ComplaintsforEastside Integrated Primary Care

• Initial Complaint

  08/07/2024

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  I am reporting a *********** provider for deception, Ahdut, C.a., Amira J. and all the providers at Eastside Integrated Primary Care. They have the option of billing Optum where the *** would have a $10 co-pay or United Healthcare where the *** would incorrectly have a $65 co-pay.I had to pay upfront $180 for each IV treatment, five at a time. So twice I paid them $900, total $1,800. They agreed to take the $10 co-pay and wave the $55 to bill UHC, because they say that Optum doesnt pay them. They also agreed to wave their $25 admin fee. All of this was decided before I began treatment. After a few treatments I asked to have an additional treatment. I suffer from fatigue and could not come in on another day and they agreed to do the additional treatment on the same day and bill insurance the day after with the price that was written on a yellow sticky note. It said my part of the 6 treatments was $60, which was my $10 co-pay.Half of my appointments, they did not have the supplies. Then they started changing the prices after I had had treatment. Going to my appointments became so antagonistic, that I stopped treatments with my last $180 prepay unused. I only went to five of the additional treatments. One of the changes they made was that if I wanted the additional treatment on the same day, they would charge me the $25. I think they did it just to be mean. It was always this way, it was like walking into crazy-land. So many times my *** would start out with We have a situation, where they didnt have supplies or they were changing prices.Then they charged my credit card on-file $90 without telling me. $65 + $25, on the last IV treatment I went to. It took several phone calls to get this reversed and I had to block them from charging on my credit card. This left $180 prepaid less $50 of the additional treatments that they owe me, $130. Instead they have decided to bill me $325. And definitely they dont want to give me back the $130.

  Business response

  08/08/2024

  Dear *******,

  EIPC has provided you the information we have received from you insurance company. Your insurance sent us an original explanation of benefits and then sent updated explanations of benefits months after your appointments stating that they miscalculated their payments. We received this information only last week. You have been in communication with our office manager and billing office all along and spoke to ******** about this yesterday. We are required to collect your copay and deductible/coinsurance portions deemed by your insurance company. 
  Unfortunately there was a shortage of IV vitamin C from our suppliers for a time,  and this is why my office provided you with an IV one week that was not quite your full concentration of vitamin C. We provided this to you complimentary as a courtesy.  We were very candid with you as to why we didnt have your full dose and provided you with an option that day. 

  You are still welcome to come in for a 6th IV vitamin C treatment. As you know, IV supplies are expensive. You specifically requested that my clinic offer you a discount which we decided to heavily discount the package for you. Unfortunately we dont have any discretion over what your copay, deductible and consonance is.  That is a contract between you and your insurance company. 

  Please contact my office and we are happy to work with you on any additional balance you may owe and to help clarify any questions. I know we have reached out to your insurance several times on your behalf and are willing to do this again for you if it appears that they are not processing the claims correctly. 
  
  Sincerely,

  Dr. Ahdut

  Customer response

  08/08/2024

   
  Complaint: 22109033
  
  I am rejecting this response because:

  Im sorry you have been misinformed, twice I came in and you did not have supplies, four times my appointments were canceled by you because you didnt have supplies. Once because your credit card bounced. You have to take responsibility for the services promised. I provided you with two other suppliers (something you should have done), finally you used one of the suppliers I provided so I could get treatment. But I never received the consecutive treatment required.
  
  Unfortunately, you have made at least two other mistakes. I have never met you and most of the appointments were billed as you being the provider: Billing under another provider's name and NPI can also violate commercial payer contracts and include criminal liability under the federal healthcare fraud statute for claims submitted either to the government or to private insurance providers.
  
  As you know I brought this up with billing before treatment and in writing when you changed the billing provider to another provider. I was told she was in-network, but now, four months after my treatment began and one month after I ended it due to the office hostility, lack of supplies  and your constant changing of prices after service. This illegal action is explained in: ***************************************************************************************: An in-network provider that uses an out of network provider can only collect the in-network co-payment. For four months you claimed you were in-network with my plan and I have sent you documentation proving that. Im shocked you are not embarrassed at the very least.

  Sincerely,
  
  *************************************

  Business response

  08/17/2024

  Hi *******,

  Your appointments were rescheduled because we did not receive the Vitamin C we ordered from the pharmacy timely. I have messages within the portal that provide a paper trail showing staff contacting the pharmacy to follow up on the medication that we purchased and we were charged for but still had not received. This was NOT an oversight on the part of Eastside Integrated Primary Care. We did everything we could during that time to remedy the supply issue - we ordered timely and followed up with the pharmacy when we didn't receive our order in the timeframe expected. My staff being proactive contacted you to reschedule your appointment. 

