Complaints

• Initial Complaint

  11/30/2024

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  I was referred to a GI doctor by my PCP both are within my network. I received an approval from the medical group. The doctor sent my biopsy Metroplex for testing and they continue to bill the wrong insurance office and submit wrong insurance numbers. The following are the chronological notes of events:12/21/2023: Approved by my medical group for endoscopy and colonoscopy procedure.1/19/2024: Had procedure done in **********, ** by my GI Dr. ******* *******.2/7/2024: Rec'd 1st bill from Informed Diagnostics Metroplex Pathology Assoc. I called my insurance company *********** of CA and they informed me that this billed as Blue Shield of TX which is out of state and not covered. But I had the procedure at the location approved by my medical group. I called Metroplex the subscriber number was incorrect. I provided the correct number.4/1/2024: Rec'd another bill dated 3/20/2024. I called Metroplex spoke to ***** and they still had the wrong subscriber number.5/8/2024: Rec'd another bill dated 4/19/2024: Called Metroplex spoke to ******. He said he will re-submit indicating Blue Shield of CA not *****. Reprocess takes ***** days.6/2024: Rec'd another bill dated 6/14/2024 with note: "N450-Covered only wh en performed by primary treating physician or the designee". Mailed Metroplex copy of my approval letter (attached page 2).9/1/2024: Rec'd another bill dated 7/28/2024. Called Metroplex spoke with **** in Collections and ***** in Billing. Discovered the Group number was wrong - there was a zero missing. ***** corrected the number and told me they will contact me if they have questions.11/27/2024: Rec'd a collections letter. California No Surprise Act

  Business response

  12/17/2024

  We received the patient's specimen from date of service on 1/19/2024. Insurance that we received came back as inactive. Patient was mailed a letter on 2/7/24 informing them we were missing information to bill their insurance and to please contact us. Patient was issued a statement on 3/29/24. Patient called our billing department on 4/1/24 to provide correct insurance information. Insurance was billed on 4/2/2024. On 5/8/24, patient called back and was advised of balance and pending with insurance. On 5/23/24, received denial from patients' insurance for Non covered charges. Patient was mailed statements on 5/24/24, 6/23/24 and 7/28/24. After no communication from the patient their account turned over to collections on 9/5/24. Patient called us on 9/16/24 upset they had turned over to collections, provided insurance information as well as an authorization. On 11/11/2024, patient account was reviewed and determined the insurance processed the claim out of network. Account was adjusted to match in-network benefits and adjusted in full. There is no balance remaining from the patient. Additionally, the claim was filed to BCBS TX instead of BCBS CA due to where the pathology rendering was performed. In this case the specimen was received and read in ******

  I was advised by our collection agency on 12/12/24 that updated activity files had not been received from our billing vendor since mid-November that could have impacted the collection agency to continue their collection efforts. I have reached out to our collection agency to ensure the patient account is closed and to send the patient a closure letter as well. 

• Initial Complaint

  05/18/2023

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  I had a test done on 4/4/23. I received a letter on 4/29/23 stating that I was being turned over to collections by this company. First, I never even knew I owed it until I got this notice. Second, it has been less than a month since I had the test done. This is ridiculous. If this hurts my great credit, I will have my lawyer get involved! I al aye pay my bills in time (if I know I owe them) this the great credit score.

  Business response

  06/01/2023

  Hello,

  I can not find that our company, Inform Diagnostics, submitted this patient to collections.  The patient Date of Service is 04/04/2023 and claim was billed to the patient's insurance on 04/12/2023.  Insurance processed and paid the claim with no patient responsibility on 04/19.  I have searched for other Dates of Service for this patient with no success.  I have also attempted to reach out to the patient and left a voicemail on 06/01 to try to obtain more details that *** help ** resolve.  At this time I do not believe our company sent this patient any statements or to collections unless we can gather more information to research further. 

  Business response

  06/05/2023

  After further review, we were able to identify the correct account sent to collections.  The account sent to collections was for Date of Service of 12/22/2022. Statements were sent to the patient on 01/07/2023, 02/11/2023 & 03/18/2023 in the amount of $158.17.  A partial payment was made in the amount of $25.00 but the remaining balance of $133.17 was never paid on and was sent over to the collection agency in April 2023.

*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. ↩