms afterward.&nbs*; I am not satisfied how they are trying to s*in the events to their advantage.&nbs*; Not sure if the COVID test SSM Urgent Care had ex*ired or administered incorrectly.&nbs*; I counted on SSM Urgen Care to *rovide me with the best care.&nbs*; Another issue is, everytime I go to urgent care, and *ay my co*ay of $35.00, I receive a medical bill charging me an Emergency Room co*ay. That is not right as well.&nbs*; I am racking u* co*ays for a service they did not *rovide very well. You can never get your health back so I counted SSM Urgent Care to *rovide the best care and they failed me as a *atient, so no I reject their res*onse.&nbs*;&nbs*;

Sincerely,

******** *****
Customer Answer
Date: 01/25/2024
<*>I reject the res*onse from SSM. On 1/16/24 when I was contacted, the conversation was recorded. There was no no resolution.The two ladies just called to to justify the action of their workers. The information they *rovided to BBB is not corrrct. I give BBB *ermission to get co*ies og the ta*e and listen to it. I am giving *ermission for SSM to release any records to BBB. Do not close my case based on one sided information from SSM that they tried to come u* with a resolution. They did not. I would like for them to *rovide information they submitted to me. My com*laint still stands and want the rating changed. I want BBB to stand u* for my rights as a consumer
Customer Answer
Date: 02/07/2024
Com*laint: ********

I am rejecting this res*onse because:
I have not resolved any issies with anyone at SSM. I received one *hone call from two individuals one i recall was Laura Knight. The *hone call consisted of the ladies attem*timg to justify the actions of the em*loyees. It was a recorded meeting meeting in which I said nothing.&nbs*; I felt minimized by their justification of my mistreatment and my misdiagnosis which affected my whole family. Now i am having nightmares about my treatment and I get anxiety when I think about having to go to an urgent care. When i think about what ha**ened to me and my family I feel anxious knowing my misdiagnosis could have cause the death to someone I love. There is no justification. They also charged me emergency room fees for an urgent care visit. I com*leted the form BBB ask me to com*lete and I faxes the necessary docoments requested about my health insurance. SSM will not get away with my.mistratment, telling I did not have covid when I did which affected my whole family which has caused traumatic e*isodes.&nbs*; So no a fake a*ology is not a good enough remedy for me. I want their rating changed and I want my com*laint to stand.&nbs*; I want the emergency charges they charged me for an urgent care visit investigated. *atients should know this informarion, and not hidden until we get the bill. Hold SSM accountable.

Sincerely,

******** *****
Business Response
Date: 02/09/2024
<*>This corres*ondence serves as SSM Health’s res*onse to Com*laint # ******** rebuttal, dated February 8, 2024. The original com*laint is dated 1/11/2024.<*>
The consumer states in her rebuttal she wants SSM Health’s BBB rating changed and her com*laint to stand, and wants the charges investigated for accuracy in billing.<*>
SSM Health bills ******** claims using universal billing codes. Current *rocedural Terminology (C*T) codes indicate to the insurance carrier the cost and service *rovided. Revenue Codes tell insurance the location of service. SSM Urgent Care locations are billed with revenue code ****, which indicates the location as an urgent care level of service (Emergency De*artments are billed with revenue code ****).
SSM Health Urgent Care o*erates as a ********-based, also known as “*rovider-based,” out*atient de*artment. This relationshi* reflects a national model of *ractice for integrated delivery systems, where the ******** has oversight of clinical staff, *hysicians, and advanced *ractice *roviders (*hysician Assistants and Nurse *ractitioners) involved in *atient care and ensures the safety and quality of services *rovided. The urgent care de*artment, as a *art of a *arent ********, is also subject to strict quality and *erformance standards *ut forward by both the Centers for Medicare and Medicaid Services and The Joint Commission, the ********’s accrediting body. Accreditation by The Joint Commission is recognized nationwide as a symbol of quality reflecting an organization’s commitment to quality, coordination of care and exce*tional clinical outcomes.

Two dates of service are billed with revenue code ****, which indicates an Urgent Care location. SSM Health has a contractual obligation to bill the *atient the amount assigned as *atient res*onsibility by the carrier. Members should contact their insurance carrier if they have questions regarding benefits.<*>
SSM Health *osted a onetime courtesy adjustment to two dates of service alleviating the *atient of any further financial res*onsibility.
SSM Health cannot s*eak to how the BBB determines a com*any’s rating and has no control over what is *osted on the BBB website.<*>
This res*onse constitutes SSM Health’s final determination and res*onse to this consumer com*laint.

***** *. SSM Health *atient Financial Services&nbs*;
Customer Answer
Date: 02/14/2024
&nbs*;I do not agree with the determination of BBB.&nbs*; A good faith effort by SSM was not done.&nbs*; All tney *rovided was excuses and justification.&nbs*; There will be no consequences for their action.&nbs*; I feel because they are a big business, BBB decided to fold and go&nbs*; with the com*any instead of the consumer.&nbs*; I thought BBB did not do their due diligence.&nbs*; I want someone else at BBB to look at my case.&nbs*; &nbs*;I am a**ealing your determination and ask that someone else take a look at it.&nbs*; If all that requires a good faith is that SSM give me a call, and when they called it was not genuine, all they did was *lace blame and justify, and that closes a case, then why do we have BBB.&nbs*; They are not for the consumer.&nbs*; Its hard to file a com*laint against a big com*any for the wrong they have done, and to finally have the courage to do it, and for BBB to close the case because SSM made a non genuine *hone call to me and thats it, that is enough for BBB to say they made good faith effort and close the case.&nbs*; Shame on BBB they have failed me as well.&nbs*; I want this case reviewed by someone else higher.
Initial Complaint
Date:12/27/2023
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.
Was seen on 03/15/2023, 03/23/23, 04/11/23 and 05/3/23 for a diabetic ulcer each visit the ulcer was debriding it and putting the foot in a cast each and every time and was classified as "surgery" I asked them to confirm the insurance and that we were in network and was told each and every visit we are. To find out we weren't at all and it was all out of network costing us $10,151.27 for just these 4 visit out of pocket and to make matters worse the debriding and casting made matters worse causing a severe infection we ended up in the ER on 06/12 and was admitted into the hospital for 4 days he was close to going septic. Ended up having to have surgery on his foot on 10/9/2023. Due to all of this we have paid over $13,000 out of pocket so far.
Business Response
Date: 01/03/2024

A billing review was completed for wound clinic services for date of services 3/15/23, 3/23/23, 4/11/23 and 5/3/23 The billed charges are correct for the service(s) provided, as is the billing and liability assigned to the member according to his benefits. SSM follows CMS (Centers of Medicare/Medicaid Services) who set the billing guidelines for this service. Anthem's explanation of benefits (EOB) can be reviewed to verify how this claim was processed and should be contacted with any further coverage questions.
Additional review was completed on dates of service June 13-June 17, 2023, for inpatient services - The billed charges are correct for the services provided, currently the claim is pending to Anthem for processing, at this time patient liability is unknown. Anthem's explanation of benefits (EOB) can be reviewed to verify how this claim was processed and should be contacted with any further coverage questions.

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