ComplaintsforThe J.P. Farley Corporation, Inc.

• Initial Complaint

  03/08/2024

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  Mailed 3 ***** insurance payments to the p o box they provided but none of those checks have been cashed .

  

  Business response

  03/08/2024

  *** ******** has only had two ***** invoices generated which were issued for February and March 2024. Please find details surrounding the payments below as well as copies of the cashed checks. Please let me know if you would like me to reach out to the member directly as I don’t see an additional payment was issued to us.
  
  Check 1216 issued 1/26/2024 for $647.70 was cashed 2/1/2024 for the February 2024 ***** invoice.
  
  Check 1007 issued 3/1/2024 for $647.70 was cashed 3/8/2024 for the March 2024 ***** invoice.

  We will reach out the *** ******** and see what we can do to identify the concerns and assist if further assistance is required.

  Customer response

  03/10/2024

  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, details of the offer I reviewed appear below.
  
  [To assist us in bringing this matter to a close, we would like to know your view on the matter.]
  
  Regards,
  ******** ********
  
  
  
  
   

  Customer response

  03/11/2024

  JP Farley was mailed 4 total checks in the amount of $647.70 please find out where the 2 checks that have not been cashed are.

• Initial Complaint

  02/03/2023

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  Date of service: 10/11/22 *** ***** ***** This bill has been going around since October when the genetic testing was done. JP Farley failed to inform us of any documentation that needed filed or what was going on until ACL reached out to collect on this bill. I called JP Farley in December and was told that it's MY fault the bill wasn't paid because I didn't file a form that JP Farley needed. Okay, I filed the form and was assured it would be addressed. In January I received a notification from ACL stating that it still wasn't paid. Called JP Farley and I was told this would be handled after I email them an image of the bill. I did so, was told via email that it would be handled. February comes around... The bill is still not paid. I called JP Farley again and was told that they needed to talk to the claims department because, even though genetic testing is covered under the policy, the bill has been rejected again. So, from my experience, JP Farley has not communicated what is going on, will not reach out to customers to request needed documentation, and will allow bills to go to collections that are covered in the policy before talking to customers or explain what's happening. Nor will they provide a number or contact to request an internal review of the claim when asked and instead said that they'll provide it when they call back next week at some time with the results from the claims department leading me to believe that they have no intentions of resolving this matter proactively.

  

  Business response

  02/23/2023

  I have reviewed the claim and the calls in regard to this matter.  We did receive a call on 12/19 at which time we informed the member that coordination of benefits information was required to process the claim.  We updated this information over the phone and offered to call the lab.  The member indicated that she would just let us know if she needed further assistance.  Stephanie spoke with the member again on 1/23, requested that the claims department review the claim for accuracy of processing and called the lab to ask them to put any billing on hold.  We spoke with the lab and they placed the account on hold while the claim was reviewed.  Unfortunately, the test that was performed is not considered preventative so it is applying to the deductible.  I understand that this particular test is a screening but it is not considered preventative at this time.  I am happy to answer any additional questions the member may have but, in review of the claim and calls, this was handled in accordance with the plan document language for this particular plan.  I will ensure that a copy of the EOB is mailed out this week.  If there are further questions or any additional support is needed, please feel free to contact me directly.  I will so anything I can to assist with this matter.  *************

  

  Business response

  03/01/2023

  Please note that this is an ERISA plan and the appeal rights and information are readily available in your plan document and on the website.  I have copied that information below.  I am also happy to assist you with this appeal in any way possible.  We understand that sometimes things require additional review.  Please reach out to me if you have any questions or need additional information or assistance.  [email protected]

   

