Business Profile

Clinic

UPMC Health Systems

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Complaints

This profile includes complaints for UPMC Health Systems's headquarters and its corporate-owned locations. To view all corporate locations, see

Customer Complaints Summary

41 total complaints in the last 3 years.
18 complaints closed in the last 12 months.

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The complaint text that is displayed might not represent all complaints filed with BBB. 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.

Initial Complaint
Date:12/13/2022
Type:Customer Service Issues
Status:
AnsweredMore info
Complaint statuses
Resolved:
The complainant verified the issue was resolved to their satisfaction.
Unresolved:
The business responded to the dispute but failed to make a good faith effort to resolve it.
Answered:
The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
Unanswered:
The business failed to respond to the dispute.
Unpursuable:
BBB is unable to locate the business.
This complaint is related to BBB case #********, filed 12/13/2022 against ***** Insurance. There is an ongoing dispute between UPMC (my healthcare provider) and ***** (my health insurance provider) that has resulted in an unpaid bill of $281.00 for a service that was provided March 10, 2021. UPMC has now referred this bill to a collection agency to come after me. I have been on multiple phone calls with ***** and with UPMC, including some 3-way calls with both parties, in an effort to get this resolved. I blame the bureaucracy of both companies for this impasse. WHEN 2 CORPORATE HEALTHCARE GIANTS DISAGREE OVER A BILLING MATTER, CERTAINLY THEY HAVE A PROCEDURE FOR RESOLVING IT THAT DOES NOT INVOLVE TAKING IT OUT ON THEIR CUSTOMERS? But apparently not. Some background: ******* 4/15/2021 Explanation of Benefits regarding the disputed bill states: "We have denied all or part of this claim. However, you are not responsible for paying the billed amount because you received this service from an ***** Medicare plan (PPO) provider OR based on a referral from an ***** Medicare Plan (PPO) provider." Based on this determination, I have not paid UPMC's $281 bill for this service. Regardless, UPMC has continued to send me bills. Recently ***** has indicated to me that they would pay this bill. I relayed that information to UPMC by phone in September 2022. Nonetheless, UPMC has now referred the bill to a collection agency. One of two things is true: EITHER UPMC wrongly billed me in the first place. OR ***** is responsible for paying this bill. I am not responsible for mistakes made by EITHER of these companies and I request that UPMC communicate and resolve this matter with ***** and withdraw its referral to a collection agency.
Business Response
Date: 12/19/2022
*** ****** **********************
December 19, 2022
Ref: *** ID #: ********
Dear ******* ******

This is UPMC’s response to the complaint filed under Better Business Bureau ID number ********.
Upon receipt of the patient’s concerns, the accounts were reviewed.
The patient was incorrectly billed for an out-of-pocket amount. This was UPMC’s error. The account has been corrected, the balance adjusted to zero, and the patient has been contacted by telephone with the results of this review.
We appreciate the opportunity to provide this response and apologize for the inconvenience experienced by the patient.

Sincerely,
UPMC Office of Ethics, Compliance and Audit Services
Initial Complaint
Date:12/12/2022
Type:Product Issues
Status:
AnsweredMore info
Complaint statuses
Resolved:
The complainant verified the issue was resolved to their satisfaction.
Unresolved:
The business responded to the dispute but failed to make a good faith effort to resolve it.
Answered:
The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
Unanswered:
The business failed to respond to the dispute.
Unpursuable:
BBB is unable to locate the business.
I went to the ***** ********** in Harrisburg, PA, to talk to a doctor about weight gain and asked for a blood test for testosterone because my father has low T and I wanted to get that specifically checked to see if it was hereditary. I was sent to get blood testing done and found out that T had not been checked but I was still billed anyway. I contacted billing and was told that the bill would be contested. I called and left a message for the office manager and nobody reached out to me to discuss the issue with me. I was not told about the outcome. I called again and was given equally unhelpful answers and was told that the Nurse Practitioner had decided that the results of the test were important. I disagree citing our conversation about specifically Testosterone. I no longer want to deal with UPMC and would like to find another health care professional but would like my money back because I was fraudulently charged for services I did not consent to.
Business Response
Date: 12/27/2022
In response to Mr. ******** complaint of his office visit at ***** ********** on August *, 2022 and subsequent laboratory work on August *, 2022, we have found the following.

