Complaints

• Initial Complaint

  01/21/2025

  Complaint Type:

  Billing Issues

  Status:

  Resolved

  More info

  Well child checks for babies are supposed to be free and covered by insurance. My insurance company agrees. When ever I bring my baby in for the well child checks SSMs billing department adds on a charge for an office visit, saying that something required additional work up by the doctor, and results in me being a charged a copay. They can never tell me what required additional work up, and the doctor has no idea why they charge that either. Whenever I reach out to Ssm they either refuse to talk to me, or tell me to look in the chart..which shows nothing other than a preventative visit. There is another issue I would like you to be aware of, but insurance company is handling it. SSM is sending me bills 9 months after my babys birth for things that were already paid by myself/insurance during the birth. It is my belief that SSM purposely charges extra things, and waits so long to bill so that people wont notice / remember that it should be covered. It is my hope that their shady billing practices will be investigated and put to an end.

  Business response

  01/31/2025

  This correspondence serves as SSM Health's response to Complaint # ********. 

  A letter will be sent to the consumer that addresses her concerns regarding well child visits and statements received nine months after service was received. A detailed billing review will be included. 

  Thank you for allowing us the opportunity to respond to this complaint. 

  ***** SSM Health ***************** Services 

  Customer response

  02/02/2025

  In the response, SSM said the 259 dollar charge was billed incorrectly and removed it from my account. They stated it was billed incorrectly because the baby wasnt on my insurance yet (these are charges from his birth). This is fine, however there is a 200 dollar charge, that I already paid that I believe the same error occurred and it should have been covered. It says not covered which is also what the other one said. However they sent me the bill for that one right away and it was paid whereas the other bill wasnt sent until 9 months later. I believe I am owed a refund of $200.
  

  Additionally, I am satisfied with the one time credit to offset the co pay charge for the well child check, however SSM does state that a physical exam is included in a well child check and that is what they charged me a copay for, stating that it was outside the scope of a well child check. If a physical examination of the testicles is not included in the physical exam portion of a well child check then I would like answers as to why that was done in the first place. 

  Customer response

  02/04/2025

  Better Business Bureau:
  
  I have reviewed the business' response regarding complaint ID ******** and am satisfied with this resolution. 
   
  Sincerely,
  
  ***** ******

• Initial Complaint

  01/12/2025

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  SSM billing is a nightmare! I have tried again and again to talk with them they will not listen or respond! I was approved for 50% off medical bills they REFUSE to give me the 50% off! I have asked repeatedly for them to do this to no avail! The way I have been treated (billwise) by SSM billing has been RIDICULOUS and they need to stop doing this to people!!!!!!!!!!!!!

  Business response

  01/13/2025

  This correspondence serves as SSM Healths response to Complaint # ********. 

  A letter will be sent to Mrs. ****** directly to advise of the financial assistance award and how it was applied to her account balances. 

  Thank you for bringing this to our attention se we can address the complaint. 

  ***** SSM Health ***************** Services

   

  Customer response

  01/17/2025

  Complaint: 22800480
  
  I have reviewed the business' response and am rejecting it because:
  I have asked repeatedly for months for them to CORRECTLY ADJUST MY BILLS they have REFUSED to do it and even turned the wrong amount into collections! THIS IS RIDICULOUS!
  
  
  Sincerely,
  
  **** Sample

  Business response

  01/17/2025

  This correspondence serves as *** Health's second and final response to Complaint # ********. 

  A letter with an explanation of the Financial Assistance award was mailed to the consumer on 1/15/2024. The letter advises the award for 50% financial assistance is for all balances that exceed $2000. The guarantor is responsible for $2000 on each hospital account or professional visit. Any balance over and above $2000 on each hospital account or professional visit will be reduced by 50%. The balances are correct for the service provided and the financial assistance adjustments are correct according to the *** Health Financial Assistance Policy. 

