Complaints

• Initial Complaint

  12/12/2024

  Complaint Type:

  Service or Repair Issues

  Status:

  Resolved

  More info

  On September 17, 2024, I was seen at Ocala Eye for a serious eye condition which is causing a gradual blindness in my left eye that may, I was told earlier, potentially impact my right eye, and to also monitor other conditions that may affect my remaining sight. Prior to the appointment I had obtained confirmation of my **************************** coverage for the visit. The insurance was confirmed for Ocala Eye who was an acceptable provider in the insurer's plan. It was to include refraction there which is part of that provider's process at their office before the doctor can see you. Following the appointment I received mail advising me of a $50 fee for the refraction. After a number of phone calls with Ocala Eye and my insurer, including a conference call between representatives of both, and myself, during which the insurer reiterated to Ocala Eye that they had a contract with the insurer to provide this under their agreement. the provider argued, citing how they internally recognize/define/code the actions of the staff in their offices, and they are "strictly a medical surgical practice, not routine eye care" . This was not routine as I am losing sight in that eye. I was instructed by the insurer not to pay the charge and ignore the bill. My only charge was $10 co-pay which I made at the visit. Nothing else was said. Unfortunately, Ocala Eye continued to harass me with multiple notices in the mail until they issued a threat, forcing me to make the payment or be subjected to more severe action. I had no choice but to pay it anyway or risk possibly damaging my credit or worse. They have done this repeatedly each year I have gone there. Each is a fight, and their threats win out. This is not right and upsetting my health. How do they get away with doing this? They need to stop this type of harassment and should return my money.

  Business response

  12/23/2024

  Please see attached letter. We will issue a refund to this patient.

   

  December 23, 2024
  
  Better Business Bureau
  Serving ***************
  ****************************************************************
  
  RE: Complaint ID: ********
  
  Dear Ms. **************** you for notifying us of the recent complaint filed by ******** Craig ****** regarding a refraction charge at Ocala Eye. We appreciate the opportunity to address this matter and clarify the situation.
  
  Refraction is a critical part of the ***************************** process. This service measures the patients vision, allowing us to determine the appropriate prescription for corrective lenses and assess for potential underlying eye conditions. However, as a statutory guideline,refraction is a non-covered service under ******** and is similarly not covered by many private insurance plans, including ************** Advantage (iCare).
  
  Upon reviewing Ms. ******* explanation of benefits, it was confirmed that Aetna denied coverage for the refraction, indicated by the denial remark code D009, which explicitly states that the procedure is not covered. As a result, the balance for this service is the patients responsibility. We understand that this may have caused frustration. As a gesture of goodwill and to maintain positive relations with our patients, we have elected to waive the refraction charge for Ms. ******* examination conducted on September 17, 2024.
  
  At Ocala Eye, we are committed to transparency and patient education regarding insurance coverage and billing practices. Our team consistently informs patients that refraction services are often not covered by insurance and may result in an out-of-pocket expense. We will continue to enhance our communication efforts to prevent similar misunderstandings in the future.
  
  We trust this resolution will satisfactorily address the concern, and we remain available for any further questions or clarifications you may require.
  Thank you for your attention to this matter.
  
  
  
  
  Sincerely,
  ****** *******
  Director of Business Operations
  ************** office
  ************** cell

  Customer response

  12/24/2024

  As stated in my Complaint, under threats, Ocala Eye forced me to remit payment which I did on December 11, 2024.  At this time they need to generate a $50 refund check to me without further delay. 

  Customer response

  12/30/2024

  I immediately responded to BBB on this complaint on 12-24-2024 stating that I do not want a credit from Ocala Eye Care on my account.   I was either a $50 check that I will pick up, or $50 credit on my charge card.    I PAID OCALA EYE CARE $50 on my charge card on 12-11-2024, so giving me a credit doesn't work.   Please get back in touch with Ocala Eye Care and let's see if we can all rectify this asap.      I also called BBB today because I had not heard anything since I sent in "additional information" as requested on 12-24-2024.    I cannot see where BBB did anything with my 12-24-24 response.    I cannot "accept" anything until is it changed from a $50 credit on my account, to $50 check or charge card adjustment is issued by Ocala Eye Care.   Please advise of next step(s).   Thank you!

