Complaints

• Initial Complaint

  07/26/2022

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  May 2022 tentatively scheduled surgical procedure for June 2022 with Summit View Surgery Center (SVCC). My physician shared that someone from SVCC would be calling to discuss scheduling and cost for procedure. On 6/2/22 spoke with SVCC representative *****. She had already contacted my health insurer United Healthcare and shared that since I had not yet reached my 2022 deductible amount, that I would be responsible for full amount of procedure. That amount would be $708, which I fully paid that day. I asked a couple times "Is the $708 really the full total? Since we know my insurance is NOT providing any coverage, this is my full responsibility?" She repeatedly stated yes. I am now being billed an ADDITIONAL $415 by SVCC via statement dated 7/15/22. I called into the billing phone number ************ for SVCC spoke with ***** 7/26/22, who confirmed "yes, you owe an additional $415". When I asked what changed from June, she indicated that "the amount changed when we billed your insurance provider". I repeatedly asked what changed from when I paid the $708 on 6/2/22 with *****, when SVCC learned United Healthcare wouldn't pay anything since I had not reached my deductible, and there wasnt any need to bill my insurance, and we were still operating under the same procedure code *****, and she repeatedly said "we billed your insurance and the total changed". Did the amounts change from June for procedure code *****? This doesn't make sense and is exactly why my surgeon requested I provide my insurance, billing info to SVCC early. SVCC had all the same information prior to the surgery as they did after. I don't feel there was any need to "bill my insurance" when all parties, up front, knew my insurance wasn't in-play to cover any of this expense. The amount of the procedure doesn't just magically "change" because SVCC "billed my insurance". This is unacceptable and serves to degrade trust and transparency in our healthcare system further. Avoid SVCC.

  Business response

  08/10/2022

  Upon deeper review of this patients account, it was found that the patient had an insurance, United HealthCare. Our center has 2 different contracts with United HealthCaredepending on if they are for a Centura facility or not. The contracts can have different reimbursement amounts for the same procedure.
  
  This patient presented with an insurance card that was United HealthCare, with a Centura insignia on it, so our staff input the insurance as "United Healthcare-Centura" instead of our ***** National contract with United Healthcare. When our staff was verifying the insurance and telling the patient how much he would owe, it was based on the Centura contract. When the claim processed through the United Healthcare, they linked the plan to our ***** National contract, not the Centura one like we had put into our system. This is also something our staff is trained to tell patientsthat the final determination is made by the insurance company, not by us. Upon admission for surgery, we also have patients sign a Statement of Financial Liability, in which it states, "All financial information prior to the procedure is an estimate and can change depending on services provided on the day of surgery."
  
  We want to thank this patient for bringing this matter to our attention, as it will help us serve our patients going forward. We understand the frustration this has caused and deeply apologize for any distress this may have caused. This matter has been brought to our staffs attention, and we will use this as an opportunity to better determine the differences in these contracts that we have with United Healthcare, so that this does not happen again. We currently utilize a 3rd party vendor for our patient billing and would encourage the patient to reach out to the facility directly for further explanation. Thank you again for bringing this to our attention.
  

  Customer response

  08/18/2022

   
  Complaint: 17626994
  
  I am rejecting this response because: As stated multiple times, having not reached my insurance carrier's deductible, responsibility for the procedure was mine alone. Whichever 'correct Centura' is referenced isn't relevant. Insurance was NOT in-play. The surgery center's claim that they quoted the wrong carrier shouldn't have any bearing on them changing their price to me. I am struggling to accept this response as a valid justification for increasing this billing, thank you.
  
  Sincerely,
  
  *****************************

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