  ***** *** Health Patient Financial Services 

• Initial Complaint

  12/30/2024

  Complaint Type:

  Service or Repair Issues

  Status:

  Resolved

  More info

  *** Health Account ************. The date of service was 5/20/24 with the *** health Clinic in *********, ** for a physician appointment and lab work- collection of a blood sample. We received a statement dated 11/17/24 indicating that the patient balance was $40.00 for the collection of the blood sample. This statement indicated that both ******** (primary insurance) and APWU-United Healthcare (secondary insurance) did not make a payment on this $40.00 charge. We also received a statement dated 12/17/24 indicating the patient balance was $40.00 for the collection of the blood sample. This statement also indicated that both ******** (primary insurance) and APWU-United Healthcare (secondary insurance) did not make a payment on this $40.00 charge. On 11/27/24 I made a phone call to the *** Health business office regarding this $40.00 charge. The representative, *****, said *** Health would send the ******** estimate of benefit information for this particular charge to United Healthcare so they could make a claim determination for this $40.00 charge. She also said I would get a call back within ***** hours. I did not receive a call back from *** Health. On 12/12/24 I made a follow-up call to the *** Health business office pertaining to this charge of $40.00. I was told they expedited the review of this claim to United Healthcare and was assured I would receive a call back. To date I have not received any call from *** Health. On 12/13/24 I called ******** regarding this claim of $40.00. They denied the claim and told me they do not send claim denial information to the secondary insurance only to the provider *** Health. On 12/13/24 I called **** and was told they never received a claim denial by ******** from the provider so they could make a claim determination for the $40.00 charge from *** Health. They indicated the medical code for this charge was available in their system. This is very poor customer service on the part of the *** ********************** business department.

  Business response

  01/15/2025

  This correspondence serves as SSM Health's response to Complaint # ********. 

  The complaint states the consumer received a statement for a service that was billed to and not paid by the primary and secondary insurances. Repeated calls to SSM Health customer service failed to correct the billing. A courtesy adjustment was posted to the account balance to relieve the consumer of the financial responsibility for this denial. A coding review and revision has been requested, and a corrected claim will be filed to the insurance carrier for reimbursement. 

  Thank you for allowing us the opportunity to respond to this complaint. 

  ***** SSM Health Patient Financial Serivces 

   

  Customer response

  01/17/2025

  Better Business Bureau:
  
  I have reviewed the business' response regarding complaint ID ******** and am satisfied with this resolution. 
   
  Sincerely,
  
  ****** ******

• Initial Complaint

  12/09/2024

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  I paid ****** for service on 5/29 and they only applied 4 payments total ******. They wont apply the ****** after I showed them proof I paid for everything and they cashed all the vouchers. There were 8 total vouchers and only applied 4 of them.

  Business response

  12/18/2024

  This correspondence serves as SSM Helath's response to Complaint # ********. 

  Proof of payment provided by the consumer was sent to the appropriate department for research. A hold has been placed on this account balance until resolved. Separate correspondence is being sent to the consumer with details of the investigation and will provide a direct contact at SSM Health going forward. 

  Thank you for allowing us the opportunity to respond to this complaint. 

  Kare SSM Health Patient Financial Services

• Initial Complaint

  11/19/2024

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  My daughter broke her finger in February 2024. The bill for the clinic has not been billed to both of her insurance providers. We are now in danger of being sent to collections. I will pay the balance after the bill has been sent to BOTH insurance companies.

  Business response

  12/23/2024

  This correspondence serves as SSM Health's response to Complaint # ********. 

  The account balance was recalled from collections and the secondary insurance carrier was billed. A second statement will be mailed if there is a balance left after adjudication. 

  Thank you for allowing us the opportunity to respond to this complaint. 

  ***** SSM Health Patient Financial Services 

• Initial Complaint

  11/05/2024

  Complaint Type:

  Customer Service Issues

  Status:

  Answered

  More info

  I came to the emergency room for a stroke and my personal belongings were taken from me including cash money and jewelry. Security came and took my belongings and when I got it back my money was missing. I need my money back.

