ComplaintsforSelf Matters, LLC

• Initial Complaint

  07/14/2023

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  Transaction Dates: • 3/24, 4/7, 14, 5/5, 19, 6/02: The amount of money I paid: • $510.83; we ended up paying $294.83 above our normal Copay due to the business' negligence in allowing their Tricare certification to lapse during the period of my daughter’s treatment without informing us. What the business committed to provide us: • The business claimed and were a Tricare (Humana Military East) provider in good standing. What the nature of the dispute is • On 4/14, our copay began to fluctuate higher than the first two, so we asked the business why. They were unresponsive to calls/emails, but we continued our child’s treatment since it is extremely difficult to find a child psychologist that accepts new patients, minors, and female within a reasonable distance from our home that also accepts Tricare. • Due to the billing irregularities and the business’ general lack of responsiveness, we ceased treatment (6/02/23). • After conferring with Tricare, the business had allowed their certification to lapse, therefore Tricare could not process the claims as though it were a network provider. We brought this to the business’ attention, and they were unaware that their certification had lapsed. • The business reapplied for Tricare certification but are not yet in-network. Both their Psychology Today site (h******************************************************************************) & business site (****************************************) claim they are a Tricare provider. This claim is fraudulent. Whether or not the business has tried to resolve the problem • Over the past month we have been playing phone tag with intermittent success. • We asked the business to readjust the billing to reflect their error in allowing their insurance provider certification to lapse without informing us of the prejudicial circumstances that would place us in, but the business refused to negotiate a lower rate to compensate for their negligence in allowing their Tricare certified to lapse.

  Business response

  07/30/2023

  Self Matters is an outpatient private practice providing psychotherapy services. We serve adolescents and adults and accept many different insurance plans as well as private pay. We are HIPPA compliant and have an ethical obligation to protect confidentiality. To release information without an authorization on file would be a breach of confidentiality and therefore I will not be able to speak directly to the current complaint. I cannot confirm or deny any information pertaining to this specific complaint without a release on file or without being court mandated.

  
  That being said, I can peak to general policies and procedures of our practice. When patients initiate services with our practice, we have them sign several forms to help them understand our policies and procedures as well as a payment agreement form. Please see attachments. If they choose to use their insurance, we encourage clients to confirm their benefits based on their individual plan with their insurance companies as this can vary per individual. We encourage they do this prior to seeing us for their first session. We do not charge clients until claims are submitted and insurance companies have processed the claims. The processed claim can be found in patient’s explanation of benefits (EOB). Patients receive a copy of this often before our office receives a copy from their insurance. As a contracted provider with insurance, EOB’s will indicate what insurance will cover and what we are obligated to collect in payments from patients as this is their portion they owe based on their plan. This is a non-negotiable rate set by insurance (not our private rates).  We are obligated to collect this payment to prevent insurance fraud as we are contracted with these companies.  Patients are welcome to pause services with our office without a delay in rescheduling if there have concerns regarding insurance or payments.  Patients are always able to contact their insurance companies to dispute claims they feel are processed incorrectly or to understand their benefits. Our office works diligently in working with patients and insurance companies to correct anything we can as a provider's office, however, are often limited when working with insurance. Please feel free to reach out if you have any further questions, we are happy to help. 

  Customer response

  07/31/2023

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

  In response to the following quote from the business: "Patients are welcome to pause services with our office without a delay in rescheduling if there have concerns regarding insurance or payments." As clients, we were never notified by the business that their insurance license had lapsed or we would have paused and eventually rescheduled services once their license was reinstated in order not to accumulate the higher rate. This lack of transparency, business ethics, and general unprofessionalism ended up costing us a considerable higher payment than we would have needed to had the business been honest with us the moment their license lapsed.

  In response to the following quote from the business: "Patients are always able to contact their insurance companies to dispute claims they feel are processed incorrectly or to understand their benefits. Our office works diligently in working with patients and insurance companies to correct anything we can as a provider's office, however, are often limited when working with insurance." As the clients, we were the ones who discovered that the business' insurance license had lapsed and informed them, not them informing us. After contacting the insurance company to dispute the claims that we felt were processed incorrectly, the insurance company informed us that the business' license had lapsed. We in turn called the business to inform them that they were no longer Tricare certified, yet advertised as much on their websites. This is fraud. As stated earlier, we would have gladly paused service while the business sorted out their insurance licensing issues, however, due to their negligence in informing us, we along with other clients were scheduled and seen as if nothing was happening. When we emailed or called to ask why the rates increased, the business could not explain it to us until Tricare explained it to us after the fact.

  Sincerely,
  

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

  Business response

  08/03/2023

  I have attached a release form for consumer to sign

*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. ↩