ComplaintsforAllegheny Health Network

• Initial Complaint

  09/28/2022

  Complaint Type:

  Billing Issues

  Status:

  Resolved

  More info

  Allegheny Health Network continues for bill me for services that my insurance company, United Healthcare, insists I don’t owe. In, other words, my insurance paid what was owed to AHN for this service. I’ve been arguing with them for months and they won’t return my calls anymore. I also sent them a copy of a letter from United Healthcare saying I don’t own them any money for this particular service. In addition, a payment I recently made online to another doctor, was automatically put toward the amount they say I still owe, which I do not. In other words, this $15.00 payment will not go directly to the doctor from whom the bill came. And I will still owe this other doctor $15.00, as it will look as though I didn’t pay him.

  Customer response

  10/11/2022

  From: **** ****** **********************
  Date: Mon, Oct 10, 2022 at 9:26 AM
  Subject: Re: You have a new message from the BBB serving Western Pennsylvania regarding complaint **********
  To: Better Business Bureau <[email protected]>
  
  
  Thank you so much for addressing my billing problem with Allegheny Health Network. I am happy to report that the issue has been cleared up and I no longer have a balance with them. I received for a very apologetic phone call and after months of myself and my insurance provider attempting to resolve this, it has been taken care of. 
  
  I have no doubt, whatsoever, that had you not looked into this, I would still be faced with a balance I simply did not owe. Again, thank you for your prompt response to my inquiry for assistance. It is greatly appreciated. 
  
  **** ******

• Initial Complaint

  09/22/2022

  Complaint Type:

  Product Issues

  Status:

  Answered

  More info

  Ongoing attempts since June to get reimbursement of out-of-pocket costs (prior to receiving an exception from insurance company to cover payment in full) been futile. Engaged at least 15 service reps passing the buck, not responded, or provided account reconciliation documentation to NOT reimburse my out of pocket expenses in full. Cannot speak to anyone personally. June 1, 2022: charged $8,140 to my personal credit card as service was denied. June 2, 2022: Confirmed that Cigna contacted surgeon (left message for Ashley to send documentation the procedure would be covered by Insurance). Insurance asked provider to send claim directly to Service Executive so claim is processed correctly. This never happened. June 6: Surgical Procedure at AHN Plastics/AHN Hand Surgery, 4815 Liberty Avenue, Suite 425, Pittsburgh, PA 15224-2156 August 30: Notified “Ashley/Stacey M” that we prepaid $8,140 on credit to Allegheny Health Clinic that would need to be reversed. August 30: “Stephanie” notified credit refund of $1448.54 on August 23. August 31: “Stephanie” notified an “update from the “Management Team” of an additional refund of $1449.10 issued for a total of $2,897.64 and stated “the facilities and service costs are now satisfied.” September 1: Another credit to charge account in the amount of $937.96 was made from ALLEGHENY CLINIC on August 31. September 7: Again, notified AHN that I paid $8,140 out of pocket prior to confirmation of insurance coverage and asked for full accounting which I have never received on three separate occasions. September 8: Received check in the amount of $511.14 from ALLEGHENY CLINIC. Still no accounting, explanatory or reconciliation documentation. 8140 PAID ($1448.54)CREDIT ($937.96)CREDIT ($511.14) CREDIT $5,242.36 REIMBURSEMENT DUE (LESS $2000 DEDUCTIBLE PAID) New total due: $3,242.36 September 18: “Thomas” responded to request for accounting. He ‘forwarded to presentative(sic).’ September 19: no response to date.

  Business response

  10/27/2022

  
  Thank you for the opportunity to respond to the concerns expressed by ********* ****** that you shared in a letter dated October 19, 2022 and received by the Customer Care Center on October 23, 2022. Allegheny Health Network places great importance on the resolution of concerns that are expressed by our patient and/or their family members.
  I understand that ********* ****** has the following concerns with Allegheny Health Network:
  Ms. ****** is awaiting reimbursement of overpaid funds and accounting information for balances paid.
  We would like to thank you for bringing Ms. ******’s concerns to our attention, and for providing us with the opportunity to address them. Ms. ******’s concerns were immediately shared with the appropriate leadership for investigation and follow up. In response to Ms. ******’s concerns, we have determined:
  There was an additional balance due to be refunded back to the patient. Our internal billing department made corrections to the date of service. After the review, an expedited refund was initiated for Ms. ******’s overpayment.
  Additional training will be provided to Customer Care Center staff regarding follow up procedures to ensure a more timely resolution.
  Accounting of the balance remaining with Allegheny Health Network was explained to Ms. ******. She was in agreeance that this amount matched up with the documentation she received from her insurance company.
  Charnetta Lane, thank you again for sharing ********* ******’s concerns. We will utilize the feedback you have shared in our efforts to continually improve our services. I wish all the best for her good health and well-being.
  Please let me know if you have any additional concerns or require additional information.
  
