ComplaintsforCoastal Administrative Services

• Initial Complaint

  04/22/2024

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  date of transaction ********. mandatory force paid business $1000.00 a month for 2 years totaling 24000..00. business committed to pay medical bill. business did not pay medical bill. business did not try to resolve rather delay, pass the buck, and finally refused. account number is *********

  Business response

  04/26/2024

  This is NOT a CAS complaint.  Member had a Health Plan that utilized 6 Degrees Healthcare as their network discount vendor.  CAS processes and pays the claims based off their determinations.  According to the notes listed below it appears there was an attempt to resolve the matter a year ago and member was unresponsive.  Unfortunately, members employer is out of business and CAS has no "administrative rights" to the plan.  here are the case notes from 6 Degrees Heatlh:

  5/16/2023 - Called provider ************ - Transaction ID - ***** - UC Health - G - ********* - spoke w/ ****** - provided member information she put me on hold to research account - ****** provided notes on account: on 03-03-2023 UC Health Billing spoke with member - they informed member this balance is in collections and offered to bill the plan, at first member stated he did not have subscriber ID but then accused the provider of double billing and hung up the phone. According to the notes on account, this claim was originally billed as a self paid discount as member did not provide information. I thanked rep and did not provide subscriber ID either since account notes that member is accusing the provider of double billing him.
  5/16/2023 - Called provider ************ - Transaction - ***** - spoke with rep/****** - this account was sent to collections on 3/9/2023 - this claim can no longer be billed to plan by UC Health - rep suggested the member contact collections agency directly to see if they would bill plan - but UC Health will no longer bill this plan since account was sent to collections already
  5/17/2023 - Email sent to member outlining what we would need in order to work the case
  5/18/2023 - PSS spoke to member and explained we need the Release of Information (ROI) completed before we can talk to the collections agency
  5/22/2023 - Emailed member again to remind him about the ROI
  5/26/2023 - Email to ******************* at CAS, with others copied, requesting CAS's help to get the claim
  5/26/2023 - Email response from ***** stating:  Good Morning *********, I reviewed the information I had with this case and found that the patient advocacy team had sent this response over to me back on 05.16.2023.  I relayed the request to the member to ***** us both access to the collections agency also on 05.16.2023 and he has not responded to me. I will send him over a follow up. Thank you,*******************
  And the final note is from 4/18/2024
  
  Member called in w/Collection *************** on the line. **** said they would be willing negotiate/settle on this balance. I advised that since 6DH never received/repriced this claim and the hospital is unwilling to rebill the claim,we're unable to assist. Additionally, the run out period for this plan ended 5/31/23.
  Member said they had been referred to us by CAS, so **** from collections agency said he would disconnect from phone call because member needs to work out to whom they will be dealing with first.
  Member asked me to remain on the line and to go on 3 way call with CAS rep, I agreed.
  
  We got ***** from CAS on the line. She reviewed notes from their end on this case and listened to my review of our notes. She spoke with her Account Manager (supervisor) and relayed that
  since group termed, and run out termed both CAS and 6DH "has no administrative rights" to work this issue. ***** referred member to work with their HR. Member stated the company is out of business. Member very frustrated, says they were in talks with CAS last year about this issue and kept getting referred to 6DH for help, but he was getting told by 6DH CAS had to help.
  ***** said they were never given authorization by member to speak with the ****************** thus legally not able to initiate any LOA. Member claims he had provided that, CAS rep says nothing in notes/on file. Member said he would speak with his attorneys and hung up.

• Initial Complaint

  04/08/2024

  Complaint Type:

  Service or Repair Issues

  Status:

  Unanswered

  More info

  CAS has not been working correctly for the last 6 weeks. E-filing is completely down for claims and I am having trouble getting medications approved for PO authorization. This has caused problems that have risked my health and well-being. Both mentally (many panic attacks and intrusive thoughts) and physically. I can't see my therapist and have had hypertension rebound from missing a dose of guanfacine (putting me in stroke territory)CAS has claims that go through First Choice and First Choice bills under Change Healthcare. Change Healthcare and United Healthcare (who owns Change) were hacked on the 21st of February and have not officially sent me correspondence about the issue or when or if it will be resolved.I have called many times and they have both told me it is a problem and have denied that it is a problem. Sometimes on the same day. I have not heard any public correspondence on this situation.

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