Complaints

• Initial Complaint

  08/21/2022

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  Counseling Associates of Southern Illinois (CASI)  has filed fraudulent ****** / ******* counseling claims regarding my daughter (******* ****) as client per Explanation of Benefits. CASI filed claims for appointments 1) counseling appointment that did not occur, 2) telecon / zoom appointments occurred but charged a “no show” fee ($75.00), 3) CASI filed claims for additional time / sessions that took place less than 15 min but charged a full hour (Counselor ******** ****** ended the counseling session &/or cancelled it within hours of scheduled appointment time 4) scheduling of appointments with minor patient without consent of adult sponsor. This notice onto ****** / ******* fulfills state and federal lawful guidelines notifying ****** and CASI, *** ****** ******* and CASI Office Manager, Ms. ****** ***** of being held responsible for past and specifically May 2022 to present fraudulent insurance claims, and false charges onto client ******* **** / sponsor **** ****. Office Manger refuses to reimburse sponsor ($75.00) for May 2022 past due invoice; investigation revealed appointment never transpired validating phone / zoom records – CASI took no action to reimburse sponsor stating CASI only keeps 30 days of records therefore CASI cannot / will not reimburse. Federal law mandates 10 years files / records must be maintained unless I’m mistaken. **** **** has hereby filed “Grievance” against CASI applicable with state and federal law regarding past appointments and reversed post notice of this correspondence of which CASI filed fraud mental health claims and conducted very poor customer care mental health practices in reference to ****** claim ************** *************** ************** *** **************.

  Business response

  08/29/2022

  This is a medical office and I am not able to provide EOB's, personal information, and specific account information.
  This client's father is upset, because we will not release information as to what his child has been saying in session with the counselor.

  We are protecting her privacy as requested and he is upset and been verbally abusive to my staff as well as myself.
  This is retaliation and not the first avenue he has taken.

  
  We are aware that ******* paid on 1 incorrect date of service. It happens sometimes when the insurance processes so many claims. 
  ******* was notified at the time and as I already explained to Mr. **** several times, we are awaiting the paperwork from ******* so we can refund the money.
  Once I receive the refund request from ******* I can refund the monies that were incorrectly paid, but until they assign it a RCN number I can not send the funds in as they will not know who to apply them to.

  This client did have a NO show in May- at that time Mr. **** did NOT have a problem with the No Show fee and acknowledging that his child (16y/o) was at fault for missing the appointment. He paid for the no show  some time ago.

  Typically teenagers do schedule their own appointments with the office and this client has been scheduling her own appointment since she was established by Mr. **** as a client with ******** in 2021. This has not been a problem until he became upset that we would not share what she is saying in session.  He asked for a refund the day before this grievance was filed. I did refuse to give him a refund for a 3 month old NO show fee that was paid and acknowledged as a no show. As I explained to Mr. **** he signed paperwork stating he understood our NO Show policy. We schedule hourly appointments, we ask for 24hour notice of cancellation unless there is an emergency (we understand things happen). This was an honest NO CALL NO SHOW. That is a $75 fee as the hour was booked and the provider was not notified she would not be coming. Again, it was not an issue when he paid it some time ago, it only became an issue when he did not get his way.

  I have spoken with the provider and reviewed records for the days this particular client was seen and all but one of her appointments was a full hour long. There was one that was somewhat shorter, but the client did not have anything further she wanted to discuss so we billed appropriately for a 45min session. I have also explained this to Mr. **** several times. In mental health sessions are billed as 16-37min, 38-52min, and 53+min. All sessions were billed as time was notated by check in and check out with the appropriate coding.

  We have received several "grievances" from Mr. **** since this complaint was filed that all appear "legal", but have come from his own hand and his own email. He is bordering on harassing our company with his fake claims. 

  Thank you for your time,

  ******

   

   

   

  Customer response

  08/30/2022

  Complaint: ********
  
  I am rejecting this response because:

  I am not at least surprised by Office Manager ****** ***** response and lack of professionalism and business manners.  At no time did I ask to see or read what my daughter stated in counseling — that is a lie.  If she has such proof — provide it, which I’m certain she nor counselor have such request of nature/topic.
  

  i did not agree to pay the May no show fee as ****** states but only to keep the account in good standing order so she may continue with counseking services — another lie.  CASI staff advised me she would not be seen until account is settled — so I paid it in good faith. 
  

  cASI has never called me to resolve this issue or kind to follow up on topic — they just want the greedy money providing sub par counseling services.  I’ve known this company for 6 years and very familiar with their unfortunate business practices.  Trust me I would never recommend any of the counselors or ** ******* on ethical rights and views which I have records of to remove some of the counselors licensing within IL.  

  i specifically request CASI provide 2022 financial records under my ******* which reflect all co pays or any financial records in regards to my daughter — CASI / ***** refused to provide on 21 July — stating they only have 30 days on file — federal law mandates 10 years. CASI needs to provide documents to support their claim.

