ComplaintsforSoutheast Eye Specialists

• Initial Complaint

  08/25/2023

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  My husband was scheduled for eye surgery on 7/26/23 after waiting 5 months for this appointment. The evening (7/25/23 )before at 4:55pm (5 mins before their office closed) calls and leaves a VOICEMAIL that they are canceling his surgery because of a pending prior authorization that WAS NOT even required for surgery. They did not attempt to call insurance directly to resolve. I called insurance and got approval but they still refused to proceed with surgery. My husband had been taking out of our pocket $65 eye drops in preparation for surgery 3 days prior which is all now moot and waste of our money. I had to schedule time off work for this appointment causing me to lose a day plus now having to ask for more time off for another day. They filed claims on my insurance higher amounts than expected and I am still waiting on refund. This *************** has NO respect for their patients!

  Business response

  09/08/2023

  Due to a remote working situation, this letter was located today in an incorrect physical mailbox of another employee. We are reviewing this immediately. 

  Customer response

  09/11/2023

  Their response requires them to contact me after they review the complaint. *************** so it is not closed because they have not giving a satisfactory answer. 

  Customer response

  09/11/2023

   
  Complaint: 20378354
  
  I am rejecting this response because: they did not provide any answers , they are reviewing 
  
  Sincerely,
  
  *****************************

  Business response

  09/21/2023

  I have attempted to contact the patient and his wife but have not received a return phone call.  After looking into this matter I found that there were 2 components to the surgery, one that required a PA and one that did not.  The PA was submitted to insurance 7/17/23, it was still in pending status at 4:35 on 7/25/23, the day before his surgery.  The patient was notified that we were still waiting on the PA, the surgery was canceled so the patient would not end up with a large bill.  Unfortunately it is out of our control how long the insurance company takes to respond to our requests. The status of the PA was checked again on 7/26/23 and had been moved from 'pending', to 'in review". We called the insurance company and they could not give us a reason it was not completed, but stated it could take up to 72 hours form that day to approve or deny the request.  On 7/31/23 we received a call from the patient requesting to proceed with surgery - we called the insurance company once again and the portion of the surgery that required a PA was denied.  We discussed with the doctor and was advised it was safe to proceed with the one portion of surgery that had been approved. The doctors surgery calendar is booked out 4 - 6 weeks but given the situation we felt it was important to take care of him as soon as possible and did everything we could to add an additional surgery for the following week.  The patient was able to have surgery the following week and we were under the impression he was happy with our effort to make this right and happy with the outcome of the surgery.

  Customer response

  09/22/2023

   
  Complaint: 20378354
  
  I am rejecting this response because: There has NO attempts made to contact either one of us. No missed calls, no voicemails, no letters. These people are not being truthful. 
  
  Sincerely,
  
  *****************************

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