ComplaintsforQualified Emergency Specialists, Inc.

• Initial Complaint

  02/29/2024

  Complaint Type:

  Billing Issues

  Status:

  Resolved

  More info

  I have two cancers and a brain tumor so I got hurt in **** and was in the ********* system and ** Hospital in ** ****. I had the bill get late and they turned $912 to this collection company But I Paid All my bills to the hospital and have no balance yet this medical group and collection company won’t work together and harass me daily.

  Business response

  03/01/2024

  March 1, 2024
  
  Better Business Bureau - Cincinnati
  1 E. 4th Street, Suite 600
  Cincinnati, OH 45202
  
  RE: Complaint ID. ********
  ****** ********
  
  Good Day,
  
  
  Thank you for bringing this complaint to our attention. We appreciate the opportunity to help resolve this issue
  for the consumer.
  

  After receiving your correspondence dated February 29, 2024, I have thoroughly reviewed the account
  referenced. Qualified Emergency Specialists, Inc. is an independent group of medical providers that staff the
  Emergency Department at ******** ***** *******. I represent ** and we are privileged to act as revenue cycle
  manager for Qualified Emergency Specialists, Inc.
  
  *** ******** sought emergency medical treatment in June 2022 and was rendered medically necessary services
  by Ljubica L*****, MD. The charges on the account are appropriate for the medical services rendered.
  
  At the time of registration, the patient provided ***** ****** with the policy number beginning with ****. This
  insurance was billed on 08/19/2022 but was rejected due to ‘member and/or member ID not found. A patient’s
  statement was sent on 08/30/2022.
  

  The patient and wife called on 10/10/2022 and updated insurance information for Health ***** ****** Plan (a
  ******** HMO) with the policy number beginning with ******. The claim was billed to Health ***** ****** Plan
  on 10/11/2022. A conference call between our office, the patient and a representative with Health ***** ******
  Plan was on 10/31/2022, to which the insurance representative confirmed the policy number is correct. The
  claim was then billed again on 10/31/2022 to Health ***** ****** Plan.
  
  We received a denial on 11/21/2022 as a duplicate claim – due to the rebilling of the claim on 10/31/2022.
  On 12/08/2022, we received an explanation of benefits (EOB) remit from Health ***** ****** Plan, showing the
  claim has been processed and $90.62 has been applied to the patient’s deductible. The health insurance would
  have also sent the patient their copy of the EOB showing how the claim was processed and what was paid
  and/or due by the patient.
  
  The patient’s account had been on hold allowing time for the updated insurance to process the claim. However,
  when the EOB was received and posted on the patient’s account on 12/08/2022, the contractual adjustment
  was missed being posted, and the full billed amount was billed to the patient in error. The patient and wife
  called on 03/27/2023 stating their insurance said the patient responsibility was only $90.62, however, the
  patient never has paid his portion. The account was turned to collections on 04/28/2023.
  
  Due to the error of the missed contractual adjustment, the provider has agreed to adjust off the full billed
  amount, have the account removed from collections and from the patient’s credit report.
  
  
  During registration at the hospital, patients are informed of separate billing. Therefore, any payments made to
  the hospital or hospital payment portal, will be only for the hospital portion of the bill. The hospital bill will not
  include the provider’s portion of the bill, which is why patients will receive a separate bill for the provider’s
  service.
  
  Under federal law, the Hospital may not include certain services in your hospital bill. Therefore, you will receive
  separate physician's bills for each service rendered by the following:
  
  -Anesthesiology
  -Pathology
  -Cardiology
  -EEG
  -EKG
  -Speech Therapy
  -Emergency Department
  -Pulmonary Function
  -Surgical Assistants
  -House Staff Psychiatry
  -Nuclear Medicine
  -Radiology (films & interpretations)
  
  The charges you have inquired about are the physician fees for professional services rendered and/or
  interpretation of studies performed. These services were not included in the bill from the hospital.
  
  We very much regret that *** ******** has experienced this issue. When this concern was received, I began an
  investigation. I can reassure *** ******** and the BBB of Cincinnati, that **** and our client’s actions have been
  remedied. I would be happy to discuss **** and the client’s position on this matter, and we very much thank
  *** ******** for prompting us to take a closer look at our processes to ensure all appropriate actions have been
  taken. I can be reached at ###-###-#### or emailed at *****************.
  
  Regards,
  
  Melissa D***** ***
  Manager, Payment and Revenue Integrity
  

  
  

  Customer response

  03/04/2024

  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. 
  
  Regards,
  
  ****** ********
  

• Initial Complaint

  02/26/2024

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  I went to the ER on May 1, 2023. I have received several bills thereafter showing I owe WAY more than what my insurance provider states I'm responsible for. I paid the $40.26 that was due, but somehow my bill has skyrocketed to $563.74. I have included both Aetna's Explanation of Benefits as well as the most recent bill I received from Qualified Emergency Specialists. I have called their customer support dozens of times and never get a resolution. They just keep sending me bills for an amount that I do not owe. I need help!

