Complaints

• Initial Complaint

  08/12/2024

  Complaint Type:

  Product Issues

  Status:

  Answered

  More info

  I had a physical in Jan 2023. As part of the normal process, they do blood work. Physicals are supposed to be covered according to ACA. Summit medical (the provider) keeps filing the lab works as "general healtcare" instead of preventative, which means the insurance company (The American Worker) won't pay it. Last year I got so frustrated with the mess I called Summit medical and asked them what I owed and they said $124.27. I asked if that was everything I owed because I did not want to ever deal with them again. They said yes, so I paid it. After a YEAR from not hearing anything from them, I get ANOTHER bill for $71 for a GENERAL HEALTH PANEL. I've spent hours on the phone including a conference call between Summit Medical and the American Worker and both sides keep pointing at each other and expect me to pay the bill. I've even sent a copy of Summit's bill to the American Worker showing them I'm being charged for a GENERAL HEALTH PANEL. I've tripled confirmed that Summit Medical was in network (once with American Worker on the phone). THERE IS NO REASON ROUTINE BLOOD WORK SHOULD NOT BE COVERED AS PART OF A PHYSICAL! THAT'S THE MAIN POINT OF GETTING A PHYSICAL!!!! Summit medical is now hounding me with e-mails and phone calls over something they refuse to do competently. I am asking BBB to help make this go away and have American Worker refund me the $124 for my headache in all of this. I am also going to file a report on American Worker stating the same thing as this.

  Business response

  08/23/2024

  To Whom It May Concern,
  
  Mr. ******* established care with one of our providers on January 26, 2023. During this visit, several lab tests were ordered and subsequently performed on January 31, 2023, to monitor ongoing medical conditions. The initial claim for these lab services was processed by both the primary and secondary insurance on file, and the remaining balance was assigned to patient responsibility on April 24, 2023, which Mr. ******* paid on May 15, 2023.
  
  Throughout this period, Mr. ******* contacted us multiple times with inquiries regarding the coding of the lab work. We confirmed with our Coding and Compliance Department that the diagnosis codes used were appropriate, based on the documented reasoning for ordering the lab work. The only adjustment necessary was a revision to the diagnosis coding on the general health panel, which was completed on May 19, 2023. A corrected claim was subsequently filed with the insurance, but it was processed the same way as the original claim. As a result, a balance of $71 was assigned to patient responsibility on June 10, 2024.
  
  Following this, Mr. ******* reached out to us multiple times to express his frustration that the lab work was not covered in full by his insurance. On August 10, 2024, he filed a complaint with the Better Business Bureau to draw further attention to this issue. On August 16, 2024, Mr. ******* made a $16 payment and indicated that the remaining balance would be settled soon.
  
  To address Mr. *******'s concerns and in consideration of the age of the balance, we have consulted with the provider’s office and reached an agreement to adjust the remaining balance in the interest of patient satisfaction. We appreciate the opportunity to serve Mr. ******* and value his feedback.
  
  Thank you,  
  Summit Medical Group

  Customer response

  08/26/2024

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

  Summit medical is acting like they are just writing off what I owe. I had been in contact with the insurance provider and was told they made a payment of $55 to Summit medical due to this physical. That is why I paid the $16.  I had been told multiple times you had not coded it as preventative and I actually had to send a copy of the bill with the actual names of the procedures ran. Why I could do this and you couldn't is beyond me

  If a patient is going in for a routine physical, which BY ACA Is supposed to be 100% covered, and you are going to order a bunch of things NOT COVERED and not advise me of the cost to me the consumer, that is not right.

   

  Furthermore, when I called you LAST YEAR and point blank asked if everything was settled so I could put you people behind me, I was told yes.

  Now you're acting like you are being all magnanimous when in reality you have been paid in full. Sure, your poor practices meant you got $71 a year late, but I have wasted dozens of hours on this 

  But hey, this is just another reason to never do business with Summit medical 

  PLease change your practices soon or I am sure I will be able to dance a jig when you go out of business 

  
  Sincerely,
  
  Matt *******

*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. ↩