ComplaintsforSadar Psychological and Sports Center

• Initial Complaint

  08/05/2021

  Complaint Type:

  Product Issues

  Status:

  Answered

  More info

  Despite admitting the insurance payment calculator was $25 due from patient/visit they charged me what they "thought" I should be paying for 3 dates of service stating I would be refunded/could apply balance to future visits once insurance was billed.I paid a total of $305.03 instead of $75 for the 3 visits.Once they were paid by my insurance company as per contracted rate,a refund was not immediately issued for the difference in the amount of $230.03.My insurance company contacted *** in billing who indicated "I have 30 days to refund" meaning it would be issued by the end of Dec. 2020.I waited 2 months to follow-up giving the company the benefit of the doubt that they were acting w/integrity & the refund had just been delayed in transit.A check w/ no explanation of refund in the amount of $121.15 was issued 82 days after I received notification from my health insurance company that the provider had been paid.At no time did the company reach out to me with an update, etc.

  Business response

  08/19/2021

  August 18, 2021 
  

  Dear *** ******: 
  

  We're anxious to resolve your claim with the Better Business Bureau to your satisfaction. In order to provide a sufficient resolution, we need to have a signed Authorization to Release/Receive Records to discuss payment details with the BBB. 

  Please find this form enclosed, and a postage paid return address envelope for your convenience in getting this letter back to our office. I appreciate your attention to this matter. 
  

  Sincerely, 
  Angelika S.,

  MA Owner

  Customer response

  08/24/2021

  [To assist us in bringing this matter to a close, you must give us a reason why you are rejecting the response. If no reason is received your complaint will be closed as Answered]
  
   Complaint: ********
  
  I am rejecting this response because:
  
  The issue is not resolved, but I have completed the requested release form provided by the company (attached). I am also attaching my health insurance companys (*****) Explanation of Benefits which documents the amount owed by patient ($25.00 per visit, total $75.00)
  
  Regards,
  
  ***************************
  

  Business response

  09/09/2021

  September 1, 2021 
  

  Dear *** *******, 
  

  In response to the above reference complaint, I would like to offer the following history: 
  

  09/25/2020 Patient first telephoned the office to schedule services 
  

  10/29/2020 Initial appointment email and paper work was emailed to patient (see attached-Item A) 
  

  10/21/2020 Patient arrived at the office. At this time the patient's insurance card was scanned into our system. While the card shows a $25 copay, the Aetna provider portal showed there was a $600 deductible that had not been met. Patient advised there was a Health Savings Account (HSA) that pays deductible. Patient was explained that the provider's contract was with Aetna and, as such, was required to comply with the information provided by the portal. Should the insurance portal be incorrect, or should the HSA reimburse the deductible, the difference of the provider contracted rate and the deductible and/or co-pay would be refunded to the patient. (see attached-Item B). 

  On this date, additional paperwork was completed that included an Advanced Beneficiary Notice (ABN), which is a form that informs the patient of the services that would not be covered by the insurance company as a result of not being part of the plan coverage. If this service is provided, it the responsibility of the patient to pay for the service. Specifically, the ABN noted a fee of $50 for any biofeedback services provided. (see attached Item C). 

  10/26/2020 Office visit and biofeedback services provided.

  11/2/2020 Office visit and biofeedback services provided.

  11/6/2020 Insurance was billed (see attached-Item D)

  11/10/2020 Insurance processed payment, which reflected that the information on the provider portal was incorrect and there was not, in fact, a deductible remaining. The insurance paid for the initial visit and two subsequent visits. (see attached-item E) 11/18/2020 Functional EEG evaluation was scheduled. This was cancelled prior to the appointment by the patient, who indicated that she was not interested in further services. The date of the phone call in which the evaluation was cancelled was not recorded. 2/8/2021 Patient was reimbursed $121.15, along with a summary of the services. (see attached-Item F) 3/16/2021 Reimbursement check was cashed. (see attached-Item G) 
  
  The summary of payment and services is as follows and shows an error of $.12. The patient should have been reimbursed $127.27 instead of $121.15 

                      Total Due         Total amount allocated      Amount            Convenience fee for       Amount               Balance due

  Date             Based on Plan   to ABN-due to patient      patient paid        credit card payment    insurance paid       to patient

  10/21/2020    $146.15                                                 $146.15                        $4.38              $121.15               $116.77

  10/26/2020    $158.42                        $50                     -                                                       $133.42                  ($75)

  11/2/2020       $158.42                       $50                    $150                             $4.50            $133.42                 $79.50

  Total                $462.99                                                                                                                                     $121.27

  While insurance contracts allow 90 days for payment/reconciliation following payment of timely filed claims (ie., 90 days from November 10, 2020), we recognize that although our reimbursement fell within this time frame, there was a significant delay in our reconciliation. To this end, if it meets with your review and 
  all offer the patient $50 as a gesture of good will. 
  

  Thank you for your consideration and we await your response. 
  

  Sincerely, 
  Angelika S  
  Owner 

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