  Business response

  03/04/2024

  Please see the attached for the provider's response.

  Thank you for bringing this to our attention and the opportunity to respond the the complaint. We are hopeful our response and actions are satisfactory to the consumer. 

• Initial Complaint

  01/29/2024

  Complaint Type:

  Billing Issues

  Status:

  Unanswered

  More info

  I was seen 2/7/2022 by QES. I never received a bill from QES. Fast forward to 3/11/2023, I was seen in the same ER. I received a bill from QES for $841. I paid in full. I later found out that this claim was never submitted to my insurance. After calling several months in a row, I finally got them to bill the correct insurance for the march 2023 visit. Insurance paid 100%. They then took $609 of the $841 refund i was owed (refunded $232to me) and applied it towards an outstanding bill from 2022, which I never received. I later learned that the bill from 2022 was outstanding as again they never submitted it to my insurance. They submitted the claim to *******, which i have never been insured by violating HIPPA as my protected heath information was share with a health care company i never consented my information be given too. I have since spent several months trying to get them to submit a claim for a visit in 2022. My insurance has since denied the claim from February 2022, due to them not filing in a timely manner. After another half hour, long conversation with a supervisor today, I’m left frustrated with still no solution. They verbalized that they received an explanation of benefits, stating that this was denied due to not filing within a reasonable time. I ended the phone call with them as they continued to state that this is money owed by me to them despite them being at fault for not filing in a timely manner (which could have been avoided if they did not require 30 days to ‘review my file’ every time i called). I originally paid them $700 on 7/30/23 and $141 on 8/4/23. Insurance later paid them $312.90 and discontinued $528.10, making them whole for that visit. The issued me a refund for $232, applying the remaining $609 for 2/22 visit. Insurance later denied the claim as it took then to late to submit. Leaving them owing me $609 dollars. Which they are refusing to give.

• Initial Complaint

  01/10/2024

  Complaint Type:

  Billing Issues

  Status:

  Resolved

  More info

  I have spoken to my insurance provider ********** as well as *** ****** that have reported this debt to have been paid in full. ********** has stated that they have a contractual agreement with Qualified Emergency Specialists for a payment of $175.73 at which point insurance paid *** ****** has on record that there is a $0.00 account balance for time of service. Qualified Emergency Specialists fraudulently had a $893.00 debt placed on my credit report through ********* *** **********. My rights as a consumer have been violated and at this point I have every right to sue for damages if the issue is not resolved IMMEDIATELY.

  Business response

  01/11/2024

  Please provide additional information such as the name of the patient, name of the provider group/provider of service, facility name, date of service, and account number. This information will allow us to verify the correct account in question and begin our investigation. We appreciate the opportunity to help resolve this issue for the consumer. Thank you.

  Customer response

  01/11/2024

  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, reasons for rejection are included below.

   

  Qualified Emergency Specialists and ********* *** ********** denied my request for the account number they have so I did my own investigating because no debt was ever brought to my attention. The hospital in question is *** ****** ***** ******* with service date of 01/17/2020, and account number ************ they have a $0.00 account balance for my self. The insurance company at the time of service was ********** who confirmed they ran a bill for that day but had a contractual agreement with the providers for payment of $175.73.  I do not have the providers name as I can't seem to get either party to cooperate with providing information. 
  
  Regards,
  
  ***** *****
  

  Business response

  01/23/2024

  January 18, 2024
  
  Better Business Bureau of Cincinnati
  1 E. Street, Ste 600
  Cincinnati, OH 45202
  Phone: ###-###-####
  Fax: ###-###-####
  
  RE: Complaint No. ******** – ***** *****
  
  Good Day,
  
  After receiving your correspondence dated January 10,2024, I have thoroughly reviewed the account referenced.
  Qualified Emergency Specialists, Inc (QESI). is an independent group of medical providers that staff the
  Emergency Department at ******** ***** *******. I represent R1 and we are privileged to act as revenue cycle
  manager for Qualified Emergency Specialists, Inc (QESI).
  
  Per request for additional information to be able to locate the correct account for *** ******* complaint, I would
  like to thank you for enough information that I was able to locate your account and begin my investigation.
  
  On 01/23/20, ********** was billed the claim for this date of service (01/17/2020). We received the explanation
  of benefits (EOB) response and posted to *** ******* account on 02/21/2020, stating $175.73 was applied to the
  deductible. The contractual adjustment was missed being applied to the account, which in turn caused the full
  charge amount to be billed incorrectly to *** *****.
  
  The first patient statement was mailed on 02/25/2020.
  
