Complaints

• Initial Complaint

  12/02/2022

  Complaint Type:

  Sales and Advertising Issues

  Status:

  Answered

  More info

  I went to the company on March 28, 2022 for annual routine eye examination. I was referred to the company by a sales representative of an optical store in that building. At the front desk of the company, I showed the receptionist my Cigna True *************** (PPO) card and asked whether they accept the insurance card. The answer was yes. I also told them I wanted to have the annual routine exam including refraction. They assured me that they would do that. Since March 2022, I have received one statement after another asking me to pay $60 for eye diagnosis by eye specialist. I called several times to explain to them that I did not ask for diagnosis; nor did I have any problems with my eyes. Based on the Evidence of Coverage of Cigna True *************** policy, the annual routine eye examination including refraction is free of charge, as shown on page 64 under ************

  Business response

  01/09/2023

    We have tried to explain ************ insurance to him and he still seems to be upset that he owes his $60 copay.  Originally his patient responsibility was $105 but we adjusted off the refraction fee which the insurance considers the routine part of his eye exam.  We have spoken with ***** and have sent the claim back to them at ************ request, with the same result (balance is pt responsibility).  You can see in his attachment his billing statement that shows we adjusted off the refraction fee leaving his copay due amount.  Legally we can not write off copays or we would have to for everybody.

   

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

  Practice Mgr.

  Customer response

  01/26/2023

   
  Complaint: 18449366
  
  I am rejecting this response because:

  Thank you for your help. I have viewed the response from the clinic.  I have got to point out that the clinic used a wrong code to charge me.  As I mentioned before that for an annual routine eye examination, based on the evidence of coverage of my medical insurance plan, there should be no any copay.  Therefore the response from the clinic is not acceptable.
  
  Sincerely,
  
  *******************

  Business response

  01/31/2023

   We have tried to apologize for the misunderstanding on ************ insurance. The original bill was submitted as medical because we were not aware that he had a "Routine Vision Plan" . The claim was resubmitted with the routine codes and rejected because his routine vision plan is a carve out of his medical plan and we are not a participating provider with Superior Vision.  The confusion comes from when he scheduled the appt and asked if we took his insurance. We were told it was Cigna which we take but did not know of his vision plan.  In good faith we have written off the balance of his account which included his $60 copay and the $45 refraction fee.  He now has a ZERO balance.

  Not all insurances have a carve out plan and unless we are told which vision plan they have we do not know.  This confusion lies with the insurance company not telling the patients that their vision coverage is separate or a carve out. It does not say it on their cards. Some cards say vision and dental coverage and the patient thinks it's under the main name such as ******

  We are very sorry for this confusion.  Hopefully this clears up this matter.

  Customer response

  02/06/2023

   
  Complaint: 18449366
  
  I am rejecting this response because:  see the file of "response"
  
  Sincerely,
  
  *******************

*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. ↩