   

  Customer response

  01/02/2025

   
  Complaint: 22676822
  
  I am rejecting this response because:

   

  As stated in my Complaint, under threats, Ocala Eye forced me to remit payment which I did on December 11, 2024. At this time they need to generate a $50 refund check to me without further delay. 

   

  I immediately responded to BBB on this complaint on 12-24-2024 stating that I do not want a credit from Ocala Eye Care on my account.  I was either a $50 check that I will pick up, or $50 credit on my charge card.  I PAID OCALA EYE CARE $50 on my charge card on 12-11-2024, so giving me a credit doesn't work.  Please get back in touch with Ocala Eye Care and let's see if we can all rectify this asap.   I also called BBB today because I had not heard anything since I sent in "additional information" as requested on 12-24-2024.  I cannot see where BBB did anything with my 12-24-24 response.  I cannot "accept" anything until is it changed from a $50 credit on my account, to $50 check or charge card adjustment is issued by Ocala Eye Care.  Please advise of next step(s).  Thank you!         

   

  
  Sincerely,
  
  ******** Craig **********

  Business response

  01/13/2025

  Hello,

  I spoke with ******** Craig ******* This situation has been resolved. We credited this patients credit card back $60.00. I informed patient that we waived copay this time due to miscommunication. Mrs. ****** was informed that she would acrue the refraction charge of $60 for future visits. Patient understood. Patient informed us that they have switched thier insurance for 2025 and the new plan covers the refraction. Patient was happy with solution.

   

  Thank you,

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

  1/13/2025

  Customer response

  01/19/2025

   
  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. Their refund has been received. 

  Sincerely,
  
  ******** Craig **********

• Initial Complaint

  02/07/2023

  Complaint Type:

  Billing Issues

  Status:

  Resolved

  More info

  I made an appointment with Ocala Eye for an eye exam by an ophthalmologist. Prior to my appointment, I provided them with my insurance information. My insurance pays for one refraction per year by an optometrist and I have a $15 copay for a specialist. Upon arrival, I was taken into a room for a refraction. Everyone in this office wears scrubs and I was not informed that the person giving me the refraction exam was a tech. I couldn’t tell a tech from an optometrist, ophthalmologist, or desk clerk! After the refraction exam was completed, Dr Jodie A******** Ophthalmologist came in to exam my eyes. She signed my prescription from the tech. My complaint is this: upon receipt of my bill, I found I was charged $60 for the refraction and $15 copay for the specialist. I called the director of billing and explained to her that my insurance covers my refraction. She tried to pass the bill off as being my copay. I insisted that it was not my copay and again told her my insurance covers a refraction. At that point she told me it doesn’t cover a tech performing the refraction. I told her I didn’t make an appointment with a tech and although they had my insurance information, no one informed me that my exam was to be done by a tech. I feel strongly that this company misrepresented their employee by not stating up front that I was seeing a tech, not an optometrist! This is unethical and I believe it is their responsibility to inform a patient, not do the bait and switch then bill a patient. The burden of being ethical is on them. The solution they offered me was to file a hardship claim and ask to make payments! I refused, as I feel they misrepresented their employee to me and now my insurance won’t pay.

  Business response

  02/16/2023

  Thank you for allowing me to respond to this compliant.  After speaking with the patient, we resolved the misunderstanding.  The patient's insurance plan does not cover the refraction under their comprehensive medical benefits.  The refraction is only covered by the patient's vision insurance plan, we are not providers.  We apologize for the confusion and adjusted the refraction fee.  The patient was happy at the end of the conversation and said we resolved this issue to her satisfaction.  If you need any additional information, please contact me directly at ************* 

  Customer response

  02/17/2023

  
  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,
  
  ******* * *******

*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. ↩