ComplaintsforCornerstone Primary Healthcare, Inc.

• Initial Complaint

  01/19/2022

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  Cornerstone Primary Health Care charged me the FULL amount for an annual doctor's visit and then immediately filed a claim and collected the FULL amount again from my insurance company. Here are the details: On a follow up doctor's visit 11/2/21 I was charged the full amount of $228.41` for a previous visit from 05/07/21. Oddly enough, the doctor's bill states the total at $285.00 not sure why the discrepancy. Despite the fact that the office had complete documentation that I was fully insured, the office manager refused to run the claim through my insurance company. After repeated requests to have them run this through my insurance and send me a refund for being over charged, the office manager Kristy Raymond refused. Immediately after the last refusal sometime in Nov. 2021, Ms. Raymond then secretly filed the claim and received a FULL payment from Aetna Insurance as well. On 01/18/22 my insurance company notified me that Cornerstone had received Full payment from both me and them. Cornerstone was double paid. Immediately I contacted Kristy Raymond at Cornerstone, asked for the exact dollar amount that I was overcharged, she refused to supply this information and simply said, we will use whatever the overcharge is on your future visits. Not feeling comfortable with this, I once again requested a full refund on what I was overcharged, she only said that she would put in a request, but no guarantee. I have filed a complaint with Attorney General of State of Tennessee as well. Whether or not this constitutes Insurance Fraud being that they collected money from insurance after receiving the full amount from me, I do not know. This double dipping done behind my back and playing blind banker with my money does not seem like an ethical business practice. My hope is not only to receive a full refund on what was wrongfully over charged, but to put a stop to this deceptive, unethical business practice and poor customer service shown by Ms. Raymond.

  Business response

  05/18/2022

  Business Response /* (1000, 9, 2022/03/18) */ March 8, 2022 RE: Shannon ****** File #******** To whom it may concern, Please accept this letter and attached documentation as rebuttal to the recently filed complaint against Cornerstone Primary Healthcare by Shannon ******. On 05/07/2021, Mr. ***** was present for an office visit. At this time, he was asked if he still had ***** as his insurance to which he responded yes. Mr. ***** was then asked to fill out an updated Demographics form where he indicated again that he had ***** as insurance. This is reflected in ATTACHMENT A. By signing this form, Mr. ***** also agrees to several Cornerstone Primary Healthcare policies. These include the understanding that it is the patient's responsibility to know their insurance plan and what that insurance covers, the understanding that they are for responsible any remaining balance not covered by insurance and that all balances will be collected prior to being seen. Claim was submitted electronically but not accepted by ***** as shown by ATTACHMENT B due to an Invalid Member ID. We attempted to research patient's policy on the ***** Healthcare Providers website to see if there had been an update to Mr. *****'s policy. As shown on ATTACHMENT C, this policy termed on 12/31/2020 and no further information was available. An email (ATTACHMENT D) was sent to patient on 06/15/2021 letting him know that his ***** policy had termed and to contact our office with updated insurance information. Patient responded (ATTACHMENT F) on 07/05/21 with a phone number and ID number. I emailed patient on 07/06/2021 that we would need the actual insurance card to insure we were billing the correct payer. Mr. ***** emailed the front and back of this card to me on 07/06/21. The card provided by Mr. ***** is shown as ATTACHMENT G. We immediately refiled his office visit. ATTACHMENT H shows where again this claim was not accepted this time by ******** due to being an inactive policy. Attempts were made to reach Mr. ***** by phone to discuss as we could not get accurate insurance information from him via email. We were not able to reach him. On 10/25/21 a statement was mailed (ATTACHMENT J) to Mr. *****. Mr. ***** came into the office on 11/02/2021 for an office visit. He told the front desk that he had received the statement from us and that he knew that his claim had not been paid. Mr. ***** was asked for his outstanding balance as is Cornerstone Primary Healthcare Policy. Mr. ***** told the front that he in fact had new insurance and that we should file with the new insurance. Mr. ***** provided a new card (ATTACHMENT K). He was told that we would update this information but that it was unlikely that we could file his past claim due to the filing restrictions most insurances have. We offered to give him the needed documents so that he could file for reimbursement himself. Mr. ***** did pay for his past visit and was seen in the office. On 11/03/2021 Mr. ***** sent a series of emails (ATTACHMENTS L, M, and N) regarding this situation. Mr. ***** insisted that the proper insurance had been provided and that we did not follow thru with proper filling of this claim. I did respond by sending all former correspondence including the past cards he had provided. Mr. ***** did respond with a final email on 11/03/2021 (ATTACHMENT O) in which he did admit to providing the wrong insurance card but still accuses us of not being more accommodating. Mr. ***** has accused us of "double dipping". He states that we charged him for this visit and then filed with his insurance as well. As mentioned above, our policy does state that all outstanding balances will be paid prior to any office visits. We did explain that we were unable to file with his new insurance due to the time that had passed since his 05/07/21 office visit but directed him to do so. ATTACHMENT P reflects interoffice communication showing where patients insurance WEBTP reached out to us via phone on 11/04/2021 to let us know that their filing status does not expire for 365 days (not the typical 90 days). She provided a fax number to file the claim or said that we could still file electronically and provided the Payer ID which matched the information on patient's insurance card. The only reason this claim was submitted to WEB TP was as a result of this phone call and at the direction of the representative. At no time did we plan on keeping funds from patient if claim paid to us directly from WEB TP. ATTACHMENT Q shows where this was accepted by his insurance. Mr. ***** has also made the claim that we have not issued his refund or refunded him less that he is owed. ATTACHMENT R is an invoice for his 11/02/2021 visit where monies collected on 11/02/2021 were applied. Mr. ***** called in on 01/18/2021 and said that he had received notice that WEB TP had paid us for the 05/07/2021 claim. He said that he wanted to be refunded for the money left on his account. I explained that the monies had been used to pay the patient responsibility assigned by WEB TP for both 02/07 and 11/02 and I would put in a request for the refund on his account since I am not the one who issues the refunds. ATTACHMENT T shows interoffice communication where the refund was requested on 01/18/2022 and mailed on 01/19/22. ATTACHMENT S is an invoice for the 05/07/2021 visit showing all monies in and out including the refunded monies. In summary, had patient given us his correct and current ***** insurance card at his appointment on 05/07/2021, and not older cards from ***** and ******** Health, this entire situation could have been avoided.

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