  A final statement was mailed to *** ***** on 03/31/2020, which did include the $5.00 late fee since no
  communication was received after the first statement was sent out. During the time in between the first and final
  statements, there is no indication that *** ***** called requesting a review of her account for a possible missed
  adjustment.
  
  The statements sent to *** ***** included the phone number to contact the billing company, the account
  number for this date of service along with details stating a portion of the charges being applied to patient
  responsibility and notification if not paid timely, a $5.00 late fee will be added to the bill.
  
  Two months after the final statement was mailed, *** ******* account was sent to the collection agency on
  05/31/2020.
  

  The account is noted the first time of *** ******* contact with the billing company regarding her account is
  01/08/2024. There is no other communication from *** ***** prior to this date.
  
  We do apologize for the mishandling of this account regarding the contractual adjustment not being applied
  timely, and as such, the provider has agreed that the account will be fully adjusted off and removed from ***
  ******* credit report.
  

  We very much regret that *** ***** has experienced this issue. When this concern was received, I began an
  investigation. I can reassure *** ***** and the BBB of Cincinnati, that R1’s and our client’s actions have been
  remedied. I would be happy to discuss R1’s and the client’s position on this matter, and we very much thank ***
  ***** for prompting us to take a closer look at our processes to ensure all appropriate actions have been taken. I
  can be reached at ###-###-#### or emailed at *****************.
  
  Regards,
  
  
  Melissa D***** ***
  

  
  

  Customer response

  01/23/2024

  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. 
  
  Regards,
  
  ***** *****
  

• Initial Complaint

  01/05/2024

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  On 11/30/2023, I paid $58.87 (full bill amount) to Qualified Emergency Specialist Inc. for ******** ***** Hospital EE & MS services rendered on 07/24/2023. I received an email confirmation (********) and the payment posted to my bank account on 12/02/2023. Yesterday, I received a statement dated 12/26/2023 for the same amount, procedure and date of service with 01/23/2024 as the due date.

  Business response

  01/15/2024

  Good Afternoon, Please see the attached correspondence for the provider's response to the consumers complaint (text below). Thank you for the opportunity to respond. Janet M********/Payment and Revenue Integrity.

  January 15, 2024
  
  BBB of Cincinnati
  1 E. 4th Street, Ste 600
  Cincinnati, OH 45202
  Phone: ###-###-####
  Fax: ###-###-####
  
  
  RE: ****** ******
  Complaint Number: ********
  
  Hello,
  
  After receiving your correspondence dated January 14, 2024, I have thoroughly reviewed the account
  referenced. Qualified Emergency Specialist Inc is an independent group of medical providers that staff the
  ******** ***** Hospital. I represent R1 and we are privileged to act as revenue cycle manager for Qualified
  Emergency Specialist Inc (QESI).
  
  I have reviewed *** ******** account for date of service 07/24/2023 and show it reflects an amount due of
  $58.87, applied to co-insurance.
  
  Upon further review and comparison of the payment details *** ****** attached in her compliant, her payment
  of $58.87 was applied to her related account (# *********) that also had $58.87 for the balance.
  The transaction detail attachment from *** ****** shows “Account Number on Statement” **********. With
  the confirmation number of ********. I have matched this confirmation number to the account **********
  and payment being made on 11/30/2023. Account ********** has a zero balance.
  
  When this concern was received, I began an investigation. I would be happy to discuss R1’s and the client’s
  position on this matter, and we very much thank *** ****** for prompting us to take a closer look at our
  processes to ensure all appropriate actions have been taken. I can be reached at ###-###-#### or emailed at
  *****************.
  
  Regards,
  
  
  
  Melissa D****
  
  
  

• Initial Complaint

  11/14/2023

  Complaint Type:

  Billing Issues

  Status:

  Unanswered

  More info

  I received care at an emergency room in Cincinnati, Ohio in July of 2023. My insurance was billed and payment was approved the following week. I received an additional bill in November of this year for $608 that was denied by my insurance and provides no explanation for the associated cost, only that it is for care received during my emergency room visit. My insurance will not pay for it without additional information, and I have not been able to get any out of this company, which I assume staffs the hospital that I went to. I just want to know what I was charged for.

• Initial Complaint

  10/20/2023

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  Qualified Emergency Specialists reported negative information to a collection agency. Someone used my name but used a birth date and SSN that doesn’t belong to me, the date of birth and social security number used to start this medical account was not mine nor have I ever lived in ****. I explained this to a manager at Qualified Emergency Specialists and he agreed the information wasn’t mine. This collection account prevented me from getting approved for a house and other things.

  Business response

  10/30/2023

  We are in the process of obtaining registration details from the facility. The consumer will need to provide to us a copy of the police report filed for identity theft. Thank you.

  Customer response

  10/30/2023

  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, reasons for rejection are included below.

