ComplaintsforSSM Health St. Louis

• Initial Complaint

  08/06/2022

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  On 8/5/22 I received services at an SSM Health Urgent Care on ******* **** which is NOT SSM Health ****** ******** *** *****. My insurance is being billed as a emergency visit despite this being an urgent care and not connected to the hospital. I paid my $35.00 copayment and now getting a bill for a copayment for an ER visit. This fraudulent billing and I’ve also contacted my insurance company.

  Business response

  08/10/2022

  A review of the medical record was completed for auditing purposes. Patient was seen in the SSM Health- ******* Urgent Care. – ***** Hospital.
  
  Documentation in the medical record supported that the patient was evaluated and treated at SSM Health- ******* Urgent Care.  Final report is listed in the medical record by the physician. Charges are correct for the services provided, and the diagnosis coding is correct for the condition for which the patient was treated. You may go to any SSM facility and obtain a copy of your medical records for your review and personal records.
  
  Claim was billed with Revenue Code **** which indicates to the insurance company services were rendered at an Urgent Care.  Currently the claim has not completed insurance processing it is unknown patient liability until insurance has completed processing patient’s claim.  SSM follows CMS (Center of Medicare/Medicaid Services) who set the billing guidelines for these services. ******** explanation of benefits (EOB) can be reviewed to verify how this claim was processed and should be contacted with any further coverage questions.
  
  We apologize for the inconvenience that this might have caused you. We appreciate the opportunity to address your concern.

• Initial Complaint

  08/05/2022

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  I visited SSM ****** for a mental healthcare issue (which was NOT resolved) and they charged me $390. My insurance paid for it within a month but SSM still claimed I owed money and sent my account to collections when i refused to pay! This affected my credit and took months to resolve

  Business response

  08/12/2022

  August 12, 2022
  
  BBB Complaint # ********
  
  Dear *** ********
  
  Account Number: ***********
  Date of service: January 28, 2021
  
  SSM Health has received your concern regarding the charges at SSM Health- DePaul St. Louis Behavioral Health Department.
  
  
  A review on your account was completed for auditing purposes.
   
  Documentation supports patient presented to SSM Health – ****** *** ***** ********** ****** **********. Patient was triaged, treated/observed, and discharged. Final reports are in medical record. Patient may go to any SSM Health facility and obtain a copy of his medical records for his review and personal records.
  
  If you have questions regarding your medical treatment, please contact your healthcare provider directly.  If you have questions regarding your medical benefits, please contact your insurance carrier directly.
  
  Billed charges are correct for the services rendered to the patient, coding is correct according to the physician's orders and documentation of procedure and tests. SSM follows *** (******* ** ***************** Services) who set the billing guidelines for these services. Charges were appropriately billed with *** applying services to deductible, patient liability is $397.00.
  
  SSM Health offers several options for repayment. Financial assistance is available for those patients who find their hospital bills create a financial hardship. Please contact customer service at ***** ********, Monday-Friday.
  
  We apologize for the inconvenience that this might have caused you. We appreciate the opportunity to address.
  
  
  
  Sincerely,
  
  **** **  Corporate Patient Liaison - Patient Financial Operations- SSMy here...

• Initial Complaint

  06/22/2022

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  I delivered a baby in December 2021. They gave me 4 separate accounts for 1 hospital stay. I’ve been paying $20 a month on each account. They sent me to collections. Told me I have to pay $50 an account, per month or they will keep me in collections. They said I don’t qualify for a reduced an amount, because of my income isn’t low enough. I tried calling yesterday to get things figured out. A customer service representative Jeff, gave me huge attitude and flagged my account because I called them off my mothers cell phone. **** claimed I was committing fraud, when I literally said I was just trying to pay my bill. I called back to get another representative, so I could speak to a manager and get my account unflagged. A manger has still not called me back. I don’t have access to my account. I can’t get my account paid. No one will help me or give me answers. I’ve been treated with disrespect. I’m in collections. They are going to force me into bankruptcy, telling me I will pay them more than I can afford.