  Business response

  11/05/2024

  11/5/2024
  
  To the Better Business Bureau:
  
  Thank you for providing SSM Health St. Marys Hospital-St. Louis with the concerns you received regarding our organization.  SSM Health takes all customer concerns very seriously.  Upon receipt of this notification, we began to review all aspects of the concern and will follow up on any potential opportunities for improvement necessary as part of our complaint and grievance process. We are actively working to resolve the concerns with the customer directly but are unable to share any details with the BBB regarding our review and response due to patient privacy laws.
  
  Sincerely,
  
  ***** *.| Opportunity for Improvement Specialist
  Phone ************

• Initial Complaint

  10/25/2024

  Complaint Type:

  Service or Repair Issues

  Status:

  Resolved

  More info

  My father (who is now deceased) had his first immunotherapy infusion treatment at SSM Health on 10/27/23. ******** paid their allowed 80 percent, but when it went through his secondary insurance (**********************************), they denied payment. After some digging, we were able to determine that it was a coding error on the part of SSM Health that resulted in the denial, and when I spoke to a **** representative in January of this year, she told me that if the coding was corrected, it would qualify for coverage. I subsequently called SSM Health's billing department and informed them of the error and how it should be corrected. I was told the claim would be sent to the coding department for correction and would be resubmitted. It was indeed resubmitted but again denied by **** because the primary diagnosis code was still wrong. Over the next eight months, as we continued to receive bills, I called and sent MyChart messages numerous times requesting the correction be made. Each time, I was assured the claim would be corrected and resubmitted, but **** had no record of any subsequent resubmissions. What makes this particular debacle particularly perplexing is that during this time, my father had five subsequent infusions, and they were all coded and paid on correctly. The absolute ineptitude of the system to resolve what is actually a very simple issue is astounding. I'm sure the insurance company has a timely filing limit, and given that it has been nearly a year since this DOS, I assume that date has passed. SSM Health is now threatening us with collections, but we are not paying this bill, as it is their repeated errors and incompetence that brought us to where we are today. There is a small balance on the bill for which we are responsible and intend to pay, but we have refrained from paying that for now for fear that it would be allocated toward the portion of the bill for which we are not responsible.

  Business response

  11/13/2024

  BBB Complaint # ********
  
  SSM Health is in receipt of consumer complaint # ******** This correspondence serves as SSM Healths response to this matter.
  
  November 13, 2024
  
  ******** ******
  ******************************************************
   
  Dear Ms. *******  
   
  Guarantor Number: 101002780568 RE: ***** ******
  Date of service: October 27, 2023 
   
  SSM Health has received your concern regarding the charges at SSM Health- ************************* We apologize for the inconvenience that this might have caused you.We appreciate the opportunity to address your concerns. 
   
  A review on your account was completed by our auditing team.  
    
  A coding Review has been performed and all code(s) for this date of service have been reviewed and are correct as submitted by physician. Final reports are in medical record. Patient may go to any SSM ********************** facility and obtain a copy of his medical records for his review and personal records.  
  
  Billed charges are correct for the services rendered to the patient, coding is correct according to the physician's orders and documentation of procedure and tests. SSM follows CMS (Centers of *************************** who set the billing guidelines for these services.  
  
  SSM health is committed to providing exceptional health care services. After an extended review of the circumstances, it has been decided that *** will grant a one-time courtesy adjustment in the amount of $4461.96. Leaving patient liability in the amount of $0.00.  
  
  SSM Health offers several options for repayment. Financial assistance is available for those patients who find their hospital bills create a financial hardship. Please contact customer service at **************. Monday-Friday.  
  

  Customer response

  11/15/2024

  Better Business Bureau:
  
  I have reviewed the business' response regarding complaint ID ******** and am satisfied with this resolution. 
   