  Regards,

  Personal information used to open this account doesn’t match my personal information.   Verify birthdate and social security number with credit bureau. According to the fair credit act when I disputed this the first time your company was supposed to verify name, birthdate, and SSN, your company failed to do so.  It’s not my job to get a police report,  however, it is your company’s  job to verify personal information before you destroy someone’s credit report.  I talked to the original creditor and the my personal information does not match up in any way with this collection account.  And Also the original medical debt was $189 which is under $500, which means this medical collection account should not be on anyone’s credit report by law.

  ****** *******
  

• Initial Complaint

  08/24/2023

  Complaint Type:

  Billing Issues

  Status:

  Resolved

  More info

  I have a bill in collections from qualified emergency specialist in the amount of $888. I have had medical insurance since this bill occurred and still currently have the same insurance. I have called qualified emergency specialist several times to try to get a copy of the bill to see if my insurance could take care of it. When I called this time I was told that there is no record of this bill yet somehow it is still in collections. If there is no record of this bill then qualified emergency specialist needs to call the collection agency and have this removed from my credit report. This has been going on for far too long and needs to be resolved immediately.

  Customer response

  08/24/2023

  I do not have a copy of the bill as stated before, I called qualified Emergency Specialists to get a copy and they do not have it either. This is all that I have, a screen shot of the account on my credit report. 

  Business response

  09/07/2023

  September 6, 2023
  

  Better Business Bureau
  Serving Southern Ohio, Northern Kentucky, Southeast Indiana
  1 E. 4th, Suite 600
  Phone: ###-###-####
  Fax: ###-###-####
  

  ***** ********
  

  RE: Complaint No. ********
   ****** ********
  

  *** ***** ********,
  

  After receiving your correspondence dated September 2, 2023, I have thoroughly reviewed the account
  referenced. Qualified Emergency Specialists, Inc. (QESI) is an independent group of medical providers that staff
  the Emergency Department at ******** ****** ****** Hospital. I represent R1 and we are privileged to act as
  revenue cycle manager for Qualified Emergency Specialists, Inc. (QESI).
  

  *** ******** sought emergency medical treatment in November 2017 and was rendered medically necessary
  services by QESI. The charges on the account are appropriate for the medical services rendered. Per review of
  medical records, health insurance was not provided at the time of service, therefore the provider’s bill was
  mailed to *** ******** with the address provided at the time of service. Returned mail was received due to
  insufficient address and no new address was provided, hence the account being turned over to the collection
  agency in January 2018.
  

  A call was received from *** ******** in October 2019 and provided her correct address and requested a
  statement be sent to her so she can forward to her insurance company. Per our account, no insurance was given
  at this time when she updated her address.
  

  In October 2021, *** ******** called again providing her insurance details, which at this time is past timely
  filing for the provider to be able to obtain payment from the insurance for the services provided to **.
  ********.
  

  As a courtesy and age of account, Qualified Emergency Specialists, Inc has adjusted the outstanding balance and
  the account will reflect a $0 balance. The collection agency will be notified to remove the debt from ***
  ********** credit report.
  

  We very much regret that *** ******** has experienced this issue. When this concern was received, I began an
  investigation. I can reassure *** ******** and the Better Business Office that R1’s and our client’s actions have
  been proper. I would be happy to discuss R1’s and the client’s position on this matter, and we very much thank
  *** ******** for prompting us to take a closer look at our processes to ensure all appropriate actions have
  been taken. I can be reached at ###-###-#### or emailed at *****************.
  
  Regards,
  Melissa D****

  Customer response

  09/07/2023

  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. 
  
  Regards,
  
  ****** ********
  

• Initial Complaint

  08/24/2022

  Complaint Type:

  Billing Issues

  Status:

  Unanswered

  More info

  I was treated at ******** ***** ER on 1-20-22 for a miscarriage. The ER doctor onsite billed separately from the hospital and the statement came from Qualified Emergency Spclst Inc. I have healthcare coverage with both my parents, so *** and ****** **** *****. They paid the balance on the statement of $294.34. But my mom also paid that same amount not realizing the second insurance company was in the process of processing and paying the claim. So the account was double paid and a refund is owed back in the amount of $294.34. I was told in March that the refund was being issued. Now the billing department phone number is kicking out out a message about "unforeseen circumstances" and they can't take any calls. This has been happening for weeks. The Chat feature rep said that patient accounts can't be accessed at this time. I don't know what's going on but this refund is valid and owed back to me.

• Initial Complaint

  05/27/2022

  Complaint Type:

  Billing Issues

  Status:

  Unanswered

  More info

  Qualified Emergency Specialists, Inc have a bill in my name that I am not responsible for this is body injury claim that was handle by Progressive insurance and paid back in 2019. Spoke with Vincent today which is 05/27/22 told me that he send request that does not make sense to have not liable for this claim due to insurance

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