  Business response

  06/24/2022

  
  June 24, 2022
  
  BBB Complaint # ********
  
  
  SSM Health is in receipt of consumer complaint # ******** This correspondence serves as SSM Health’s response to this matter
  
  SSM Health has an established billing policy that outlines our billing policies and procedures. It addresses First Party Collections, Bad Debt Collection Efforts and Consumer Credit Reporting. The policy also outlines our financial assistance guidelines.
  
  After 120 days of ordinary collection efforts, the Patient Liability is still outstanding and the patient has not submitted an application for financial assistance or set up an approved payment plan, SSM Health may place the account with a bad debt agency as described below under Bad Debt Placements. The unpaid patient balance will be placed with the bad debt collection agency after the patient has received at least 120 days of in-house or early-out collection efforts and the account is not on an approved payment plan or in good standing. Accounts with consistent monthly payments in the last 45 days will be reviewed prior to being sent for bad debt placement. This review will include notification to the patient to prompt them to establish an approved payment plan or pay the balance in full. If the patient fails to respond and does not meet SSM’s guidelines for payment, the account may be sent for bad debt placement.
  
  SSM Health offers several options for repayment. Financial assistance is available for those patients who find their hospital accounts create a financial hardship. Patient may contact customer service at ###-###-#### to discuss her  options.
  
  Sincerely,
  
  ******* * Corporate Patient Liaison - Patient Financial Operations- SSMs

  Customer response

  06/24/2022

  Complaint: ********
  
  I am rejecting this response because:
  These policies were never given or explained to me. It’s not my job to seek them out. Nor was I explained that because I’m an employee, I could have a payroll deduction and receive an employee discount. After calling you guys over and over and over again, it was the 11 customer service representative that actually explained things correctly. Now I have an account locked out for 30 days, because I called off of my mothers cell phone and a representative named ******* felt the need to flag me. A week later, and I’m still waiting on a phone call for a manager! Also your financial aid department only gives reduces payments to individuals who fall at or under the poverty line, which is ridiculous. You shouldn’t get to decided how much I can afford to pay when you don’t pay my bills. It’s not appropriate to send someone to collections who is making payments. I’m a single mother, with several jobs thanks to inflation. A manager needs to contact me within the next 48 hours to get my account unlocked. 

  
  
  Sincerely,
  
  ****** **********

  Business response

  07/11/2022

  July 5, 2022

  BBB Complaint # ********

  SSM Health is in receipt of consumer complaint # ******** This correspondence serves as SSM Health’s response to this matter

  SSM Health has an established billing policy that outlines our billing policies and procedures. It addresses First Party Collections, Bad Debt Collection Efforts and Consumer Credit Reporting. The policy also outlines our financial assistance guidelines. The policy is listed on SSM Health.com for patient review it is also available upon request. The above information is provided on the patient monthly patient statement.

  Consumer stated she was not informed of employee deduction option this information is provided to all employee’s at new hire orientation. It is the employee’s responsibility to request payroll deduction and to complete deduction form. If employee has questions regarding her employee benefits, she can discuss with her Leadership.

  If patient is not able to access her My Chart, she will need to contact My Chart technical support at ###-###-####.

  Please contact customer service at ###-###-#### to discuss your options or to make a payment.

  We appreciate the opportunity to address your concern.

  Sincerely, ******* * ********* ******* ******* * ******* ********* *********** ***

  Customer response

  07/11/2022

  Complaint: ********
  
  I am rejecting this response because:
  Your response conflicts with several customer service employees. It sounds like people are trying to be deceiving about how to get the true employee discount. And even your response is incorrect. Considering I called again, and they gave me my 20% discount over the phone and let me pay the bill, no paperwork or payroll deduction needed. But thank you all for the awful customer service and deception.  
  