  CASI has been reported to ****** ******** for insurance fraud and other infractions; ****** is aware of CASI track history of poor and sub Par healthcare practices. This isn’t harassment, this is grievance claim through official channels. 

  
  
  Sincerely,
  
  **** ****

  Business response

  09/01/2022

  We are a mental health office. I can not release any records to you showing interactions and communications with Mr. **** as it would be a violation of the patients privacy. Since Mr. **** brought the complaint to the BBB I can however respond.

  As I stated to MR. **** multiple times I can not release our EOB's to him as they have other clients names and information on them. It would be a violation of the patient privacy act. If he would like copies of the explanation of benefits (EOB) from his insurance HE will have to contact his insurance to get a copy with just his daughter's information on it. At CASI we never destroy eob's we have kept every eob we have ever received since the day we opened in 2006. They are stored digitally on our secured server inhouse. Mr. **** was never told that we do not keep records. We keep everything. 
  

  CASI is in good standing with *******, **, and ******. I just spoke to our representatives this morning and there are no issues as Mr. **** would like everyone to believe. As per our ******* representative there is nothing in our corporate file indicating any issues in our billing practices, no fraud investigations, and no indications of client complaints that have warranted investigation. As per *******, CASI is in great standing. That is why we have 100s of new referrals from ******* monthly. Matter of fact, we are the number one office in the area that ***** *** ***** **** refers clients to for off base services. CASI has a great reputation within our local community and on the local air base.

   Mr. **** has gone through several providers at our office for the same reason. When he does not get his way and we do not tell him what is being spoke in session he changes providers and/or creates "grievances". This is not our first run in with Mr. **** and his relentless complaints and fake legal documents when he does not get what he wants- this has happened to other providers in our practice. We will no longer allow MR. **** to receive services at CASI.
  

  We are a mental health office. Our patient's privacy and mental health are our main concern. We do NOT refuse service to someone for a no show. If a client has multiple no shows in a short amount of time we ask that the fees are paid prior to their next appointment, but we never turn someone away for a no show fee. If they are not able to pay the fees the provider will work out a payment plan and many times write off the fees to keep the client in counseling as their mental health is more important. Mr. **** paid the fee with out any complaints and acknowledged at the time it was his daughter's fault the appointment was missed. The missed appointment was in May. The client has had many appointments between the missed appointment and Mr. ****'s latest grievance. There was NEVER any talk by CASI of her not being able to be seen. Mr. **** is the one who pulled his daughter out of counseling. 

  Mr. **** is correct in stating that I nor a representative of my staff have not contacted him to work this out. The last time I spoke with MR. **** he was verbally abusive to me and I told him I would not allow him to speak to me the way he was speaking to me and informed him I was hanging up with him. He then sent a "legal" document to us late that very same night which at first glance appeared to be from an attorney , but the document was obviously created by Mr. **** in an attempt once again to bully CASI into giving him his way- it did not work. It was not an official legal document- legal terminology was used incorrectly and it was full of punctuation and spelling errors which is not typical of an attorney's office. I spoke with the owner and since Mr. **** cancelled all of his daughter's future appointments there was no need to reach out to him to clarify any issues as he does not even attempt to listen, but just yells and becomes verbally abusive. I will NOT subject my staff nor myself to that kind of behavior. We have taken enough of Mr. ****'s verbal lashings.

  All of our providers are in good standing with the mental health board, the state of IL, and our insurance panels. Not one of our counselors has ever had any disciplinary action taken against them - ever. *** ******* is a member of the county mental health board and also in good standing. The court system in Illinois sends a majority of their needs to our office since we have such a good reputation in the area. People come as far as *******, ********, and ******* to see our providers.

  At this time if MR. **** continues to slander our practice within the local community we will have no choice, but to contact our corporate attorney.

  Thank you for your time,

  ****** *.- office manager @ CASI
  

  Customer response

  09/01/2022

  Complaint: ********
  
  I am rejecting this response because:

  I never asked for EOBs, I provided them within this BBB grievance.  See below! 
  

  But I will once again request a full financial record request of my account as a paying former customer — what is so difficult about providing such information - i have retained a lawyer if deemed necessary irt to fraud and medical staff practices.  I have no slandered to anyone, I have called and spoken to poorly trained staff as clearly annotated by others of their ratings —a manager who takes matters personal rather than professional. That is what I’ve dealt with each time I’ve called — no written correspondence — so if you keep everything I await what 2x I’ve requested and was denied via phone Ms *****.  

  My daughters were seen only by CASI by court order by order of a county judge — at request to their mother who was a patient as well — my daughters who clearly did not like some of the counseling services —  only * ******. Again all under their mothers account in prior months I never ever asked for anything during such time — either in writing or a phone call with CASI, if so prove it—- I await yo see it since you keep everything!!

   Before bringing forth additional info irt to my daughters get your facts straight Ms *****…/ CASI I would never recommend CASI nor would I ask for ANY services from CASI irt anyone — far better services in the local community as seen in ratings and ****** ratings available. 
  
  Awaiting requested info for further actions deemed necessary.
  

   

  
  
  
  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. ↩