Complaints

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:03/20/2025

  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.

  For data Isight to stop processing our claims, we have no contract, we also dont agree to their rates and I cant stop them from processing also I cant explain to patients why their bill is so much higher than other patients with the same insurance company and the same coverage, there should be a lawsuit going against data Isight for processing these claims without a contract or agreement, the difference is so big and patients should not take this lose, this should not be legal without an agreement or contract with data Isight because we are defiantly collecting the different from patients, please give us the option of stopping data Isight from processing claims or give the subscriber the option to have Data Isight stop processing/pricing claims, it is the same as having a contracted rate with the option to balance bill, Not Fare

  Business Response

  Date: 03/21/2025

  Good Day,

  We are sorry to hear the patient is dissatisfied.  While we appreciate your inquiry, were unable to disclose any more information than what has been previously provided due to its confidential nature.  We are happy to discuss the matter further in a way that doesnt involve disclosing sensitive information.  Further questions concerning this matter should be addressed through established processes by the insurer. 

  Thank you again for your inquiry.

  Sincerely,

  Research and Disputes Department

• Initial Complaint

  Date:01/27/2025

  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 received out-of-network procedures and Data iSight priced them significantly lower than the amount Aetna quoted me prior to the procedure. ***** said the average price would be $2400 for my area but some how Data iSight's magical analytics, modules,and databases said it would only be $240 therefore Aetna only had to pay like $120 leaving me with the rest of the thousands of dollar bill because in reality the procedures costs a lot more than Data iSight configured. There is no way a colonoscopy and upper endoscopy in *************, ** costs $240! Data iSight, I want to see these analytics, modules,and databases that says that those procedures do!

  Business Response

  Date: 02/10/2025

  We are in receipt of your recent inquiry and thank you for contacting us.  The out of network claims involved were correctly sent to Data iSight by the insurer and followed proper protocol in our review services.  In follow up, the patient has been contacted and the processes,additional details involved concerning this matter as well as to the extent and scope Data iSight is able to assist in addressing the inquiries has been explained.  At this time,  should the patient have any additional questions concerning the benefit plan,  the insurer should be contacted directly to further assist as explained on the patients medical identification card.  Thank you again for reaching out to us on this matter. 
  
  Sincerely,
  
  Research & *******************

  Customer Answer

  Date: 02/21/2025

  They are actually making false advertisement claims on their website. This is what they say:

  Reimbursement for out-of-network
  medical bills using a
  PATENTED approach that is
  DEFENSIBLE, market
  TESTED, and completely
  TRANSPARENT to all parties.

  They are failing to be transparent. When I asked for the numbers for how they came up with the reimbursement amount they stated that they would not give them to me. By not providing information on how they come up with the figure is the opposite of being transparent. 

• Initial Complaint

  Date:01/10/2025

  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.

  Absolutely appalling, completely fraudulent and illegal practices, by both Data iSight and *****. I am a provider and payment for weekly psychotherapy was slashed from $241 to $90 once ***** started farming out claims to Data iSight for pricing, leaving my patients with the balance. They suggested that I accepted this reduced amount, which I did not, as I never even received an offer to negotiate pricing of the claim, let alone agree to anything. I called and emailed to advocate and was assured by Data iSight that my request to return claims to ***** for pricing would be honored once I provided them with the necessary claim information. I did so, heard nothing back, followed up by email, was told I'd receive a response in another 1-5 days, still heard nothing, then called to speak with someone directly. I was told by the *** that my case was closed about a week prior because they couldn't reach me by phone (I have no record of a call from them) nor by email (they had sent an email confirming receipt of the requested info at 12:46pm, I emailed back at 1:22pm, and I was told by the *** they had closed my case at 2:30pm). She then tells me that they are trained to close a case if they are contacted by a provider. And also that they are not allowed to return claims to *****, even though I was previously assured that this would be the outcome, plus this makes zero sense anyway. They deceptively shut providers out of the process so they can proceed with their unethical/illegal practices. It's beyond me how they are able to get away with this, but I am in consultation with an attorney, have been recording all phone calls, and I am p***ared to do what is necessary to put a stop to this.

  Business Response

  Date: 01/24/2025

  Thank you for your recent inquiry.  We investigated this matter and see that the out of network claims involving Data iSight followed proper protocol through our claim evaluation processes.  In follow up, Data iSight has been in contact with the healthcare provider and addressed concerns involving any claims involving Data iSight. Additionally, Data iSight shared additional information concerning the inquiry processes and resources available should the healthcare provider have any additional questions. 
  
