Complaints

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:12/26/2023

  Type:Order 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.

  I was not advised in advance that my secondary insurance provider does not cover this surgery.

  Business Response

  Date: 12/28/2023

  Patient had ******** primary and Tricare secondary insurance. We verified the Tricare benefits prior to her date of surgery (her benefits were active). The secondary (Tricare) typically pays the 20% that ******** applies toward patient responsibility. Tricare did not pay this, as they stated that this procedure is not covered under their plan, which we were not aware of at the time of surgery. The Explanation of Benefits provided by Tricare shows the balance is 'patient responsibility', not provider responsibility. Therefore, the patient was sent the bill. The patient then contacted us questioning it, and we explained the situation. After some time, she contacted us again, asking if we would settle the amount she owed with a $550 payment. We agreed and discounted the remaining $11.38 off of her bill, bringing her account to $0.  She then paid us on 11/28/23. She called our billing company on 12/18/23 stating that her appeal was denied with Tricare and she wanted to confirm her account had a zero balance, which the billing office confirmed. She then called us at the surgery center on 12/22/23, very angry and upset about this, asking who was responsible for letting her know her insurance wouldn't pay. I explained that our business office manager was off that day, but that I would have her call when she returned on Wednesday the following week (due to the Christmas holiday, we were closed Monday and Tuesday and would reopen Wednesday). The patient was not satisfied with this answer and stated she would be filing a complaint with the BBB. Our office manager did call the patient on Wednesday, as we told her we would, and the patient stated she's already turned this matter over to the BBB and hung up the phone.

  In summary, we followed our normal protocol and billed the patient per her insurance company's instructions, per the Explanation of Benefits (EOB), as Tricare deemed this 'patient responsibility.'  We had spoken to her several times, and agreed to reduce the amount owed, per her request, which she paid. Our office manager tried to talk with her on 12/27/23, but the patient hung up the phone. We feel we've resolved this matter to the best of our ability. Please let me know if you have further questions. Thank you.

  Customer Answer

  Date: 12/28/2023

  Complaint: 21054269
  
  I am rejecting this response because:  They did not verify surgery was covered as stated in the last line quoted.  

  They also state " The secondary (Tricare) typically pays the 20% "  Note the word typically.

  
    "Patient had ******** primary and Tricare secondary insurance. We verified the Tricare benefits prior to her date of surgery (her benefits were active). The secondary (Tricare) typically pays the 20% that ******** applies toward patient responsibility. Tricare did not pay this, as they stated that this procedure is not covered under their plan, which we were not aware of at the time of surgery. "

  lity
  
  
  Sincerely,
  
  *************************************

  Business Response

  Date: 12/29/2023

  We verified that the patient had active benefits with Tricare on the date of service, which she did.  The *** states 'patient responsibility' for any amount due. Please see attached.

  Customer Answer

  Date: 12/29/2023

  Better Business Bureau:
  
  I have reviewed the response made by the business in reference to complaint ID ********, and find that this resolution is the only way to proceed. 

  The business's continually  fails to accept and acknowledge they made the presumption that just because having a secondary insurance, the client knows what is allowed. 

  Also, my err in being honorable and honest by making payments before settlement of the appeal process. 

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