During Mr. ******'s new patient visit to establish a new primary care, Marija K*********, CRNP, discussed and ordered the laboratory work based on the information Mr. ****** provided during that new patient visit. Mr. ****** received a copy of his laboratory order and an after visit summary when he checked out from his appointment.

Mr. ****** had his laboratory work completed on August *, 2022. At that time Mr. ****** also signed the UPMC Consent for Treatment, Payment and Health Care Operations (TPO) in Pennsylvania, attached. The total charge for his laboratory work was $2*6.00 and was submitted to his Blue Cross Blue Shield insurance. Mr. ******'s insurance processed the services and applied $159.77 to his deductible. Deductibles, coinsurance and co-pays are a patient's responsibility and are billable to the patient.

Mr. ******'s complaint also states he contacted UPMC in Central Pa Customer Service (billing) which he did twice on October 31, 2022. The first representative that he spoke with advised Mr. ****** he would need to contact the office to discuss the clinical reason the laboratory tests were ordered. He again stated he didn't know why the tests were ordered and as the representative started to explain, he hung up on the representative. Mr. ****** also utilized messaging through the UPMC Central PA portal on October 31, 2022, to which he was in contact with Marija K*********, CRNP. She explained the clinical reasons why each test was ordered. During this time of messaging, Marija K*********, CRNP, did include an order for the testosterone testing Mr. ****** requested. Mr. ****** called customer service a second time on October 31, 2022, and the representative that he spoke with advised Mr. ****** another request would be sent to the office manager for review, because Mr. ****** feels he shouldn't have to pay for the tests completed on August 9, 2022, since the testosterone test was not on the order, and he would have to make another appointment.

On November 7, 2022, Mr. ****** contacted customer service to follow up on his account from the October 31, 2022, phone call. Mr. ****** wanted the representative that he spoke with to mark his concern as high importance and shared he needs to get another test done and he wants to be refunded the money he paid for his laboratory work performed on August 9, 2022. He stated he feels he shouldn't have had to pay for the tests on August 9, 2022, since it did not include the testosterone test.

A review was completed by the office manager on November 25, 2022, and stated the laboratory work was necessary based on the clinical reason for his visit on August *, 2022. Mr. ****** is correct, the customer service representative did not contact him with the results of the review from the provider's office.  Due to the representative not responding timely, this prompted Mr. ****** to call back into customer service on December **, 2022. The customer service representative he spoke to advised him of the outcome of the review from the office manager. Mr. ****** was not satisfied with the outcome and stated he was going to contact the office manager.

Mr. ****** called the office manager on December **, 2022, and the office manager explained again why the tests were ordered. The office manager had Marija K*********, CRNP call the patient back on December 13, 2022. Marija K*********, CRNP discussed with Mr. ****** his August *, 2022, visit and his laboratory orders. The provider also advised Mr. ****** he may go to any lab his insurance approves to have blood drawn. At that time the patient advised the provider he does not trust UPMC and is not coming back because it is very expensive.