  
  
  
  Sincerely,
  Samantha C***
  Revenue Cycle Supervisor, Customer Care Center
  Customer Service
  
  

• Initial Complaint

  09/21/2022

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  My PCP retired so I made appointment with Dr H******'s office for Aug 23, 2022. I told them I had UPMC Insurance. I went to appointment. Filled out paperwork. Was ask for drivers license and insurance card. Had appointment and tried to pay copay. Of which I was told I would be billed. I said it's only $10. No we will bill you. I thought that was quite odd. Fast forward I get a $274 bill. I call UPMC and am told Dr H******* is out of network. I was literally stunned. Because had I have been made aware of this I certainly wouldn't have went there. They had many opportunities to tell me and didn't. This is wrong on so many levels. I called the office today and she said oh I'm sorry you should have been told we don't take the UPMC you have. I will make sure future patients are told. Well that does me no good now. She said we don't take UPMC marketplace insurance. I said that's what I have. I told the office what insurance I had when I made appointment and wasn't told it wasn't accepted. Well your group number is different than most marketplace insurance. I said that's a mistake within your office not on my part. I wouldn't have come if I was made aware of that fact. This was a mistake they made that I shouldn't have to pay for. I tried to call last week and discuss this with Dr H*******'s office and was brushed off and hung up on. This is so unprofessional.

  Business response

  10/06/2022

   

  Hello, 

  This complaint was also raised internally around the same time.  The office brought it to our attention and after investigating it does appear that the patient was given misinformation at the point of scheduling.  The office didn't catch this until after the appointment.  It was reviewed internally and the patient responsibility of $274 has been adjusted off on 9/29.

  The results of the findings and resolution were shared back with the office at that time.

  We apologize for the inconvenience this caused.

   

  Sincerely, 

  Philip W*******

• Initial Complaint

  08/29/2022

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  Ischeduled an appointmet for a physical before my insurance expires in order to gain emloyment. I went to th eFreeport Road Location and due to asthma and a deviated septum, I do not wear a mask. The giral the front told me I only needed to wear it in the waiting room until I got to the back. I did not have it on over my mouth and nose for the above said reasons. They called me to the desk and asked if I was comfortable wearing a mask and I said no. The girl then proceeded to tell me that the provider refused to see me. This is medical discrimination and I should have been made an accommodation as I am when I go to the hospital with my father for his cancer treatments. We are taken to an empty room to wait. This is medical malpractice and this type of behavior must end.

  Business response

  09/15/2022

  We apologize for the inconvenience.  We do require face coverings at this location and most of our locations.  If a patient is unable/unwilling to wear a mask they can wear a face shield.  Virtual visits are also offered if/when the office visit type allows this.  We can refuse visits if those procedures aren’t accepted.
  

  
  We have reached out to the patient to see if this was clearly explained at the time, and we’re currently awaiting a call back to confirm.

   

  Thank you, 

  Philip W*******

  AHN CCC Manager

• Initial Complaint

  08/27/2022

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  On Dec,1, 21 , I got a CT scan, Without contrast they charged me $3003.01. And on Dec,8,21 I got a CT scan again with contrast and that cost me $6005.01 ,And an additional charge of $500 from the pharmacy for the medication that they put in my body for the CT scan with contrast I paid over $1500 out of pocket so far, and eight months later I received a bill saying I owe an additional $703.70, and then when I spoke to them I asked Allegheny health Netwerk why was it a $3000 difference from the same machine actually the same lady that operated the CT machine and I even paid for the medication for them to do a CT scan with contrast I asked for an explanation on why such a big difference in a bill , needless to say she couldn’t answer my question I ask her for somebody to call me to explain this to me before the bills being paid, this is totally ridiculous, how could they could charge $3000 more for the same test with nothing any different other than without contrast or with contrast and I found out the contrast means the medication they put in my body which I paid for out of there pharmacy of $500, so I don’t see why they charged me $3000 more , totally upset because nobody has called me back to explain why, My explanation is they think they could do whatever they want and I have to pay it , I paid enough out-of-pocket already this is a total rip off, Can you please help me out or get me the answers, thank you so much for everything, Any questions call me ************ 