  Thank you again for reaching out to us on this matter.
  
  Sincerely,
  
  Research & *******************

• Initial Complaint

  Date:08/20/2024

  Type:Order 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 am a healthcare provider in private practice and my business sends claims to insurance companies on patients' behalf. In submitting claims to ***** I began to receive notices that a company called Data iSight would be "negotiating" the reimbursable amount for services as paid out by *****. As I understand, typically the fee reimbursed by insurance companies is determined by a Usual and Customary amount and it is based on things like billing code (i.e. CPT code), zip code and the ******** fee schedule. In this example my patient's plan documents say Aetna is to pay 70% of what is Usual and Customary for the service I provided. However, with Data iSight intervening with my patient's claims, reimbursement rates were slashed more than 50% and my patient has been left with a unreasonably high balance for services despite the fact that the services are considered "covered" by the insurance company. Data iSight's involvement makes healthcare inaccessible to patients who work, who pay for their insurance, and submit claims in a timely fashion. Furthermore, my patient has contacted Data iSight to ask that they be removed from the case as their services were never requested by the patient. No attempt has been made by Data iSight to remove their services from the case and we are now in a lengthy appeal process that has gone on for six months with claims unpaid, totaling now $7000 just for my services alone. This issue has been documented similarly with Multiplan. -When calling ***** to resolve this issue, they suggest only that my team contact Data iSight to resolve it, who then tells my team to contact ***** again - there has been no attempt to resolve this issue so that this patient may continue to access care. -Other sources: 1. ******************************************************************************************************************************************** 2. ***********************************************************************************

  Business Response

  Date: 08/30/2024

  Thank you for your recent inquiry.  In follow up, Data iSight has been in contact with the healthcare provider to address concerns involving any claims involving Data iSight.  Additionally, Data iSight has been in contact with the healthcare providers office coordinator.  We look forward to discussing the processes involving these out of network claims with the healthcare provider when they are available and back in the office.
  
  Sincerely,
  
  Research & *******************

  Customer Answer

  Date: 09/04/2024

  I am rejecting this response because:  The call between my office and data isight's representative only served to reiterate that they do not adjudicate claims and that they cannot adjust claims, they can only set rates. The representative said that they are hired by the insurance organization and do not choose to be a part of the claims process which is an inaccurate representation of my experience. They are adjudicating claims and refusing to allow an appeals process. 
  
  

  Business Response

  Date: 09/11/2024

  Thank you for your additional correspondence.  After we spoke with the provider office last, a follow up call with the healthcare provider was made concerning the latest concerns.  Additional clarification was explained for the out of network claims in questions. Based on review, we find that proper protocol was followed concerning repricing services and out of network claims submitted to Data iSight from the insurer.Additionally, information involving the appeal process was explained should the provider wish to pursue directly with the insurer.  We are sorry to learn the provider is dissatisfied and we welcome the provider to contact us directly for questions or information involving Data iSights repricing services.

  Thank you for your assistance in this matter.
  
  Sincerely,
  
  Research & Disputes Department

  Customer Answer

  Date: 09/12/2024

  I am rejecting this response because:  the business has made no good faith effort to respond to my or my patients request to decline their services. Both myself and my patient have contacted this business and the payer multiple times to decline Data iSights services and have been provided no recourse to do so. The business has called me only to explain what their services are, and have offered no information as to how to decline their services. 

• Initial Complaint

  Date:04/02/2024

  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.

  Data iSIght is a third party company hired by insurance companies to negotiate service rates with out of pocket medical providers. However, they advised my insurance provider, Aetna, to reduce the allowed billable amount from $250 to $149.50 WITHOUT contacting my provider first.

  Business Response

  Date: 04/11/2024

  Thank you for your recent inquiry.  We have received a request through the insurers standard appeal process to assist in
  the explanation of an out of network claim that involved Data iSight.  On behalf of the patient, Data iSight has contacted the healthcare professional and explained the process involving the claim in question and has made amiable resolution.  Additionally, Data iSight followed up with the patient and provided an explanation on the review completed and outcome of
  the resolution of this matter.  We have also shared resources available for addressing any future questions.

