ComplaintsforInjury Specialists

• Initial Complaint

  12/05/2023

  Complaint Type:

  Order Issues

  Status:

  Answered

  More info

  Date of service - Sep 6, 2023. Dr. **** ***** office seems to trap patients into receiving procedures that is not covered by insurance without prior notification to patients. The doctor’s office made the appointment for Sep 6, 2023, after confirming that they accepted my insurance. They administered a procedure without confirming if my policy allowed or not so I am now stuck with a bill from the doctor’s office which my insurance denied stating that the procedure is not covered under my policy. According to them, it is patient’s responsibility to find out what is covered before the office visit. In reality, patients are not aware of what type of procedures will be provided till after it is administered. The charges under question are for the psychological and social behavior assessment, without which, Dr. *** won’t even see the patients or prescribe any narcotics for pain management. In my case, I didn’t need any narcotics so the assessment wasn’t even useful. I contacted the billing office to check why they even administered the assessment when it was not covered by the insurance, I was told that they don’t have bandwidth to check everyone’s insurance so they just administer and ask patients to pay, which seems unfair as patients could incur significant bill even when they go a doctor that is in network. Fortunately, my bill is only $44 as I had already met the deductible, otherwise, it would have been significant amount. The office also argued that they ask patients to sign a document stating patients are responsible for anything insurance doesn’t cover, which should mean, anything that is elective and discussed with the patients. At no point during my visit, assessment being not covered was brought up. I am requesting you to look into their billing practices and have them waive $44 from my account. I haven't paid the $44 yet as I am determined to contest the charges. Feel free to contact if additional information is needed.

  Business response

  12/18/2023

  Our office policy is that all patients fill out assessments for prescription drugs. This is due to the type of pain medications prescribed so that we keep up with patients that may develop addiction, depression or other conditions along with taking narcotics. This also helps the doctors keep in accordance with their DEA license. Ms. ***** was aware that she could be billed for this service and even signed the acknowledgement before completing the assessments. Our policy was explained to her when she called and questioned her bill. We do check the patient's insurance coverage as a courtesy, to make sure the procedures we do here are covered. It is up to the patient to know their own medical benefits as well. Ms. ***** asked if I could send her the acknowledgement she signed, and I mailed that to her the same day, which was not enough time for her to receive it before making this complaint. I am hesitant to attach the acknowledgement she signed, due to HIPPA  policy, but if it is needed, we can have her sign a records release stating it is alright with her to send that to you.

  This is the disclaimer we put on each patient's encounter explaining the assessments:

  "We have evaluated the patient using *****, ****** and ***** assessments. Based on data collected from the *****, we are evaluating the risk for abuse, misuse and diversion. Furthermore, we are screening the patient for depression using the ****** assessment. Lastly, we are utilizing ***** to ensure that the current treatment plan is not impairing cognition."

  Customer response

  12/20/2023

  I don’t agree or accept their explanation for the charges.  if this is a mandatory assessment for maintaining the DEA license, this should be part of their office visit for which they have already charged me. They sent me a copy of the letter I signed. That page was buried in the middle of 50 some pages when I filled out paperwork for the initial visit and wasn’t explained to me what the amount charged would be. When I contested the charges, they told me that this assessment is necessary every 6 months, which means, patients would have to incur additional charges every 6 months regardless of them needing pain medication or not. Which seems to be wrong. I was told that they have removed $9 from my statement, but my account balance does not reflect that.  You can close the complaint as I don’t believe they are going to make further adjustments to my statement or change their billing practice. I will seek medical care elsewhere, which is unfortunate because, the doctor is really good and he will probably lose other patients due to bad billing practice.

  Customer response

  12/20/2023

  Complaint: ********
  
  I am rejecting this response because:

   

  I don’t agree or accept their explanation for the charges.  if this is a mandatory assessment for maintaining the DEA license, this should be part of their office visit for which they have already charged me. They sent me a copy of the letter I signed. That page was buried in the middle of 50 some pages when I filled out paperwork for the initial visit and wasn’t explained to me what the amount charged would be. When I contested the charges, they told me that this assessment is necessary every 6 months, which means, patients would have to incur additional charges every 6 months regardless of them needing pain medication or not. Which seems to be wrong. I was told that they have removed $9 from my statement, but my account balance does not reflect that.  You can close the complaint as I don’t believe they are going to make further adjustments to my statement or change their billing practice. I will seek medical care elsewhere, which is unfortunate because, the doctor is really good and he will probably lose other patients due to bad billing practice.
  
  
  Sincerely,
  
  ****** *****

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