Complaints

• Initial Complaint

  09/24/2024

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  We were required to pay $1000 the morning of my husband’s colonoscopy or else they wouldn’t be able to proceed and when I just got off the phone with my insurance I was notified that they had paid the charges in full and to call them about a refund because they had double dipped. Upon calling the office they were able to see that I was owed a refund and my question is why on earth wouldn’t that be issued the moment they realized their error? It took for me to call and I wonder how many people don’t call and lose out on $1000 of their own money. I’m curious as to what other illegal business practices go on in this facility.

  Business response

  10/11/2024

  Per our benefits review performed on 5/9/2024 for a diagnostic colonoscopy, patient had not yest met his deductible and his out of pocket expenses were going to be $1013.67.  When benefits are obtained and given to the patient we explain that they are an estimate and that insurance can change how the process the claim once submitted.  We expect a patient to pay their expected out of pocket portion of an office visit or procedure to be paid at time of service.

  The patient paid their amount asked at time of service on 5/20/2024. All charges were billed to the insurance company on 5/21/2024.  The last payment was received from the insurance company on 7/11/2024 via EFT, the insurance company decided to pay for the procedure differently than was expected due to it being a diagnostic procedure.  Payments received via EFT are posted to accounts automatically.  Unfortunately the EMR does not create a refund work list.  Multiple requests for enhancement have been placed with the EMR vendor.  To work around this we run a report periodically to find patients with a balance due to them. 

  The report was due to be run on 10/1/2024.  When the patient's wife called on 9/23/2024 the account was reviewed and was discovered that the insurance paid the procedure in full but applied the office visit on 2/29/2024 to the deductible. The patient was due a refund of $876.47.  The patient called in on Monday morning, allowing me to add the patient refund to the weekly check run that was processing that day.  Check number ***** in the amount of $876.47 was issued to the patient on 9/23/2024 and was placed in the mail for pick up on 9/24/2024.  The check cleared the bank on 9/30/2024.  Nothing in our policies is illegal.

*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. ↩