  Sincerely,
  
  ******** ******

• Initial Complaint

  10/21/2024

  Complaint Type:

  Customer Service Issues

  Status:

  Resolved

  More info

  I had a colonoscopy with **** *** Wisconsin on April 10th, 2024. I was told it was a screening colonoscopy but I was billed for a diagnostic colonoscopy. I called to ask for clarification and was told it was mis coded and I should call the *** **** GI billing and coding department to have it corrected. I called and was told I would get a callback but never did. I called multiple more times and no callback. I reached out through mychart and was sent a message that I should pay while it was looked into. I paid it and shortly afterwards got another message that it was closed from *** side and there would be no change in the mis coding. I have tried to follow up with the patient financial experience team at ***, the ************** and customer service but I can't even get a callback. I attempted to contact them started in July 2024, then August, and now October. I have since followed up with other colleagues who had the same procedure with the same results on the same insurance and it was properly coded as a screening colonoscopy. I looked into the actual rules for coding diagnostic vs. screening and clearly this was screening. I have still not received a call from the **** *** GI department to have this properly coded. The difference in copay for me is $2,459.91.

  Customer response

  11/12/2024

  My complaint has not been resolved. Thank you for reaching out to the business.

• Initial Complaint

  10/15/2024

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  I had a scheduled C-Section at SSM Health *************************** on 04/15/24-04/16/24. My OB/GYN office billed the physician charge to my insurance and had no problems with reimbursement. The facility for some reason stated they didnt have my insurance on file. I called on 7/24/2024, 09/09/2024, 09/30/2024, and today 10/15/2024. On my initial call, I was told they didnt have my insurance on file, again, this was a scheduled surgery and a prior authorization was requested from my OB/GYN, so, I know I provided the correct insurance, however I was told due to timely filing they could not submit the bill to my correct insurance and it was my responsibility. On 09/30/2024 I escalated to a supervisor who acknowledged the authorization and stated they billed BCBS IL as thats what was provided when I was at the hospital, this is incorrect. I havent had this insurance for quite sometime and I have *************. Again, my OB/GYN had the correct insurance and didnt have an issue. The supervisor at this time stated she would escalate this but due to timely filing USUALLY being 90 days from the date of service, it might be my responsibility. I also have ***************** of Illinois as secondary. The *** said usually and did not state the timely filing had been verified. On 10/08/2024 I received a call from *** asking for the payor ID of my insurance but nothing else came of this. Today I called and was advised by Canille the insurance said there is an error with eligibility as my last names dont match and they were told this on 10/08/2024 under call reference number *********. The *** again told me its my responsibility to know this error and it was my responsibility to check status of my bills. I have provided this information numerous times. *** refused to transfer me to a supervisor. Theyre balance billing me and making me spend hours on the phone arguing with me and telling me Im supposed to submit my bills. Its in collections and theyre calling my job. $24632.30

  Business response

  11/14/2024

  This correspondence serves as SSM Health's response to complaint ID: ********. 

  The complaint states SSM Health failed to bill a claim to the ***** Repeated requests failed to correct the billing, resulting in the total charge being sent to collections. 

  The billing has been corrected and a claim submitted to the correct insurance. The account is recalled from collections with no adverse effect the patient credit. 

  Thank you for allowing us the opportunity to respond to this complaint. 

  ***** - SSM Health Patient Financial Services 

• Initial Complaint

  10/15/2024

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  10/15/24 My Appointment date was 8/30/2024 the correct amount Due was $267.00 based per my ***. SSM overcharged me by ******. *** sent me a bill stating the Balance was ****** but I paid the Amount I owed $267.00 on 10/7/2024 but I still have a balance of $******. They said they have Escalated this mater but still have not heard back. Please note this is the 2nd time previous complaint # ******** now back again for the same thing. I sent the *** on 9/24/24 & 10/7/24 to SSM Health on 10/8/24 SSM stated that my account in still under review & to please allow additional time to Review Account. As of 10/15/2024 I should have a ZERO Balance but I still have a Balance of $******. Thanks ******* ******* Email: ************************* Ph: **************

  Business response

  10/21/2024

  This correspondence serves as SSM Health's response to Complaint # ********. 

  The balance of $213.60 is adjusted to $0.00. An incorrect contractual adjustment was posted to the account creating a balance owed. The error has been corrected and the balance resolved. The consumer will no longer receive billing statements for this account balance. 

  On behalf of SSM Health, we apologize for the inconvenience this has caused. Thank you for allowing us the opportunity to respond. 

  ***** - SSM Health Patient Financial Services 

*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. ↩