No refund will be forthcoming for the laboratory services completed August *, 2022, as Mr. ******'s laboratory work was ordered based on the concerns he presented during his new patient visit on August *, 2022.  We will however, waive the patient responsibility assigned to Mr. ****** if he chooses to have the testosterone completed at a UPMC Central Pa location, to which is billed by UPMC Central Pa. Mr. ****** may contact UPMC Central Pa Customer Service at ###-###-#### once he receives the bill for the testosterone and request to speak to a team lead who will adjust the patient portion as applied by his insurance.
We hope the information provided resolves Mr. ******’s concerns.
Sincerely,
UPMC Office of Ethics, Compliance and Audit Services
Initial Complaint
Date:12/09/2022
Type:Billing Issues
Status:
AnsweredMore info
Complaint statuses
Resolved:
The complainant verified the issue was resolved to their satisfaction.
Unresolved:
The business responded to the dispute but failed to make a good faith effort to resolve it.
Answered:
The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
Unanswered:
The business failed to respond to the dispute.
Unpursuable:
BBB is unable to locate the business.
I have been on ******* to treat my MS for years. The drug company covers the cost of my medication. UPMC has made a deal with Pfizer to switch all ******* patients to ******** which will cause patients to incur significant costs.
Business Response
Date: 12/13/2022
Dear Ms. *****,
Please note Ms. ****** did not enter nor sign a HIPAA release form for our organization to properly address her concerns; therefore, we cannot proceed with our review at this time. We ask that Ms. ****** provides her signature on HIPAA release form and return to us so we may begin our review of this complaint.
Sincerely,
UPMC Office of Ethics, Compliance and Audit Services
Initial Complaint
Date:11/08/2022
Type:Service or Repair Issues
Status:
UnresolvedMore info
Complaint statuses
Resolved:
The complainant verified the issue was resolved to their satisfaction.
Unresolved:
The business responded to the dispute but failed to make a good faith effort to resolve it.
Answered:
The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
Unanswered:
The business failed to respond to the dispute.
Unpursuable:
BBB is unable to locate the business.
UPMC community health choices ************ ,is my insurance carrier who subcontracted a company named ******* ****** *** located at *** ****** ******* *************** ***** **** ***.to install a poured concrete handicap walkway on 10/07/2022.The workers had no work order or contract to work from. In addition no one spoke English. They mixed concrete from bags on my lawn.It was not poured from a truck as my work order indicated. They had no idea what work was to be completed. I gave the workers a case of water, soda and lunch then they threw their trash on my lawn and my neighbors yard. I’n addition they urineated on my lawn and bushes. My neighbors were irate and UPMC would not return my calls or address this issue.Upon completion they left my walkway lights in a pile , cut the wires in 3 places and left them inoperable. I made several attempts to ask UPMC for help but my calls to UPMC fell on def ears.(photos and security video furnished upon request) The men urinated on my bushes and lawn. They left live electric wires sticking out of the ground and my walkway lights inoperable.This was days before Halloween when the children could get hurt. Still UPMC has not addressed my concerns and damaged my property.They would not let me file and sit in on my greavance. DHS and the PA insurance commission have been notified.
Business Response
Date: 11/29/2022
Hello,
We are in receipt of the complaint. At this time, we have forwarded the complaint to the UPMC Health Plan for further handling.
We appreciate the opportunity to respond this complaint.
Sincerely,
UPMC Office of Ethics, Compliance and Audit Services
Customer Answer
Date: 11/30/2022
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.

*** ****** ** ** ******** **** ****** ** * ****** ** ***** **** ** **** **** **** ** *** ********
******* ****** hired by UPMC to install a safe walkway in my home. They cut walkway wires and broke walkway lights. The contract states to replace and install lights.Hazardous conditions exist.
******* *******
Business Response
Date: 12/01/2022
Complaint ID # ********
**** *** ******
UPMC Health Plan, Inc. (“UPMCHP") has received and reviewed your letter dated November 23, 2022 as well as the accompanying complaint.
The above-referenced complaint did not include a HIPAA authorization that would allow UPMCHP to disclose protected health information. Without a HIPAA-compliant authorization, UPMCHP is unable to provide a response to the Better Business Bureau regarding this complaint. However, UPMCHP will determine whether the affected individual is a UPMCHP member and, if so, will respond directly or otherwise outreach to the affected individual with a more detailed response.
Should you have any further questions, please contact me at *************
Respectfully Submitted,

Steven A. V***** ****
Staff Attorney
UPMC Health Plan
Business Response
Date: 12/07/2022
Hello,
We are in receipt of the complaint. At this time, we have forwarded the complaint to the UPMC Health Plan for further handling.
We appreciate the opportunity to respond this complaint.
Sincerely,
UPMC Office of Ethics, Compliance and Audit Services
Customer Answer
Date: 12/09/2022
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.
Waiting on merchant to respond to complaint.
*
Regards,

******* *******
Customer Answer
Date: 01/05/2023
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.

The HIPA form was signed, faxed and mailed on 12/1/2022 .I contacted UPMC 3 times regarding this matter.(copy enclosed)The information UPMC is providing is incorrect.

Regards,
******* *******
Customer Answer
Date: 01/05/2023
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.

Nothing has been done by UPMC or ******* ****** contractor to repair or resolve this issue. Hazards conditions exist due to the work ******* ****** contractor preformed . DHS and PA insurance commissioner have been notified.

Regards,

******* ********
Business Response
Date: 05/10/2023
UPMC Community Health Choices, Inc. (“UPMC CHC") is in receipt of your letter dated January 12, 2023 and accompanying message from ******* *******. As we believe this situation now to be resolved, we can offer the following response.