  Sincerely,

  Research and Disputes Department

  Customer Answer

  Date: 04/12/2024

  I am rejecting this response because:   The agent I spoke to on the phone was extremely nice and while she said Data iSight would resubmit the last two bills to Aetna for their consideration, she was unable to provide me with any assurances going forward that this will not continue to happen,  Unless I misunderstood, she implied that each bill is considered separately so this can continue with each and every bill.  I have spent two hours on the phone trying to deal with two bills and I cannot keep doing this.  And the agent could not explain to me in terms I could understand how this process works, i.e. how is a data company is qualified to assess the value of my provider's care.  

  Business Response

  Date: 04/19/2024

  Thank you for the additional feedback.  Data iSight did follow up with the patient and addressed remaining concerns.  Further information was explained concerning out-of-network claims that *** involve Data iSight and the insurers appeal process to give attention to these matters.  Within the insurers appeal process and when available, steps were explained on how to contact Data iSight for assistance concerning any issues going forward.  Thank you for your assistance in this matter.
  
  Sincerely,
  
  Research and *******************

• Initial Complaint

  Date:10/16/2023

  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.

  Data isight is nothing, but they just adjust the payments from the original insurance payment WITHOUT my agreement, EVEN they do negotiate the reimbursement. We never get it and it is a ridiculous situation. why do all the 3rd parties get involved between medical providers and insurance companies, There are NOT single benefits for clients and small medical business owners. Please The Federal or state should check the issue for all medical providers who are taking care of patients well and clients who pay huge amounts for their medical condition. To be honest, i feel like they are just thefts nothing more nothing less.

  Business Response

  Date: 10/30/2023

  We are in receipt of your recent inquiry; however, we are unable to identify information related to this matter.  We have contacted the daytime phone number provided in this inquiry.  When additional information is received, we will be glad to assist in any way that we are able.
  
  Sincerely,
  
  *************************

• Initial Complaint

  Date:09/22/2023

  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.

  Data iSight is an absolute sham and UMR Healthcare should be ashamed of themselves for using such a company. In claims I have going back to Jan 16th, 2023, they have created such large "discounts" that I cannot make my OOP, despite having paid well over 5k with another 2k current claims processing. They have made is that UMR doesn't have to pay the provider a proper amount, and and I cannot get credit for the money I've actually paid. For example, I pay my provider over $150 per session before I hit my deductible. In 2020, 2021, and 2022, my EOB and accumulators actually reflected what I paid. This year, my EOB had me paying under $120, so I didn't credit for the full amount I paid. This is not a provider issue, my provider and I have an excellent relationship build on 3 years of trust. They were the ones who flagged the use of Data iSight to me and they are also being screwed out by UMR and Data iSight. I would like to all of my claims reprocessed at the agreed upon discounts, and to have my accumulators reflect what I actually paid.

  Business Response

  Date: 10/02/2023

  We are sorry to hear of your frustration.  Out of network claims eligible for Data iSight repricing services follow standard methodology claim evaluation processes in determining fair and appropriate reimbursement determinations when no other rate is available. A provider may set their own fees at whatever level they feel is fair for a service or supply, but the payor is obligated to seek fair alternate pricing when no other rate is available.  We would be glad to assist providing any explanation on the methodology utilized for any claims with questions; however, members must follow appeal instructions outlined on the member's medical identification card and information about out of network claims as communicated through explanation of benefits statements from the insurer to the member.  If you believe we can be of any assistance,please contact Data iSights customer service or the insurers member services department.  A representative will be happy to assist you.  Thank you for your assistance in this matter.
  
  Sincerely,
  *************************

• Initial Complaint

  Date:08/30/2023

  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.

  REPRICING CLAIMS... I am a Aetna member. I use an Out of Network provider, and once I reach my deductible, Aetna will cover 70% of my cost and I am responsible for the other 30%. Everything was fine with this provider for almost 2 years. All of a sudden, WITHOUT any notification to myself or my ******* ***** "changed" the pricing of what they would cover. My doctor did not know this for months and once they discovered the change, they let me know and now I have a large outstanding bill. I called Aetna and turns out, they send all their Out of Network claims to a 3rd party company called DATA iSIGHT. Data iSight then REPRICES the claim. Without any notifications, approval or contract with the provider. For the past 10 months I have been paying 70% and Aetna now only pays 30%. Data iSight completely reversed my coverage pricing. My insurance policy clearly states that "once the deductible is met, Aetna will pay 70% per visit." ***** tells me to talk to Data iSight and Data iSight tells me they only process claims but have no access to my Aetna claims directly. What gives Data iSight the right to UNDERPRICE and REPRICE claims that clearly are covered by your insurance policy? Nothing has changed with what is reasonable & customary, location/time. This was done without any update or notification. This is FRAUD and Data iSight is fabricating rates. All one has to do is ****** the company and see the numerous lawsuits. I would like all my claims pulled back and reprocessed for the CORRECT price of 70% Aetna and 30% myself. I work hard to meet my deductible and pay my insurance premium. This is awful and people are getting taken advantage of while Data iSight and Aetna make money off out backs.

