Complaints

• Initial Complaint

  05/06/2023

  Complaint Type:

  Service or Repair Issues

  Status:

  Unanswered

  More info

  I called to make a prenatal appointment, which was scheduled for 3/2/23. I had an established pregnancy with multiple HCG Beta tests as well as ultrasounds confirming a twin pregnancy. I asked for records to be faxed over and my previous provider faxed them on 2/24/23, as this was a transfer of care from a reproductive endocrinologist to OBGYN care. At my appointment, I received prenatal care - from pregnancy questions and also receiving an ultrasound. Rancho sent me a bill for a $35 copay, which I informed them was incorrect, as my prenatal care is covered 100% through my policy with Blue Shield of California. My insurance told me Rancho billed it as a regular physician visit, which it was not. Rancho refused to correct the coding (I spoke w someone named Jessica on 5/1 and 5/2) to prenatal care, which to me is fraudulent. I booked a prenatal appointment as a transfer of care *because* I was pregnant and graduated from fertility treatments, have medical proof of a twin pregnancy, and received prenatal care while at that visit. I am attaching proof of multiple blood tests (which would also have been in my lab records/medical history from CNY, sent over to Rancho), as well as proof of ultrasounds prior and during my visit to Rancho. I want Rancho to correct their billing to prenatal care as their current coding is inaccurate for the care I booked and received. I should not owe anything for this visit. This was clearly prenatal care and should be coded as such.

• Initial Complaint

  05/19/2022

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  I had two office visits in August and September of 2021. Rancho Family Medical billed my insurance with the incorrect tax ID. After multiple calls with my insurance and Rancho Family Medical billing, Rancho has repeatedly sent incorrect bills to Blue Cross and have sent me to collections. I explained to them that this was their billing error, they agreed but refused to take me out of collections, Their billing specialists are dishonest and have lied about their interactions and bills sent to Blue Cross. They have not followed up with Blue Cross since March 22 and only followed up on May 17 because I called them.

  Business response

  06/16/2022

  Patient: ***** ****** ***** August & September 2021 Experienced a system (EPIC) glitch that caused the claims to be billed with the wrong TIN (83). Under TIN (33) we are in network under 83 OON. Carrier processed with greater out of pocket responsibility for the patient. 10/14 Insurance adjudicated 10/11/2021 Pt called w/ BC on the line 10/11 Claims were updated and rebilled to BC with corrected TIN. 10/26 newly adjudicated claim denied as duplicate PR97 10/27 Pt called 10/28 BC pt note box 19 indicate corrected claim 11/22 Denial from carrier OA18 denied as duplicate 12/7 Pt called again 12/7 Call to carrier said still under review to wait 30-45 days 01/27/2022 Followed up with BC although corrected claim still reprocessed under wrong TIN 03/22 Followed up on two corrected claims with correct TIN 33 04/30 Patient account sent to collections 5/17 Called BC and again was told claim would be reprocessed 
  Both resubmissions were processed under the corrected TIN (33). Blue Cross has not adjudicated the claim correctly and is responsible. The patient has to get involved for this to happen. 
  All evidence of claim ref#’s for the multiple calls are documented in the account. No one lied about following up. We have spent countless hours on the phone regarding this account. This is not always an easy task because the wait for BC claim inquiry can be anywhere from 30 mins to 2 hrs. 
  Since patient alerted us we have pulled the patient account back from collections. We have advised patient that they need to follow-up with the carrier. Our reps have made a few additional attempts to work with Blue Cross. 
  

  
  

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