UPMC CHC received the first complaint from Mr. ******* regarding this issue on October 7, 2022. This complaint was conveyed over the phone to a UPMC CHC Member Services Representative. An acknowledgement was sent to Mr. ******* dated October 10, 2022. On October 15, 2022, UPMC CHC Complaints & Grievances received a fax from the member.1 This contained, among other things, a copy of an invoice from a company named ******** ******** dated October 12, 2022, which Mr. ******* indicated was for the repair of his broken lights due to the home modification by ******* ******. This invoice listed $260.00 as the amount owed. On the bottom, next to Mr. ********s signature, was written "$260.00 paid cash."

UPMC CHC has reimbursed Mr. ******* for $260, the amount listed on the invoice that was submitted to us on October 15, 2022. This amount serves as reimbursement in resolution of this issue. The check was dated March 2, 2023, and we have received confirmation that Mr. ******* received and cashed it. Additionally, UPMC CHC will continue to ensure that all work tasks related to benefits provided under the plan are performed professionally and completed per written work orders. As such, we believe this matter to now be closed.

Should you have any further questions, please contact me at ************.

Respectfully Submitted,

Steven A. V****, Esq. Staff Attomey UPMC Health Plan
Customer Answer
Date: 05/11/2023
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.

*** ****** ** ** ******** **** ****** ** * ****** ** ***** **** ** **** **** **** ** *** ********
Please be advised that UPMC paid $260 for electricians labor . However the materials to repair and replace damaged light fixtures has not been paid. (Receipts enclosed $122.00)In addition I would like the 5 year warranty in writing as promised by representative from ******* ****** and UPMC.Warranty is not on my work order.
Regards,

******* *******
Initial Complaint
Date:10/24/2022
Type:Billing Issues
Status:
ResolvedMore info
Complaint statuses
Resolved:
The complainant verified the issue was resolved to their satisfaction.
Unresolved:
The business responded to the dispute but failed to make a good faith effort to resolve it.
Answered:
The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
Unanswered:
The business failed to respond to the dispute.
Unpursuable:
BBB is unable to locate the business.
On 9/2/2022, I received an invoice for the first time for services allegedly rendered by UPMC Home Healthcare in February 2016. The invoice was for 3 copay amounts totaling $33.06. These services were allegedly rendered on 2/5/2016, 2/8/2016, and 2/10/2016. This was the first invoice I ever received from UPMC Home Healthcare for this copay amount. On 9/16/2022, I received the invoice again. I called the UPMC Home Healthcare business office (###-###-####) for an explanation. I was told that UPMC Home Healthcare was just "catching-up" on their billing and apologized for the 6 1/2-year delay in billing the $33.06 copay. I asked for some documentation that services were ever rendered. She said that she would look into the matter. On 10/12/2022, I received the invoice for the third time, and I called the UPMC Home Healthcare business office (###-###-####) again for an explanation. At 10:45 AM on 10/12/2022, I spoke with Kristin on a recorded line and disputed the charges. She agreed that this matter was "ridiculous" and recorded my dispute. On 10/24/2022, I received the invoice for the fourth time marked as "past due notice" and demanding payment of $33.06 within 5 days.
Business Response
Date: 11/07/2022
Ref: ***** *****, File ID ********

Dear **. *****:

We have received the complaint filed with your office on October 25, 2022, by **. ***** *****, our patient, due to concerns with billing. All due diligence was done to ensure **. ******* account balance is now zero for the bills he referenced in his complaint.

Thank you for the opportunity to respond to this complaint.

Sincerely,

UPMC Office of Ethics, Compliance and Audit Services
Customer Answer
Date: 11/08/2022
****** ******** *******

