Complaints

• Initial Complaint

  04/04/2023

  Complaint Type:

  Billing Issues

  Status:

  Resolved

  More info

  Date of transaction: November 2022 Patient account number is: ******** In November 2022 I was seen at Cardiology Associates located at ****************************** Ste.D,330. ****** **. *****. On January 8th, 2023, I received a letter in the mail from this business stating that I owed a balance of $154 to be paid in full. On January 12th, 2023, a payment in the amount of $77 was made to a person at the business. Another payment was made on January the 23rd 2023 in the amount of $77 with my ATM card and at that time, attempted to explain to them that I am a veteran rated at 100% disability and therefore do not owe any money for medical services rendered. In all the years I have been a veteran, never once have I had to pay any medical expenses. Several attempts on my part were made utilizing the veteran's administration system to get this problem resolved to no avail. All I've been given is the runaround and more bills. The only reason I paid the two times is because I do not want to ruin my credit. However, as aforementioned, I still believe that I am within my rights and should not have to pay this bill. I even went so far as to ask to speak with the billing person and they seem to not want to assist me in any way. For those that are unaware, any time a veteran cannot be seen at a veteran's hospital or clinic they are outsourced through a company called Optum ****************** System. Sometimes the VA changes companies that they utilize but it always works the same way. This company works in conjunction with the VA to help facilitate patients and ensure they are seen by the specialist they need and that most or all medical expenses are paid in full. There has been NO attempt on the companys behalf to look into the matter of this bill. I want this clinic off my back, and I want the bills to stop. I also am seeking $154 returned to the debit card that I used when making the two payments that I was fraudulently charged.

  Business response

  04/24/2023

  Dear BBB,

  The patients first visit with ** was on 2/14/22.  His VA *************** plan was verified on that date of service.  Per the VAs website - All non-urgent and non-emergent care requires authorization (referral) from VA in advance.  The patient had authorization when he came to us and until the referral expired on 8/13/22 (6 months after it was issued).  All claims submitted prior to 8/13/22 were paid by insurance and the contractual portions were adjusted off.  The patient did not have to pay out-of-pocket for any charges during this time.
  
  Unfortunately, the claim for the patients 9/27/22 visit was denied due to lack of an active referral.  Our staff contacted Optum who verified the denial was for no referral.  On 11/28/22, the patient called regarding his bill from us and was provided with the information from Optum that there was no active referral on file.  He agreed to contact the VA, but asked to be transferred to our pacemaker clinic regarding his device monitoring.  The patient called back that same afternoon and communicated that he would like our physicians to continue his device monitoring.  Our staff explained that we had talked with the VA and that he needed to contact them to get a retro authorization for the 9/27/22 date of service and for any future dates of service.  Patient stated he would do what he could to get the prior authorization. 
  
  On 12/05/22, the VA was again called and confirmed the patients dates of service and stated his referral had expired and that he was no longer covered for our services until he obtained another referral.  The patients claim for his 11/28/22 service was rejected by Optum with the explanation the referral had expired on 8/13/22.  On 1/11/23, the patient called again to question his bill.  Our staff explained he was required to obtain a new referral since his last referral had expired.  He stated he would contact the VA and call us back.  On 1/23/23, the patient came into the office and stated that when he checked in, he was not told his referral had expired and denied knowing he needed a referral.  The patient paid his bill and stated he would not be back.  He also stated he would not get a referral and that vets are treated badly.  His device was monitored again on 3/01/23 and we received another denial from VA Optum for no referral.
  
  Oftentimes, patients dont understand the importance of obtaining prior authorization or referrals from their insurance company or from their primary treating physician.  Our staff worked with this patient and appeared to send the consistent message that a new referral was required for the September visit and any future visits.  Per the representative at Optum and this latest denial, it doesnt appear the patient contacted them. 

  We regret that patients have to deal with these requirements of their insurance companies and the VA.  We understand the challenges they present, many times just understanding what is needed to get treatment paid for.  If we do not abide by these authorization and referrals requirements, we are not paid for our services.  ************* companies and the VA place the responsibility on the patient for handling many of these responsibilities.

  After considering the questions raised and the possibility the patient did not understand his responsibilities to obtain a new authorization for further treatment, we have decided we will write off and refund the charges related to the patient's two payments totaling $154 and will write off the new charge from March 1st as an act of good faith and for a veteran of the U.S. armed forces.  He should contact *****************************, our chief financial officer ***** at ************ to request the refund.  She is aware of this case and the exception we will make and will be glad to work with the patient to credit his debit card or issue a refund check.

  The patient, should he desire to continue seeing our physicians and seeking services at our offices will need to have a referral and authorization going forward in order to avoid further charges that he may be individually responsible for.  He is welcome to contact our office and we will assist in any way we can and help with any further questions.  We hope this resolves this issue and that our actions of good faith are received favorably by the patient.  

  Sincerely,

  ************************, D.Sc., MSHA, *****

  CEO

  Cardiology Associates

  ********************

  Customer response

  04/27/2023

   
  Better Business Bureau:
  
  I have reviewed the response made by the business in reference to complaint ID ********, and find that this resolution is satisfactory to me.
  
  Sincerely,
  
  *************************

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