ComplaintsforPhysicians East, PA

• Initial Complaint

  11/28/2023

  Complaint Type:

  Service or Repair Issues

  Status:

  Resolved

  More info

  On August 4, 2023, I had an appointment with my doctor for my annual physical. I was having the physical because it was my last day on my job and I was getting all my medical work done. While at my physical my physician recommended a ** scan. I advised her that it had to be on that day, because it was my last day of work. Her nurse came back and told me that they could not do the scan on that day. I told her that was fine I would wait the 90 days until my new insurance kicked in because it was my last day on my job and the last day of my insurance. She went to check with someone and came back and told me that we could do the ** scan on Monday and the insurance would pay. I asked her if she was sure because I could wait 90 days until my new insurance kicks in and I did not have money to pay for a ** scan. She went back and spoke with whoever was giving her the information. She came back and said they told her as long as I came in on Monday and did not reschedule Monday's appointment the insurance would pay. She advised me to just call before I came in on Monday to verify the information again. I got up first thing Monday morning and called. I explained the situation to the person who answered the phone. She said it was showing a zero copay. As per the attached, my insurance did cover the scan. Jump ahead a month, I guess when the insurance found out it was done on the Monday instead Friday, the 4th, they declined to pay and I got a bill for $874. I called and spoke with someone in billing. She apologized for the miscommunication but took no responsibility. I would never have had the scan if the Physician East rep had not assured me the insurance would pay. I asked several times because I wanted to make sure, each time I was assured the insurance would pay. I should not have to pay for a bill that I explicitly told them I did not want. I should not have to pay for their error.

  Business response

  12/13/2023

  We have spoken with the individual regarding the complaint and the issue has been resolved. 

  Customer response

  12/14/2023

   
  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

  04/14/2023

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  On 10/28/2022, I had to take my daughter to this Urgent Care as it was the closest to the hotel that I had been staying. She hadn't been feeling well and then informed me that she had these unsightly sores in her mouth and around her private area. I was informed that this business accepted my health insurance coverage, I gave them my information as my daughter is covered under me. We were literally in the office for over 8 hours, patients were coming and going and I was told that we had to wait for another doctor because there was only one on call and she was extremely busy. The *** ***** was disturbed with me because I was complaining because my daughter was in extreme pain and crying and I just wanted her to be able to eat and drink as she had nothing for 2 days. *** *****, did some lab tests and came back and told my 15 year old daughter and myself that she had herpes, prescribed medicine that made her violently ill and released her. Now, this *** *****, didn't know my daughters background medical history except for the information I gave her. I came home to ******** and immediately brought her to her pediatrician who after running tests came back with the diagnosis of Coxsackie Virus. If my daughter had any mental illness, she would have committed suicide based on *** ******' inexperienced diagnosis. I received a bill, in which I forwarded the insurance information again to the business. I received another and their reason is cause my insurance denied out of network practice coverage and haven't covered my part of the $200 deductible. My reason for this complaint is, there should be NO BILL OWED FOR INCOMPETENT SERVICE FROM A *** that could have killed my daughter with the medicine she prescribed and the diagnosis which had my daughter distraught for an entire week until we got all final results from our experienced and educated physician in **

  Business response

  04/14/2023

  Good afternoon,

  *************** to complaint 19934156. The patient's name on the practice side is not consistent with the consumer's name provided on the complaint but I was able to locate the chart.  Based on the notes from the office visit, the provider states that she suspected the diagnosis provided but that confirmation was pending lab results.  Those results were negative and were shared with the patient's mom once received.  The patient's health record is not readily available to the providers at Urgent Care unless the patient is actively cared for by one of our 20 locations/departments.  Information about past medical history has to be obtained from the patient.  I am sorry to hear that the patient was in distress after learning of her possible diagnosis.  Providing medication for the symptoms reported by the patient was part of the treatment plan and necessary to offering relief to patient for those symptoms.  The provider's intention was to help a patient in need.

  It is the policy of Physicians East to file claims to all insurance carriers.  The relationship between the patient and their insurance carrier is not easy to navigate.  The patient or their employer chooses an insurance carrier and pays the carrier for coverage.  The practice submits claims to the carrier, but that is the extent of the relationship.  While we make every effort to provide the most up to date information about carriers that the practice participates in, we are limited by the information provided to us by the carrier.  It is our standard policy to direct patients to their carrier if they have questions about coverage or network participation as often times that can be very granular down to the plan level which the practice does not have access to.

  That said, we are adjusting a portion of the charges that represents the provider's time caring for the patient as a good faith gesture.  The balance remaining on the account is $85.   

   

   

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