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
Date:10/18/2022
Type:Billing Issues
Status:
AnsweredMore info
Complaint statuses
Resolved:
The complainant verified the issue was resolved to their satisfaction.
Unresolved:
The business responded to the dispute but failed to make a good faith effort to resolve it.
Answered:
The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
Unanswered:
The business failed to respond to the dispute.
Unpursuable:
BBB is unable to locate the business.
I called and cancelled my insurance with upmc on August 5th to which the upmc representative agreed to. Since then, I have received 2 more bills claiming my payments needed to be made or my insurance would be cancelled. This action by them falsely sets me up to have not paid a bill to which they can report to a collection's agency and report to credit bureaus. I'm sure this is happening to others and needs to stop.
Business Response
Date: 10/27/2022
**** *** ******
UPMC Health Plan, Inc. (UPMCHP) has received and reviewed your letter dated October 18, 2022, as well as the Authorization to Release Health Information signed by Mr. ****. Please accept the following as the response of UPMCHP to the concerns expressed by Mr. **** regarding the above-referenced complaint.
For the 2022 plan year, Mr. **** enrolled in a UPMC ********* **** exclusive provider organization plan that he purchased directly from UPMCHP. According to Mr. ****'s Policy, members who purchase their coverage directly from UPMCHP are permitted to terminate their coverage by providing UPMCHP with either written or verbal notice of their intent to do so. Regarding when such a request for termination takes effect, Mr. ****'s Policy provides:
When to Provide Notice: You must provide UPMCHP with this notice by the 1st business day of the month immediately following the month in which you wish to terminate your coverage under this Policy. For example, if you wish to terminate your coverage effective March 31st, you must notify UPMCHP no later than April 1st
Retroactive Termination: In the event that you obtain coverage under a different UPMCHP policy or through another carrier, UPMCHP may honor your request to retroactively terminate your coverage under this Policy, if such termination would not result in the reversal of claims. You must provide UPMCHP with written or verbal notice within 30 calendar days of your requested retroactive termination date. For example, if you wish to terminate your coverage effective March 31st, you must notify UPMCHP no later than April 30th (Policy, p. 42).
Mr. **** called UPMCHP on September 12, 2022, wanting to terminate his coverage with us retroactively to August 31, 2022. Our Member Services department informed him that because he has no outstanding claims for the month of September, UPMCHP is able to retroactively terminate Mr. ****'s plan to August 31, 2022. Unfortunately, our Member Services never informed Mr. **** that he would need to provide proof of new coverage prior to the retroactive termination. Mr. **** mentions in his complaint that he called UPMCHP on August 5, 2022, to cancel his coverage, however UPMCHP does not have any records of such a call being made.
On September 12, 2022, and September 16, 2022, UPMCHP Enrollment Team attempted to reach Mr. **** to inform him that he needed to provide UPMCHP with proof of new insurance prior to the retroactive termination being implemented. A call back number was provided each time. Our records indicate that Mr. **** never called UPMCHP and never provided UPMCHP with proof of new insurance.
However, due to the information provided to Mr. **** on the September 12 call with Member Services, UPMCHP will make a one-time exception and terminate Mr. ****'s coverage effective August 31, 2022. He will not be obligated to pay his premium for the months of September and October. A termination letter will be sent to Mr. ****. Additionally, UPMCHP will also provide coaching to the Member Services representative that spoke with Mr. **** on this September 12 call.

UPMCHP apologizes for any inconvenience this may have caused Mr. **** and thanks him for bringing this to our attention.
Should Mr. **** have any additional questions, he may contact our Member Services department at the telephone number on his Member Identification Card.
Respectfully Submitted,

Praneeta G. S*******, Esq.
Staff Attorney
UPMC Health Plan
Initial Complaint
Date:06/20/2022
Type:Service or Repair Issues
Status:
AnsweredMore info
Complaint statuses
Resolved:
The complainant verified the issue was resolved to their satisfaction.
Unresolved:
The business responded to the dispute but failed to make a good faith effort to resolve it.
Answered:
The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
Unanswered:
The business failed to respond to the dispute.
Unpursuable:
BBB is unable to locate the business.
I want Leslie D**** to call me so we can talk about the inefficiency of the UPMC billing and physicians departments. Was at Mckeesport Hospital on 2/1-2/3. And my bills are still not correct. First I was billed for physician visits (which did not happen), contacted UMPC and spent many many hours trying to get this straightened out. I have spent over 20 hours trying to get thing straitened out. and they are still not (June 20). When I make payments they do not go to the charges that I asked for. Today I spoke with an Aleta H (Supervisor), who was very rude. She is not customer-friendly and needs talked to. There have been some many screwups with my accounts that when I asked her to repeat what she had for my payments, she said she went over them and would not again. I want to pay my bills. I do not want to owe anything. But UPMC cannot get things straight.
Business Response
Date: 07/13/2022
The complainant in BBB ID No. ******** has submitted a virtually identical consumer protection complaint to an official Pennsylvania state forum. Accordingly, to avoid response duplication and possible confusion, UPMC will address the complainant’s concerns in that forum. We appreciate the efforts of the Better Business Bureau, but it is important to avoid the proliferation of redundant disputes.
Customer Answer
Date: 07/14/2022
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,