  Business response

  08/25/2022

  Select Specialty hospital is a long term acute care facility and we do not perform CT scans.  This concern appears to be related to Allegheny Health Network and one of their hospitals.  We are not affiliated with Allegheny Health Network.

  Customer response

  10/06/2022

  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

  06/24/2022

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  Guarantor ID ********* On October 25 2021 I went to see Dr Andrew O***r Cardiologist for chest pains. The Dr. requested blood work be done. On November 1 2021 I was informed that the claim was denied due to a coding issue. I contacted AHN billing as was told to call Highmark BCBS. The rep at Highmark took my information and contacted Dr O***rs office. The Dr office resubmitted the claim with the correct code and it was paid. A few weeks later I received a bill for the blood work that was denied. I contacted AHN billing again and was told to call Highmark. I have now called Highmark 5 times and every time the call AHN billing to explain the issue and submit the correct code. Today I received a collection bill for the $32.82. I contacted Highmark again and was told Dr O***rs office refuses to resubmit the claim with the correct code to get paid. This is utterly ridiculous. They did it for the office visit, it should carry over for the blood work as well. I have had BCBS for nearly 20 years and have never had a billing issue until I went to Dr O***rs office.

  Business response

  08/30/2022

  Hello, 

  Sorry for the delay

  The coding for these services was reviewed and resubmitted on 7/7/22, the balance was brought back from bad debt on this day as well.  Insurance paid in full on 7/20/22.

   

  Please and thank you, 

  Philip W*******

• Initial Complaint

  04/08/2022

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  Billing issues. I have been getting bloodwork done at Brentwood Medical Bldg for more than 5 years. Same insurance! Last fall went for bloodwork from my doctor and received a bill for $20 copay? Called insurance was told submitted as if done in hospital setting which is false! I paid it and now getting a bill for doctor visit copay for my yearly Medicare wellness visit paid for by meficare!!! Read darn doctor notes. Obviously billing department is beginning to charge for covered visits! Please have someone investigate this. Ready to leave this health care system for untrustworthy practices.

  Business response

  08/30/2022

  Hello, I'm sorry for the delay.

  The bloodwork we see looks like from a DOS of 12/2/21.  The $20 copay left by Humana Medicare looks correct.  On 12/2/21 the labwork left the same copay as an earlier visit for the same lab work at the same location with the same insurance provider.

  As far as the Medicare Annual Wellness visit on Monday March 14th, 2022.  Unfortunately, this happens with annual wellness visits and other generic office visits sometimes.  This is not unique to our organization and we do our best to educate, but when ailments, are discussed and addressed outside of the wellness parameters, there generally is a charge.  The best resource to determine what is within annual wellness parameters would be the insurance provider themselves.  

  There was a MyChart message submitted by the patient and what I've mentioned above was discussed there as well, that transcript is below.  The verbiage below "SIGNIFICANT, SEPARATELY IDENTIFIABLE EVALUATION AND MANAGEMENT SERVICE BY THE SAME PHYSICIAN ON THE SAME DAY OF THE PROCEDURE OR OTHER SERVICE" is not our language but rather language from insurance providers and governed by CMS guidelines.

  "You saw * *********** ** on Monday March 14, 2022 for: Medicare Annual Wellness. The following issues were addressed: REDACTED... You are being billed for the items outside of the annual wellness parameters, as a SIGNIFICANT, SEPARATELY IDENTIFIABLE EVALUATION AND MANAGEMENT SERVICE BY THE SAME PHYSICIAN ON THE SAME DAY OF THE PROCEDURE OR OTHER SERVICE, and your insurance is stating that this has a $5 patient responsibility. I would advise that if you are questioning this, to please go over the annual wellness visit parameters with your insurance provider.”

