Complaints

• Initial Complaint

  05/19/2024

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  I had Cataract and *** eye surgeries performed at Atlantic Surgery Center on 01/16/2024 and 01/30/2024. The center is an in-network provider for my insurance and both procedure are covered by my insurance. The office asked and I paid $2917.50 upfront with the expectation that they file claims with my insurance for processing. However, the office filed claim only for Cataract and asked me to file the *** surgery claim myself. I have filed the *** claim with my insurance and they paid a portion of *** covered charges only, informing if that since I filed the claim myself, it is processed as an out of network service. The office's refusal to file the claim for *** means the insurance paid only $291.00 for ***, whereas in-network the insurance would have paid 90% ($549) for the *** charges and I am paying this difference out of pocket even though the provider is in-network and the procedure is covered by my insurance.

  Business response

  06/04/2024

  Thank you for bringing your concerns regarding the billing of procedures at our surgical center to our attention. We appreciate the opportunity to address your inquiry in accordance with federal HIPAA guidelines.

  First and foremost, we want to assure you that protecting your privacy and adhering to HIPAA regulations are of utmost importance to us.Therefore, we will address your concerns in a manner that upholds these standards.

  After reviewing this complaint, it appears that there has been a misunderstanding regarding the billing process for optional upgraded services, such as the Limbal Relaxing Incision (***). Patients elect to undergo the *** procedure as an upgraded service, which is not considered medically necessary. Consequently, we do not bill insurance companies for elective upgraded services, including the $305 facility fee associated with each *** procedure.

  We understand your expectation that both the cataract surgery and the *** procedure would be billed together to insurance for processing, given that the facility is an in-network provider with the insurance company. However, it is standard practice to inform patients upfront that optional upgraded services are not medical necessary and are not typically covered by insurance plans, and patients agree to upgrade and pay for these services separately with the understanding that these services will not be billed to their insurance.

  Regarding the discrepancy in the insurance coverage for the *** procedure, we understand your disappointment in the outcome. We regret any confusion caused by the processing of the *** claim as an out-of-network service and the resulting difference in payment from your insurance provider.We appreciate your efforts in following up with your insurance company.

  We want to assure you that our staff did not intend to cause any unnecessary delays or financial burdens. We want to emphasize that our office does not refuse to file claims; rather, our office does not bill insurance companies for the *** procedure because it is an optional upgrade that is not medically necessary and has been paid before claims are filed.

  We regret any confusion or inconvenience this misunderstanding may have caused you. Additionally, our colleague ***** has attempted to contact you to discuss this matter further since this complaint was filed, but unfortunately, we have been unable to reach you.

  Please accept our sincere apologies for any inconvenience or misunderstanding you have experienced. We are committed to addressing your concerns in a manner that respects your privacy and complies with HIPAA regulations.

  If you would like to discuss this matter further or have any additional questions, please do not hesitate to contact us. We value your feedback and appreciate the opportunity to clarify this matter.

  Thank you for your understanding and cooperation in this matter.

*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. ↩