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

I want compensated for my time and the $50 charge taken off!
Initial Complaint
Date:06/17/2022
Type:Sales and Advertising Issues
Status:
AnsweredMore info
Complaint statuses
Resolved:
The complainant verified the issue was resolved to their satisfaction.
Unresolved:
The business responded to the dispute but failed to make a good faith effort to resolve it.
Answered:
The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
Unanswered:
The business failed to respond to the dispute.
Unpursuable:
BBB is unable to locate the business.
Within the last 2 months I was scheduled to see my pcp dr. Loose at annville family medicine. First time my girlfriend called to make an appointment for me while I was working. They had an available appointment the next day. The next day came, within an hour of my scheduled appointment they called me to inform me that doctor is not there that day. Already missing a days work. When it was brought to their attention they were rude. Now today 6/17 happened again. I recieved an email reminding me of my appointment for 6/17 but no time was showing. My girlfriend called to see what time I was to be there they said 10 am. So i took a days work to follow up and tind out about my recent bloodwork and mri. I am already pulling into the doctors office which is 45 minute drive from my home. They say the doctor is not in today. Offered an excuse from work. That is how much in gas, 16 hours of missed pay between the 2 days. Had to prepare my 2 year old and 4 month old. Just to be told I don't have an appointment that day now. They are losing a patient now at that facility. Our family is going elsewhere. There is no excuse for this. It is hard to make a living now with the inflation and then no respect when I get to the facility. It is not my fault. I should have been seen.
Business Response
Date: 07/05/2022
UPMC Corporate Ethics and Compliance
600 Grant Street
Pittsburgh, PA 15219
********* ****
The Better Business Bureau
520 E Main Street
Carnegie, PA 15106

July 5, 2022

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

We have received the complaint filed with your office on June 17, 2022, by *** ***** ********** our patient, due to concerns with two cancelled appointments in the last two months. *** *********, per his report is a patient of Dr. Loose at Annville Family Medicine and has missed work to attend appointments only to have the appointment cancelled on the day of the appointment. *** ********* reports having to travel 45 minutes to his appointments and the cost of gas combined with missed work is causing a hardship.

*** *********, (“pt.”) a 45-year-old male, has been a patient of Dr. Loose since December 2019. The patient has had 15 completed appointments with the Annville Family Medicine in that time, three appointments were cancelled by the practice (December 15, 2020, March 22, 2022 & June 17, 2022) and one appointment in February 2020 the patient did not arrive for the appointment or call in advance to cancel.

For any unplanned provider absences, the practice activates all available staff to assist in rescheduling patients in an effort to minimize disruption to the patient. For the March 22, 2022 visit staff were able to reach *** ********* in time to reschedule his appointment for March 29, 2022. Unfortunately, on June 17, 2022 the provider was attempting to delay his start to keep as many appointments as possible but at 9:00 am the provider made the decision that he would not be able to care for patients.

In discussing this event further with *** ********* on June 20, 2022 the practice manager was able to identify another UPMC family practice that was closer to the patient’s home. A closer practice will help both with scheduling conflicts as well as the increasing costs of transportation. The patient has been scheduled for a visit on July 11, 2022 to establish care.
In summation, a complete review of this case was conducted by the administrative team. As with every review, we work to identify areas for development and continued improvement. We encourage *** ********* to work in partnership with our facility. It is our goal to keep lines of communication open and work together to resolve any miscommunication or misunderstandings. We understand that this can be difficult and poses a challenge at times but have multiple channels available to our patients to bring issues to our attention.

We thank you in advance for your time and consideration regarding this matter. It is our goal to work together towards an amicable resolution. Please do not hesitate to contact me should you have any questions or require any additional information.