  Thank you, 

  Philip W*******

• Initial Complaint

  03/04/2022

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  I experienced a traumatic health incident on March 3rd that is going to require me to have a surgical procedure on March 8th that was unplanned. Today, on March 4th, I was contacted by someone at the billing department to communicate the balance of what I will owe for the procedure, and wanting me to let them know at that moment on the phone what I will be paying in person next week. I have not even spoken to the Doctor yet for my pre-op appointment, nor do I even have the full details or time of the procedure. Yet I'm being asked how I'm going to pay. As I am in the process of grieving an extremely traumatic medical event, the lack of professionalism and sense of empathy displayed by AGH by calling me within 24 hours of receiving this awful news to collect a bill is beyond ridiculous. Thankfully the doctors I have worked with through this experience have been wonderful in showing their care and empathy. However, the organization as a whole is showing their concern lies with seeking their money, before I even have the details of what I am going to need to do. I expect a phone call from someone within upper administration at AGH to address this business practice, as it is beyond unacceptable. Caring for the patient first and foremost should be the top priority in their time of need, not placing an unnecessary phone call 24 hours after the event asking for payment. It is cruel, callous and unprofessional.

  Business response

  08/11/2022

  Hello, 

  First we apologize for the distress this has caused the patient.

  Our process for pre-service steps happens with any scheduled procedure in advance of services.  We call for multiple reasons:
  

  1.  To preregister the patient completely, demos, emergency contact, accident info, insurance etc. 

  2. We verify the insurance eligibility and benefits in order to produce an estimate which we share with the patient.

  3. We request an upfront payment from the patient and offer the patient payment solutions if they are unable to pay. 
  

  Payment solutions may consist of speaking with a financial advocate or setting up a payment plan.   Our goal is to educate the patient, make them aware of what they can expect to be billed, and offer help when needed.  Usually this is better than calling just one day prior to the scheduled procedure or not educating the patient about their benefits at all.

  This case was entered by the physician office on 3/4/22 which is a Friday for surgery the following Tuesday 3/8/22
  We contacted this patient the same day the office scheduled the procedure

  
  Here are the agents notes from the interaction with the patient on 3/4/22
  Patient demographics were verified
  Patient estimated liability was determined
  Patient wanted to know if that was her responsibility to pay
  Patient was advised yes, deductible and out of pocket is her responsibility to meet for the plan before the pay 100%
  Pt stated she will make a payment the day of service
  
  
  Thank you and please let me know if anything else is needed.

  Philip W*******

  Interim Manager AHN CCC

   

  Customer response

  08/15/2022

  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.]

   

  This is a canned response, insulting, and incorrect.  I did not in any way shape or form state that I was going to make a payment the day of my procedure.  Understand this wasn't some sort of a routine procedure either.  This was an emergency surgery that I had to undergo due to a tragic event.  That is the only reason the surgery was scheduled so soon after the call from my doctor was made stating that it needed performed. The notion that this phone call prior to the surgery was done for my benefit is ridiculous and offensive.  This call was performed on behalf of Highmark/Allegheny Health Network in attempt to be assured they received their money.  The last thing on my mind while dealing with this situation was worrying about sending a pre-payment, or, a payment the day of my procedure.  Showing any sort of empathy for the patient here was the very last thing on the health network's mind.  If that had been the case, they would have checked their notes, and respectfully waited until after my procedure on the 8th to seek payment.  

   

  Also, 5 months for a response that is obviously canned and typed from a template is laughable.  The lack of urgency and timeliness is further proof that zero concern was shown for my well being.  

   
  
  Regards,
  
  ***** ********

• Initial Complaint

  12/07/2021

  Complaint Type:

  Product Issues

  Status:

  Answered

  More info

  Canceled multiple appointments. Then refused to se easiest within appropriate timeline. Denied patient medication

  Business response

  12/16/2021

  December 16, 2021 
  
  

  *** ** ******** 

   

  
  We have reviewed *** ****** concerns and are providing our findings below: Our patient experience team previously spoke to *** ***** regarding this complaint. They provided a  summary of what was discussed with the office and communicated to *** *****:

  · The patient was discharged due to noncompliance of the opioid policy 
  · The patient has cancelled multiple appointments  
  · The patient spoke with the nurse, agreed to the plan to find another provider, was given a  bridging dose of medication, and a list of non-AHN providers 
  

  Thank you 
  

  Delaney C******* 
  
  Manager, Customer Care Center
  

  
  

*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. ↩