Complaints

• Initial Complaint

  03/06/2024

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  I was told that a procedure was only a copay and was then billed for $800+ after insurance. When I contacted them about the bill, I was told that insurance told them to only collect a copay. Once I discussed the situation with insurance, insurance had no evidence in their system that they were contacted for estimates for the procedure. I finally got documents from the company that were used to state I only needed to pay a copay but they did not ever obtain a quote for the procedure, only office visits. I also had the same thing happen when I had to go back to them for another procedure associated with the first one because they did not correctly get an estimate like I asked through my insurance and billed me later. I have an entire dated explanation of my problem because it will not all fit in this area. I have multiple documented reference calls to insurance and my call logs to date when I have been in contact with their clinic. Every time we call to handle this with the clinic, they keep lying and stating something else, the story changes every time and they have not once tried to take responsibility for not properly going through insurance and relaying correct information. They keep blaming it on insurance when there is proof that they did not do what I asked them to do before services provided. Now they have submitted my payment to collections.

  Customer response

  03/20/2024

  Complaint: 21395613
  
  I am rejecting this response because: The documents provided by the clinic show that they did not accurately look up the 2 procedures that I requested estimates for: first being the **** procedure and the second being a closure. My insurance representative talked to ****** personally about how they did not search the codes or keywords for appropriate estimates based on the documents they provided to me. At that time, ****** again came up with another story but did state they did not look up a **** procedure to my insurance representative. She also claimed that the estimate they were looking up was for a post surgery exam following closure with the plastic surgeon. I was honest from the beginning that I may not go through with plastics for closure and even asked the day of my **** procedure for them to close it but they would not since I already had plastics set up for the following day; which again no one appropriately communicated that they would not close it the day of if I did not want to go through with plastics. I did see the plastic surgeon as they wanted me to following the surgery and he stated it could be closed in office. The new story that they use against me now is that I did not follow treatments or see the plastic surgeon for closure, but I did and there is evidence to back it with his office. Either way, my decisions should not affect compliance on their end to appropriately look up estimates for the **** procedure and for closure to let me know how much it would cost. They should not be giving people false information that it is only a copay without any detailed evidence to state that is all it is and then bill people later without any forewarning that there are other payments expected. I never received any documentation that had a break down from insurance of what my deductible may have been at that time and what insurance would cover and what I would be responsible for. Had I had this information, I would have planned my surgery according to my finances as I was already stressed with the estimates of cost I received for plastics and electively, chose not to due to finances. I have recorded some of our phone calls after the back and forth because ****** has changed her excuses and stories between myself, my husband, and my insurance representatives every time she talks to someone. I cannot obtain my insurance communication records without legal forces being involved but that would also give detailed accounts from multiple representatives that have looked into this matter on my behalf and those that have talked to Mira ********************** staff. My insurance has no documentation of any estimates inquired by Mira **********************. The portal they use they did not correctly look up the codes and cost for specific procedures that I requested them to do and they blatantly told me the wrong information. This is upsetting as myself and my husband work in the medical field and have never had issues like this before in regards to procedures and estimates. I, as a client, should be able to trust my medical office to look into my insurance for procedures to be performed. Even so, this facility performs these procedures religiously so there should be an estimate range that they know clients pay for these, especially if they do not have insurance, that they could have been forthcoming with when I asked for estimates. There were no forms signed about procedure costs at my initial consult or at the time of my procedure stating there were other accrued cost or bills to be expected. I took their word that both procedures were copays as that is what their staff told me over the phone. One staff member even called me back after asking someone else to let me know it was only a copay for the closure so she got that information from somewhere. Mira ********************** should accept that they made a mistake regarding how they obtain estimates for clients and provided the wrong information instead of continuously blaming it on insurance, or treatment plans, or any other excuse they continue to come up with. I would hope that this would help improve their practice in how they provide information to clients and that they need to obtain actual estimates from insurance that break down deductibles, what insurance covers, and what clients are to cover in written form before the procedures take place. This method would prevent another situation like this from occurring on their end.
  
  Regards,
  
  *********************************

  Customer response

  04/05/2024

  Complaint: 21395613
  
  I am rejecting this response because: There has still been no acceptance that they did not appropriately look up an estimate that I asked for, for two separate procedures. They are only looking up eligibility and using terms for office visits and not looking up actual procedures for cost with insurance. If that was the case, insurance would have their estimates on file with them (even if submitted online) and have been able to provide a proper break down with my deductible and specific plan. Not once did anyone tell me that other payments may be expected/billed later. There were no forms signed for the procedures. The different people I talked to for quotes for both procedures said its just a copay, even after asking someone else and calling me back. This means that they have been continuously doing this to people and just billing them a surprise **** later, which is not what I asked for nor is it appropriate. When someone asks for an estimate of cost for a procedure, that is not asking eligibility of cost of that day. 
  
  Regards,
  
  *********************************

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