  I'm not sure what you are referring to as "credit card bounced". or "consecutive treatment required". You purchased 2 packages of 5 infusion supplies and received 10 infusions. We offered you a complimentary infusion on the day that you came in and we did not have as much Vitamin C as you wanted. You still received 13 grams of vitamin C that day rather than the 25 grams you had hoped for. I don't know any other clinic that would give a patient a free infusion due to an inventory shortage. That was a courtesy on our part and was not a mandatory courtesy. 

  Regarding the term "billing provider", Dr. ***** was my medical resident through May of 2024. I oversaw and cosigned on all of her notes and treatments. Under the "incident to" rules, non-credentialed physicians' services can be billed under a credentialed physician's National Provider Identifier (NPI) when the credentialed provider directly supervises the non-credentialed provider. Dr. ******* credentialing contract was completed in late May with your insurance provider, and her services since have been billed under her NPI. We are more than happy to send corrected claims for any services billed under my NPI and send them under Dr. ******* NPI during that time she was non-credentialed if you would prefer this. Discussion on the billing provider was also explained to you prior to those visits and we have this documented in a text exchange between you and our billing office. Our office has been VERY transparent with you from the beginning of your care. 

  You and I both know that you were well aware of your network situation and co-pay early on. You even had the audacity to ask our billing department to bill higher codes than necessary stating that this way, you would not have to pay your portion. We informed you that we WOULD NOT do this as it would be committing insurance fraud. You went back-and-forth with ******** through text and email and she spoke with your insurance company multiple times. We billed your insurance company as we were meant to and according to the representatives information on the phone. We also wrote off the additional $50 of your $60 copay for several of your visits. We have 2 call reference numbers from conversations with your insurance provider instructing our office to bill your visits to United Healthcare payer ID *****. We also did try to ******************* ID ***** (Optum) unsuccessfully as they returned the claims and again told us to ******************* ID *****. 
  
  You are making accusations that our team intentionally deceived you or ****** you , but that is not the case at all. The billing department has been in active communication with you all along, and you have asked us to bill different ways and reach out to your insurance on your behalf. At this point, we recommend that you discuss your insurance contract with your insurance company moving forward. 
  

  Dr. Ahdut

• Initial Complaint

  02/01/2023

  Complaint Type:

  Delivery Issues

  Status:

  Answered

  More info

  I went for annual checkup with **********************. She pulled up my insurance and informed me only the Vitamin D lab was not covered, which I paid out-of-pocket that day. Later received bills from LabCorp with 6 out of 10 procedures denied because they were not considered preventative. Contacted my insurance, Aetna, multiple times and asked the provider to correct the code. Received the updated bill with 4 of the procedures still not covered under preventative. I spoke with the Aetna representative and was informed all the diagnosis used preventative codes but the procedure codes were not preventative. It meant the doctor ordered extra labs that were unrelated to my visit, which I didn't authorize. I think the doctor provided me with the wrong information during my visit. It's also unreasonable that more than half of the labs ordered for annual preventative checkup were not preventative.

  Business response

  02/02/2023

  Hello,

  Im so sorry for any misunderstanding. We are a providers office and we dont have any information as to what your specific insurance plan is or what your plan covers  as preventative bloodwork. That information is between you and your insurance company and it is your responsibility to know your plan.. Our job as providers is to give you the best care that we can.  *********** was informing you that you could choose to pay the client ******************* at time of service for vitamin D  because we find that the vitamin D t test is not generally covered by insurance. Outside of this test, your annual blood work which we consider preventive may still be subject to a deductible depending on your specific plan. Im so sorry for any confusion relating to you insurance plan itself. I would encourage you to contact your insurance customer service agent so that you can better understand your plan as to avoid confusion for the future. They should be able to tell you what tests are covered non subject to your deductible. 
  

  sincerely,

  Eastside Integrated Primary Care

  Customer response

  02/02/2023

   
  Complaint: 18969057
  
  I am rejecting this response because:

  Preventive services are written in the *** law. As a provider, it's your responsibility to know what is preventive and what is not. You are also an in-network provider with my insurance, so you should have those information better than the patients, otherwise how do you know what billing codes to use. The fact that the doctor pulled up my insurance and intendedly provided me the misinformation. I don't think it's my responsibility because the errors are resulted from your insufficient knowledge and malpractice. 

  
  Sincerely,
  
  *************

  Business response

  02/17/2023

  Hello,

  Again I am sorry for any misunderstanding. Unfortunately, the Affordable Healthcare Act does not specify which specific labs are covered as preventative. This is dictated by your insurance company and specific plan which we don't have knowledge of. I have attached the link regarding the *** in **************** for your convenience. ************************************************************************;

  We hope that this is helpful and will clear up any confusion for the future. 

   

  Eastside Integrated Primary Care 

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