  Customer Answer

  Date: 09/05/2023

  Please see the change in numbers on my insurance claims from August 2022 to November 2022.  Why did Data iSight make this change during my policy year?  There was NO NOTIFICATION to myself or my doctor.  NO DISCOUNTS were discussed or accepted from my provider.  Notice how my Aetna policy covered 70% (after met deductible) and flipped the next claim to myself having to cover 70% and Aetna only paying 30%.  Again... No Discounts were discussed, approved or accepted to make this change.

  Customer Answer

  Date: 09/09/2023

  After careful examination of my Aetna EOB's - I can see that Data iSight changed the "negotiated price" or "discount" in the month of November 2022.  They did this with NO notification.  My negotiated price went up by $30.00.  They also changed the amount that would go towards by deductible.  I 2022 - $77.78 of the $85 charge went to my *** deductible.  In 2023 - $41.42 of the $95 charge went to my *** Deductible.  Interesting fact, if I sent Aetna a Super Bill from a *** provider - they immediately send me a check for 70%.  If the *** claim is sent from the provider directly - it is sent to Data iSight and REPRICED and processed at the wrong rate.  It just gets worse and worse....

  Business Response

  Date: 09/11/2023

  Thank you for reaching out to us concerning a recent inquiry and claims involving Data iSight.  Upon review, the out of network claims eligible for Data iSight services were correctly sent to Data iSight by the insurance carrier and reviewed by Data iSight to calculate fair and appropriate amounts in the absence of a contract or other pre-established rates.  Data iSight uses various analytics, modules,and databases to ensure appropriate healthcare reimbursement determinations are made for a medical occurrence at the specific claim level.  Pricing amounts may increase or decrease because of updates within these datasets and as a result, a change in the recommended allowed amounts occurred between certain dates of services.  Data iSight has been in contact with the member regarding this matter and has received additional information for review.  On behalf of the member, Data iSight will be contacting the Provider to explain the pricing methodology and attempt to minimize balance billing.  Data iSight will then follow up with the member to help explain the review process, results and assist to the extent we are able.  Once Data iSight has completed handling on the additional information recently received, should there be questions concerning patients benefit plans, benefit questions can be directed to the member services number with the insurer listed on the back of the members medical identification card as Data iSight is not a payor.
  
   Thank you again for reaching out to us.
  
  Sincerely,
  
  *************************

  Customer Answer

  Date: 09/13/2023

  I am rejecting this response because:   **** did call me and spend 15 minutes explaining the special "methodology" Data iSight uses to REPRICE the claims.  He said they are a "repricing service" and they evaluate the claim codes, using relative value units and geographic area and then multiplies that using a conversion factor to determine the amount they will reprice the claim.  They then send the claim to Aetna for processing  **** said that during October 2022,  when I happened to have no claims - Data iSight went through a ************ Update" and that might be why my claim pricing changed. He never said what the update actually did but used the term National Median Reimbursement Data.  I am required to send them EVERY claim in question to look at, which is 56 claims.  They will then send them to a "Team of Associates" to look over and contact my provider to "negotiate" an amount they are OK accepting.  Why should my doctor have to negotiate his prices?  This was a conversation where **** never was able to answer my question - What Changed to Reprice my claims to me being the one to pay 70% after my met deductible.  Data iSIght changes the amount Aetna pays to an artificially low number WITHOUT notification to the Aetna member or provider.  They fabricate rates and try to pass them off as reasonable using big words like methodology and conversion units but never explain why they made these changes.  I am currently speaking to investigative reporters and my husband has connected with his HR who will be in contact with ******  Data iSight should be shutdown. They are taking advantage of insurance members and providers by underpaying claims.  Nothing has been solved.  Nothing was accepted on my end.