  
  Sincerely,
  
  ****** **********

• Initial Complaint

  06/09/2022

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  I am so angry and frustrated. I do not have insurance. In order to decide if I can afford to proceed with any test, appointment, etc., I need to know how much it costs BEFORE I receive the service. I was given an “estimate “ for cash pay, paid in full price, for a ********** ********* and ********. Based on that estimate, I decided to move forward with the procedure. Yes, I was told it was an estimate, but I was NOT told that her estimate would be intentionally deceptive and that the true cost of everything from my 2 dates of service would end up being thousands of dollars more that the “estimate”. Nor was I ever informed that the estimate was only for a portion of the service, or that there would or could be other entities, like the *********** *****, who would bill me separately, or that those charges were not included in the estimate. This is intentionally misleading and it is not okay. You are not allowed to spend my money for me, or add on additional charges without FIRST advising me of the amount of those charges for me to authorize. This office does these procedures multiple times every day. I do not. SSM Health and breast care center should be able to estimate correctly within a couple hundred dollars. I cannot know what I’m not told, and I was not told the estimate would not cover all the charges. I was told that I was paying in FULL. Had I been told that the estimate was actually more like a deposit, and I would continue to get multiple bills, I would have determined I could not financially afford to proceed with the test/appointment. The estimate was approximately $722, which I paid in full weeks before the date of service. I have now received another bill from SSM Health for $789.62, and one from the ********* ***** for $618. And this is just for the diagnostic tests. I also had a ****** in this office which is the same financial scenario. THOUSANDS of dollars over the “paid in full” price I was quoted. I NEVER would have proceeded.

  Business response

  06/16/2022

  This complaint was received on 6/15/22 and we are requesting additional 14 days to complete our review. 

   

  Thanks

   

  Business response

  08/15/2022

  SSM Health response to patient -  SSM Health has received your concern regarding the billing issues that you reported to SSM Health Customer Service Department. We thank you for bringing this issue to our attention, so that we may address your concerns. It is always our goal to provide an exceptional patient experience.
  
  A review of your account shows the estimate was only for the ********** *********. The representative that completed the estimate did not add the ********** to the estimation . When estimating ********** *********s the ********** should always be included.   A new process has been developed that requires Leadership to audit all finalized estimates for accuracy before given to patients.  A letter will be emailed to patient with estimation and also explain that there may be additional bills from offices that bill separately.  Unfortunately, we cannot provide an estimation on the physician(s) charges. 
  
  The amount of $789.62, being billed to you, has been adjusted to zero. 
  

• Initial Complaint

  04/04/2022

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  I received an invoice for services provided by this company to ***** ****** on several dates in March 2022. ***** ****** and I divorced in August 2021. I have no idea why I received this invoice. The invoice lists ***** as his insurer. ***** is not my insurer and I have no relationship with *****. I HAVE NO LEGAL RESPONSIBILITY FOR THIS INVOICE.

  Business response

  04/05/2022

  SSM Health has no recent dates of service for a patient by the name provided at the address provided. Additional information is needed before any assistance can be provided. An invoice, or account number, exact date of service or billing phone number would be helpful. 

   

  ***** **

  Process Improvement Specialist 

  SSM Health 

• Initial Complaint

  03/23/2022

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  SSM Health Insurance and one of their providers are refusing to cooperate in a timely manner - they say their policy is 30 days. I am now past the 30 days and it is clear I have met my deductible however the insurance company is refusing to relay that to one of their own companies. I am in desperate need of wound care product and SSM Home Health refuses to order with out me paying for the product up front. They in the past have been incredibly difficult to work with and have cost my household personally several hundreds of dollars more than was expected to pay! I believe they are a fraudulent company and need to be audited on their processes.

  Business response

  02/18/2022

  The complaint expressed by the patient is regarding services at SSM Health at Home in *****************. The contact for this complaint is *****************************, Director Home Health  and her email address is *********************************************************** Please send this BBB complaint directly to her. 

  Business response

  02/24/2022

  We reviewed our documented notes and interviewed staff who were involved in this case.  SSM Health at Home provides durable medical equipment and disposable medical supplies to patients and bills the patient's insurances and the patient for the products.  Our standard process when receiving a referral is to verify the patients insurance and deductible, along with what the insurance shows as the remaining deductible amount on that date.  This was done and we found that the deductible had not yet been met when supplies were requested.  We reached out to the patient to explain, but the patient was frustrated that her deductible had not been met as she had many recent claims for procedures and Dr visits from other providers.  When we verified the with the insurance the claims in question were still in pending status.  The patient was still frustrated and the case was elevated to management, who made the decision to provide supplies without getting money up front.  SSM health at Home did provide the patient with the necessary medical supplies in mid-December.  The customer did not have to pay anything up front to receive these supplies.  By the time our claim was reviewed by the insurance company, the deductible for the plan was met and we were reimbursed by the insurance.  We believe this matter is closed.

