Complaints

• Initial Complaint

  05/07/2024

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  05/06/2024—*****, a nurse at Dr. **** ********** office, would not provide prior authorization to a client and refused to take it with the insurance agent when they called to clarify why a prior authorization couldn't be provided at that time. ***** was very rude. The patient was in tears and could not understand why she was being treated this way. I told the patient to go to the medical board and file a complaint. This was the most unprofessional treatment I have seen as an insurance representative. The patient had to pay full price for her medication because the nurses refused to complete the paperwork.

  Business response

  05/23/2024

  I would like to know who this is in reference to before I repsond, how can i respond without knowing who we are talking about. Please let me know who the person was that ***** was talking to.  thank you  ***** 

• Initial Complaint

  03/04/2024

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  On 10-11-2023 Dr. Capelli delivered my baby boy at ******* Medical Center. I then had a follow up at his office on December 5th. During these three months, I never received a paper statement of my outstanding balance. I had even spoke to the nurses multiple times on the phone and received an email to return back to work January 2nd. None of these dates, I was notified of an outstanding balance. I called 2-15-24 to get my birth control refilled, and was notified then by one of the nurses that I was sent to collections in December due to my $405 outstanding balance I was unaware of. They are unable to send me proof of paper statements they sent out, no statements in my email, and there were no phone calls regarding my balance. This office does not provide an online portal to check/pay your balance. The nurses then could not provide me with the collection agency they sent my bill to and still have not received anything in the mail from the doctor office or collection agency. I have pictures proving I was in the office December 5th with Dr. Capelli and received no bill or warning. They also have no proof of giving me any outstanding balances.

  Business response

  03/11/2024

  Patient was given a paper statement by me on her appointment 12-05-23 because I told patient she had a balance $395.43 before she was seen at her post pardum appointment and she did states she did not received the statements by mail.  We do have proff that a statement was given to her because whenever we print off statements it gives us the date of when the statement was printed.  On that same day she was given a statement I put the note in her ledger that she was given a statement and that that she stated she has not received one statement.  When I typed a note in her ledger about givening her a statement it also states the time and day it was typed and you can not go back and change it without the computer stating it was modified and it was not modified.   Also we do not email statements to patient unless they tell us too we only mail them, we are a small office that we take payment over the phone or by mail. We do have a form that patient sign that we sent out 3 statements and if no payment we sent to collections with a $10.00 processing fee.  We never received any returned mail and patient also gets and Explantion of Benefits from her insurnace that let her know what she is responsible for either by mail or email if she created an account with her insurance.  

  Customer response

  03/11/2024

  Attached is my return to work slip in which I could have been notified of the outstanding balance or the simple fact that I had been turned into collections. I was not told I owed anything before returning back to work. Attached is a voicemail transcript from Maria notifying me of my appointment but no other information of a balance due or proof a bill was physically given to me or sent to my address. 

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