  Business Response

  Date: 09/22/2023

  We have been in contact with the provider to discuss the additional claims involving reviews completed by Data iSight.  Data iSight is a reference-based pricing service for out of network claims eligible for Data iSight services.  A provider may set their own fees at whatever level they feel is fair for a service or supply, but the payor is obligated to seek fair alternate pricing when no other rate is available. These claims involved a non-participating provider and were correctly reviewed and followed protocol through our standard claim evaluation processes.  The Data iSight methodology utilizes an enormous swath of various industry standard datasets in determining recommendations.  Reimbursement recommendations generated by Data iSight are fair, consistent, and widely accepted.  Included within our standard line-item bill review services are regular routine updates within these datasets.  As a result of updates that included categorization aligning, a change in the reimbursement recommendation involving claims between dates of services August and November occurred.  These updates ensure appropriate healthcare reimbursement determinations are made. The out of network provider rejected these adjusted rates and when that happened, patient advocacy services were applied through Data iSight to contact the Provider on behalf of the patient to discuss the Data iSight methodology,determine adjustments and or an attempt to minimize balance billing with a negotiation solution. Unfortunately, after following up with the *************** and discussions, we have been unable to reach a mutually amicable adjustment or negotiated solution with the provider involving these claims.  Data iSight has as well reached back out to the patient to go over the results of our review and efforts to resolve.  As the Provider has not elected to make an adjustment on these claims and the insurer has adopted Data iSights methodology for these out of network medical services, additional questions or information about benefits would be appropriate for the patient to contact the insurers member services department listed on the back of the member's medical identification card.  We would be glad to assist providing any further explanation on the methodology utilized for any claims with questions. If you believe we can be of any assistance, please contact Data iSights customer service or appeal through the payors review portal.  Thank you for your assistance in this matter.
  
  Sincerely,
  
  **********************;  

  Customer Answer

  Date: 09/29/2023

  I am rejecting this response because:   Data iSight tried to negotiate a LOWER visit fee with my provider at a 40% decrease in what they charge.  They declined.  Making their $95 per visit fee to $41.64.  Leaving either the provider or the patient with the remaining $53.36.  They are providing Aetna with a HUGE discount and leaving ME with the leftover cost.  The reason?  My provider will not negotiate down their fees.  The repricing of our claims started unexpectedly back in November 2022.  Data iSight ONLY attempted to negotiate with my provider AFTER we noticed the billing discrepancies in May 2023.  This repricing was all done without notification my myself or my provider back in November 2022.  The way the numbers work after the repricing is, because Data iSight decided that my provider visit was only worth $41.64 - my Aetna plan will only cover 70% of that amount, not the full $95.  So they make it seems like Aetna is following the benefits on our policy by covering 70% after our out of network deductible is met.  But it reality, that is not true and a scam. The leftover $53.36 is *****'s discount but someone has to pay it.  And that person is me.  ******************* member they are suppose to support.   What changed?  Data iSight claims they use "fair market value" and a system data update changed all the prices.  They use conversion factor and relative market values but do NOT say exactly what changed to justify a 40% decrease.  They claim it is my providers fault for not lowering his fees and negotiating with them.  The simple fact is Unless a provider agrees to a negotiated rate in writing, the insurance carriers are required by law to process a patients claims according to their benefits, not by a random third-party pricing methodology.  I do not accept Data iSights response.  

• Initial Complaint

  Date:08/07/2023

  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 seeing a medical provider for years. He does not take insurance and thus is not in-network. When I submitted claims through my employers UHC/UMR plan, I was told that a recent claim would be reimbursed to me at effectively 40% when my plan is supposed to reimburse 60% (after deductible). When I asked why, UHC/UMR said its because their pricing **** found some alleged contract between my provider and Data iSight/multiplan with some allegedly negotiated discount (that is 35% lower than what my provider bills me). My provider says he has never heard of this Data iSight or entered any contract with them. I had never heard of them either. If a provider does not accept insurance and patients pay the amount billed, as in my case, there is no incentive for that provider to supposedly negotiate some discount as alleged. This Data iSight multiplan scheme (potentially in concert with insurance cos or administrators) is purposely opaque and likely fraudulent and scamming patients out of legitimate reimbursements.