• Initial Complaint

  03/11/2022

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  I received a bill on 2/1/2022 for ******* for a medical procedure done on 4/12/2021. I called the insurance company immediately and asked when they paid their share of the bill. The advised me they paid on 5/8/2021. I had a lot of medical bills in 2021. I PAY MY BILLS. I reached my max out of pocket amount with my insurance company last year. Max out of pocket is Approximately ******* ! If this bill had been sent in a reasonable amount of time, I would have paid it and reached my maximum out of pocket sooner and I would not have to pay ******* THIS YEAR. I am retired,a vet and on SSI and pension. My income is FIXED. WHY WAS THIS BILL NOT SENT TO ME LAST YEAR? They are LITERALLY S******* ME by sending bills so late! These people EXPECT YOU TO PAY ON TIME BUT THEN THEY COMPLETELY BURN YOU BY SENDING **** SO LATE THAT YOU ARE REQUIRED TO PAY WHEN WE WOULD NOT HAVE TO IF IT WAS SENT ON TIME.

  Customer response

  02/18/2022

  The name of the facility is ***********************, ****************************************************

  Customer response

  02/18/2022

  The facility is *********************** in ****************************************************

  Business response

  03/03/2022

  This correspondence serves as SSM Health's response to Complaint ID: ******** dated 2/25/22

   

  The consumer stated he had met his out of pocket obligation with his insurance carrier for the year 2021 and this statement represents a bill that should have been satisfied had it been billed to him in a more timely manner. 

  The supervisor of billing reviewed the claim and verified the amount assigned as patient liability and subsequently billed to the patient by SSM Health is correct according to the contract and members benefits. The billing cycle was delayed due to an initial denial from the insurance carrier. Once the corrected claim was processed another delay occurred when the claim needed manual review to ensure accuracy after payment was received from the carrier but  prior to billing a statement to the patient. 

  SSM Health is contractually obligated to bill the patient the amount assigned as patient responsibility by their insurance carrier. The liability was assigned as member responsibility by DHP Marketplace based on the patients benefits for the year 2021 (when services were received). The billing cycle does not impact a members benefits. They are always processed based on the benefits at time of service. The patient stated had he paid the bill in 2021 he would have reached his out of pocket then and would not have to pay this bill now. Resolving the balance with the hospital does not change the members benefits for the year the services were provided. A member will never pay more than their out of pocket maximum for the year regardless of when the billing cycle
  begins. If the patient feels the claim was processed in excess of his benefits for the year 2021 he will need to contact his insurance carrier to discuss. 

   

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

  Customer response

  03/08/2022

  Better Business Bureau:
  
  I have reviewed the response made by the business in reference to complaint ID ********, and have determined that this does not resolve my complaint.  For your reference, details of the offer I reviewed appear below.
  
  [Please type your response here.As I said. The insurance company paid their share IN MAY.I called them to verify this when I recieved the bill.You FAILED to submit a bill to me for 8 MONTHS! That cost me money in 2022 that would have been covered as I had reached my max out of pocket.

  Regards,
  
  ***************************

  Business response

  03/09/2022

  Please sent to billing, not a care concern. *****************************

  Business response

  03/09/2022

  It differs whether it is hospital or clinic:

   

  Hospital: **********************************************

   

  Clinic: *******************************************************

  Business response

  03/14/2022

  This correspondence represents SSM Health's second response to the consumers complaint. 

   

  The liability assigned by the insurance carrier is determined by the members benefits when the claim is processed and contributes to the members out of pocket for the year in which the services were received, not when they were billed. The claim for these services completed processing in July of 2021. At the time the claim processed initially (May 2021) the patient had a remaining deductible which resulted in the balance of $1113.44. That amount then reduces the members out of pocket for the year and
  contributes to the entire out of pocket amount for that year. Processing a claim and billing a statement are two separate actions. It does not matter that the statement was mailed in the next calendar year, it does not effect the out of pocket for the previous year. The balance is correct and remains the patients responsibility. If the consumer feels he already met his out of pocket maximum for the year 2021 he will need to dispute that with his insurance carrier directly. 