  First Level of Internal Review. To appeal a denial of a Claim, the Claimant must submit in writing, a request for a review of the Claim. The Claimant should include in the appeal letter: his or her name, ID number, group health plan name, and a statement of why the Claimant disagrees with the denial. The Claimant may include any additional supporting information, even if not initially submitted with the Claim.
  The written request for review must be submitted within 180 days of the Claimant’s receipt of an Adverse Benefit Determination.
  The written request for review should be addressed to:
  Claims Administrator
  Attention: Appeals
  J.P. Farley Corporation
  29055 Clemens Road
  Westlake, Ohio 44145
  An appeal will not be deemed submitted until it is received by the Claims Administrator. Failure to appeal the initial denial within the prescribed time period will render that determination final. The Claimant cannot proceed to the next level of internal or external review if the Claimant fails to submit a timely appeal.
  The first level of review will be performed by the Claims Administrator on the Plan Administrator’s behalf. The Claims Administrator will review the information initially received and any additional information provided by the Claimant and determine if the initial benefit determination was appropriate based upon the terms and conditions of the Plan and other relevant information. The Claims Administrator will send a written or electronic notice of determination to the Claimant within:
  • 72 hours of the receipt of the appeal for an Urgent Care Claim;
  • 15 days of the receipt of the appeal for a Pre-Service Claim or a Concurrent Care Claim; or
  • 30 days of the receipt of the appeal for a Post Service Claim.
  Second Level of Internal Review. If the Claimant does not agree with the Claims Administrator’s determination from the First Level of Internal Review, the Claimant may submit a second level appeal in writing. The Claimant may request a second level appeal on Pre-service Claims (non-Urgent Care) and Post-Service only along with any additional supporting information.
  The written request for review of the first level of internal review must be submitted within 60 days of the Claimant’s receipt of the first level of internal review.
  The written request for review should be addressed to:
  Claims Administrator
  Attention: Appeals
  J.P. Farley Corporation
  29055 Clemens Road
  Westlake, Ohio 44145
  An appeal will not be deemed submitted until it is received by the Plan Administrator or the Claims Administrator on the Plan Administrator’s behalf. Failure to appeal the determination from the first level of review within the prescribed time period will render that determination final. The Claimant cannot proceed to an external review or file suit if the Claimant fails to submit a timely appeal.
  The second level of internal review will be done by the Plan Administrator, or its designee. The Plan Administrator will review the information initially received and any additional information provided by the Claimant and make a determination on the appeal based upon the terms and conditions of the Plan and other relevant information. The 59
  Plan Administrator will send a written or electronic Final Internal Adverse Benefit Determination for the second level of review to the Claimant within:
  • 15 days of the Plan’s receipt of Claimant’s second level appeal on a Pre-Service Claim (non-Urgent Care);
  • 15 days of the Plan’s receipt of Claimant’s second level appeal on a Concurrent Care Determination;
  • 30 days of the Plan’s receipt of Claimant’s second level appeal on a Post-Service Claim.
  If the Claimant is not satisfied with the outcome of the final determination on the second level of internal review, the Claimant may be eligible for an External Review. The Claimant must exhaust both levels of the internal review procedure before requesting an external review. In certain circumstances, the Claimant may also request an expedited external review.
  Both the First Level of Internal Review Decision and Second Level of Internal Review Decision will contain the following, if applicable:
  1. Information sufficient to allow the Claimant to identify the Claim involved (including date of service, the health care Provider, the Claim amount, if applicable, and a statement describing the availability, upon request, of the diagnosis code and its corresponding meaning, and the treatment code and its corresponding meaning).
  2. Specific reason(s) for a denial, including the denial code and its corresponding meaning, and a description of the Plan’s standard, if any, that was used in denying the claim, and a discussion of the decision.
  3. A reference to the specific portion(s) of the Plan provisions on which the denial is based.
  4. The identity of any medical or vocational experts consulted in connection with a Claim, even if the Plan did not rely upon their advice (or a statement that the identity of the expert will be provided upon request).
  5. A statement that the Claimant is entitled to receive, upon request and free of charge, reasonable access to, and copies of, all documents, records, and other information relevant to the Claimant’s claim for benefits.
  6. Any rule, guideline, protocol, or similar criterion that was relied upon, considered, or generated in making the determination will be provided free of charge. If this is not practical, a statement will be included that such a rule, guideline, protocol, or similar criterion was relied upon in making the determination and a copy will be provided to the Claimant, free of charge, upon request.
  7. A description of any additional information necessary for the Claimant to perfect the Claim and an explanation of why such information is necessary.
  8. A description of available internal appeals and external review processes, including information regarding how to initiate an appeal.
  9. A description of the Plan’s review procedures and the time limits applicable to the procedures. This description will include information on how to initiate the appeal and a statement of the Plan Participant’s right to bring civil action under section 502(a) of ERISA following an Adverse Benefit Determination on final review.
  10. In the case of denials based upon medical judgment (such as whether the treatment is Medically Necessary or Experimental), either an explanation of the scientific or clinical judgment for the determination, applying the terms of the Plan to the Claimant’s medical circumstances, will be provided. If this is not practical, a statement will be included that such explanation will be provided to the Claimant free of charge, upon request.

  Customer response

  03/01/2023

  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, details of the offer I reviewed appear below.

   

  Since filing the first BBB complaint in reference to the lab work, at least 2 more bills have been rejected by J.P. Farley totaling in more than $1000 just between the two. More details as follows:

  2/28/23 I was alerted to $1,105 in rejected medical bills by my medical provider, all related to prenatal care as directed by my doctor's office. I called J.P. Farley at 11:21am and spoke with Customer Experience Coordinator ****** to ask why these bills were rejected. She stated that the Coordination of Benefits form was required. I informed her that I had it filled out in December of last year. She found the form had been filed and said that she would have these bills appealed upon my request. Additionally, I asked that she appeal the 10/11/2022  bill as well as it had been rejected. I also requested Statements of Benefits for all three bills as I have not received them yet, the oldest from care date 10/11/22, as well as emailing to request copies of all appeals and electronic copies of Statements of Benefits for myself between 2022-2023. I tried to contact the POC here and was immediately sent to Voicemail where I left a VM and a call back number.

  At this point is it becoming very hard for my family to believe that these additional rejected bills, over a form that had been filled out and had been confirmed to be resolved here, are not in some form a type of retaliation for filing a BBB complaint. This is especially upsetting when considering that the business has failed or refused to provide the requested information multiple times, the Customer Support staff did not provide the referenced link to the appeal process available on the company website when asked multiple times of which I had no knowledge of and assumed that a Customer Experience Coordinator would be able to provide, and the contact given through the BBB has not returned or answered my attempt to communicate with her about this matter.  

  If you need verification of these email requests I am happy to provide them. 

   

  Regards,
  
  **** ****
  
  
  
  
   

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