  Business Response

  Date: 08/25/2023

  Thank you for your recent inquiry.  Data iSight has been in contact with *************************** to discuss the out of network claims in question and the review process involving claims when there is no contract or other pre-established amounts.  We see that the out of network claims followed protocol through our claim evaluation processes.  Additionally, Data iSight is attempting to discuss this matter on behalf of ******* with the healthcare provider to assist to the extent we are able.
  
  Thank you for reaching out to us.
  
  Sincerely,
  *************************

  Customer Answer

  Date: 08/25/2023

  I am rejecting this response because:   Data iSight has contacted me, attempting to explain their pricing methodology, which they describe as fair and reasonable, even though it is not. This methodology would cut the providers fee by more than half (meaning a $105 per session cost for a therapist in *************) and result in my being reimbursed less than half of the expense, even though my insurance is supposed to pay 60% on out of network claims. I have requested that the company contact the insurance company or administrator to state that their suggested discount is neither applicable nor appropriate so that I can be fairly reimbursed. Nothing about this experience has inspired confidence or goodwill; it is clear that Data iSight operates for the benefit of insurance companies profits at the expense of providers and/or patients. Their claim to act as an advocate for patients is a smokescreen for their attempt to deprive providers even if reasonable fees and, in this instance, strain the provider-patient relationship. 

  Business Response

  Date: 08/29/2023

  Thank you for the additional correspondence and latest concerns.  The out of network claims were correctly sent to Data iSight and appropriately reviewed. On behalf of the patient, attempts were made to discuss this matter with the provider.; however, unfortunately we have been unable to reach the provider.  We have since made follow up with the member concerning this matter and steps concerning contact with the carrier that would be appropriate for other questions about the claims in question.  Should further questions concerning the methodology utilized for any claims involving Data iSight, we would be glad to assist.  If you believe I can be of any assistance when you submit an inquiry or appeal through the payors review protocol, or contact Data iSights customer service, please ask for me.
  
  Thank you for your assistance in this matter.
  
  Sincerely,
  
  *************************

  Customer Answer

  Date: 08/30/2023

  The company attempted to contact my provider to try to get him to accept less than half his fees, which are reasonable for a therapist in *** ($225 per session). For late 2022, the companys methodology would apply a discount of over $120 and, for early 2023, the discount is almost $130which defies reason and macro-economic trends. The company claims to advocate for patients, but in fact is just trying to save the insurance companies money and line its own pockets, at the expense of patients and providers. The fact that DiS does not actually have any contractual obligations to patients underscores this posture. 

  Customer Answer

  Date: 09/06/2023

  I am rejecting this response because:   

  The company attempted to contact my provider to try to get him to accept less than half his fees, which are reasonable for a therapist in *** ($225 per session). For late 2022, the companys methodology would apply a discount of over $120 and, for early 2023, the discount is almost $130which defies reason and macro-economic trends. The company claims to advocate for patients, but in fact is just trying to save the insurance companies money and line its own pockets, at the expense of patients and providers. The fact that DiS does not actually have any contractual obligations to patients underscores this posture. 

• Initial Complaint

  Date:06/26/2023

  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.

  Data iSight claims to negotiate with out of network healthcare providers, however they do not give healthcare providers an opportunity to negotiate claims. I have called both the insurance company (Meritain Health) and Data iSight multiple times and spent countless hours going back and forth with rude customer service representatives that claim they cannot help. The insurance company claims it is a Data iSight issue and that they should be negotiating. They claim that the amount that they get has been approved via provider, however I have NEVER approved any discounted rate. Their rates are horrendous and there is no way for them to be contested. I was told by one representative to file a report to get it escalated and say to rerun the amount as I don't negotiate. The supervisor said they didn't do that and tough. This company is the most unprofessional company I have ever had the displeasure of working with and should be investigated for fraud (claiming that the amounts are negotiated without reaching out to providers) and shut down. At this point, I will have to stop seeing client's that have insurance working with Data iSight as I'm not getting paid.

  Business Response

  Date: 06/30/2023

  We are in receipt of the recent inquiry and were sorry to hear of your frustration.  We contacted the provider representative today and we were able to address concerns and further explain the out of network claims involving Data iSight followed protocol through our claim evaluation processes.  The provider will be following up with us on additional information concerning this matter and we are happy to assist to the extent we are able.
  
  Thank you for bringing this matter to our attention.
  
  Sincerely,
  
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