   

  Thank you for the opportunity to respond to this complaint. 

   

  Customer response

  03/14/2022

  Complaint: 16757740
  
  I am rejecting this response because:It is absolutely RIDICULOUS to state that it does not matter that that the bill was sent in the next calender year. 
      The *** was done in 2021. I met my out of pocket in 2021. This treatment was one of many for 2021. THEY ADD UP! Of course this WOULD HAVE BEEN PAID IF IT WAS SENT IN 2021. Then the out of pocket WOULD HAVE BEEN MET SOONER. 
  
  
  Sincerely,
  
  ***************************

• Initial Complaint

  03/09/2022

  Complaint Type:

  Product Issues

  Status:

  Resolved

  More info

  This involves a Fourteen ($14.00) refund due myself as a result of an Over Billing on the Last Payment (Paid in Full) for a hospital stay. The Last Payment was sent on 11/17/2021 and was $50.00 Fifty Dollars. In actuality the balance owed was $36.00 Thirty Six Dollars, but we were Billed for $50.00 Fifty Dollars. My wife paid this nor realizing that it was Over Billed. We have called their customer service department Numerous times and gotten Nothing except an incredible run around, told it was Refunded, and Never received any refund at all. We have spoken with Numerous customer service representatives, and a Supervisor named Perry twice! All that has resolved absolutely Nothing, we cannot seem to obtain this small refund no matter what we do! It is Now Mid-March of 2022 and this has been going on since November of 2021. This has now become a matter of Principle, a Fourteen Dollar ($14.00) refund is LONG OVERDUE on this account! Here is the information regarding this account that is due the Refund: ***** ** *********  (Patient) Account Number *********** SSM Facility was SSM SLU Hospital Sincerely, ***** *********

  Business response

  03/15/2022

  Account has been reviewed due a system error the overpayment of 14.00 was not completed. The appropriate corrections have been made and a refund check has been issued on 3-4-22 and mailed to patient address on file.
  
  We apologize for the inconvenience that this might have caused you. We appreciate the opportunity to address your concern.
  
  
  Sincerely,
  ******* * ********* ******* ******* – Patient Financial Operations- SSM Health why here...

  Customer response

  03/15/2022

  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

  01/12/2022

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  I went in for a routine colonoscopy, I was told both by my insurance company and the doctor that there is little or no fee for this screening.i asked again at the desk when I was registered the day of the colonoscopy and was told the same thing. There was basically nothing found in the screening but I received a bill for over 3000$. When I called the doctors office they said it’s a mistake and was coded wrong and told me to call hospital billing. 30 calls later and I even talked to a supervisor named Perry and still haven’t managed to resolve this issue even though 2 doctors have agreed on they’re report that it should have been coded a screening instead of a diagnostic colonoscopy.

  Business response

  01/19/2022

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

  The consumer stated he was told by his physician his procedure was considered a screening/preventative service.  This was coded as a diagnostic service which incurred a large liability for the consumer. Coding is the conversion of health care diagnoses for services, procedures and equipment into universal codes for billing to insurance. SSM Health follows CMS (Centers for Medicare/Medicaid Services) who set the billing guidelines for these services. Diagnosis codes are taken from the physician’s orders and documentation in the medical record and cannot be revised without updates or addendums from the ordering physician. 

  A request was made of the ordering physician to add an addendum to the medical record to support the screening diagnosis. As of 1/15/22 the medical record was amended and the coding updated to a screening service. A claim will be sent to UHC for reconsideration of payment. Questions regarding treatment should be directed to the provider. Questions regarding medical benefits should be directed to the insurance carrier. 

  Thank you for allowing us the opportunity to address this concern. 

  Customer response

  01/20/2022

  Complaint: ********
  
  I am rejecting this response because: as of 1/20/2022 I have got no verbal or written verification that this information is true. If the coding has been changed to a screening I would accept this response . But having been lied to in more than one occasion I am skeptical. The last time I called I was told to be “patient “.
  
  
  
  Sincerely,
  
  ***** *****

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