Respectfully,
UPMC Office of Ethics and Compliance
Initial Complaint
Date:06/13/2022
Type:Billing Issues
Status:
AnsweredMore info
Complaint statuses
Resolved:
The complainant verified the issue was resolved to their satisfaction.
Unresolved:
The business responded to the dispute but failed to make a good faith effort to resolve it.
Answered:
The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
Unanswered:
The business failed to respond to the dispute.
Unpursuable:
BBB is unable to locate the business.
UPMC will not submit bill to insurance carrier, even after receiving a letter from my lawyer. They keep sending past due bills which seems harassing. I'm tired of spending hours on hold to try to get in contact with them. I spoke with my health insurance rep and UPMC has never sent a claim. When I call UPMC they say it was denied and give no further help.
Business Response
Date: 07/08/2022
UPMC Corporate Ethics and Compliance
600 Grant Street
Pittsburgh, PA 15219
********* ****
Better Business Bureau
Serving Western Pennsylvania
520 E. Main Street, Suite 100
Carnegie, PA 15106

VIA EMAIL: [email protected]

July 8, 2022

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

This is UPMC’s response to the complaint filed under Better Business Bureau ID numbe* ******** regarding the matter of non-billing of health coverage and past due notices.

The patient was seen at UPMC and his care was billed to State Farm (Primary) and Aetna Better Health (Secondary).

The patient’s automobile insurance denied coverage. The charges should have then been billed to the patient’s health insurance. Unfortunately, this did not occur, and the patient was mistakenly billed by UPMC. We regret the error, and the inconvenience experienced by the patient.

On June 28, 2022, the patient’s bill was submitted to his Aetna insurance for reimbursement.

The patient paid $54 that is being refunded back to the patient’s credit card used to make payment. On June 30, 2022, UPMC spoke with the patient to explain the resolution.

If the patient should have questions regarding this inquiry, please have him contact UPMC at the numbers provided to him by UPMC on our June 30 call.

We appreciate the opportunity to provide this response.

Respectfully,

UPMC Office of Ethics, Compliance and Audit Services
Customer Answer
Date: 07/11/2022
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,

**** ****
Initial Complaint
Date:06/03/2022
Type:Delivery Issues
Status:
ResolvedMore info
Complaint statuses
Resolved:
The complainant verified the issue was resolved to their satisfaction.
Unresolved:
The business responded to the dispute but failed to make a good faith effort to resolve it.
Answered:
The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
Unanswered:
The business failed to respond to the dispute.
Unpursuable:
BBB is unable to locate the business.
I received two bills for the same appointment (see attachment "Bill for 1.7.22" and "Duplicate bill", both are paid for). I inquired about why I was charged twice with UPMC message service, and the customer service responded that I was charged for the ***** **** on 7/24/2021 (see "customer service response"), which I never received a bill or statement for (see attached "Never received bill for 7.24.22" outlining all bills I received since 1/1/2021). I received the ***** **** with doctor's referral for my LASIK surgery, which was clearly stated "all bundled cost with no surprise cost" on their website (see "UPMC service description" and "LASIK receipt"). I tried calling their customer service on 6/3/2022, and their response was rude, unprofessional, and denied my contest. They also informed me that I was not allowed to contest again because I didn't have enough time to respond to the attached message (see "Customer service response"). The customer service message did not require a deadline for my response, so I don't see this as a failed dispute. The billing department already made a mistake on my third follow up appointment for my LASIK surgery, so I don't trust their decision, and I'm appalled by their illegal claim that I don't have the right to dispute again. This decision is arbitrary and shady. To recap, I never received a bill for 7/24/2021, and I had doctor's order to take the test while no one told me that I was going to be charged (see "Notes on 7.24.21"). I'd like the $25 refund.
Business Response
Date: 06/27/2022
UPMC Corporate Ethics and Compliance
600 Grant Street
Pittsburgh, PA 15219

********* ****
Better Business Bureau
Serving Western Pennsylvania
520 E. Main Street, Suite 100
Carnegie, PA 15106

VIA EMAIL: [email protected]

June 27, 2022

Ref: *** ** ** *********

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

This is UPMC’s response to the complaint filed under Better Business Bureau ID number *********

Upon receipt of the patient’s concerns, the accounts were reviewed.

The patient is being refunded $25.00 due to overpayment because the patients payment was applied to another date of service. The $60.00 copayment for the ***** **** has been waived from patient liability because the description of the service could have been understood by the patient to mean that the price was all-inclusive.

UPMC Patient Relations has reached out to the patient to explain the action being taken in this case. There have been two (2) voice mails left. As of the date of this letter, we have not heard back from the patient.

We appreciate the opportunity to provide this response and apologize for the inconvenience experienced by the patient.

Sincerely,

UPMC Office of Ethics, Compliance and Audit Services
Customer Answer
Date: 06/28/2022
[A default letter is provided here which indicates your acceptance of the business's response. If you wish, you may update it before sending it.]

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,

****** ****

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