ComplaintsforOrthopedic Express Urgent Care

• Initial Complaint

  07/20/2023

  Complaint Type:

  Product Issues

  Status:

  Answered

  More info

  **** Orthopedics in ************, now a part of Golden State ******************* has sent me a bill for an "OFF the ****** hand brace for $308.61 via my BCBS insurance. After my insurance adjustment, the cost is $163.70.This product, per the manufacturer website is $44.81. As a patient of the practice, I have received several ********** braces for my son (a yr of surgeries) and never once we were charge such a high amount. This is now the second provider that claims this to be a negotiated rate with the insurance, as per ******** guidelines. After contacting BCBS and writing a complain for the high cost negotiated by them, the response is "we can't control what the provider charges"I feel this is deceptive, abusive practice from the provider. A fraud to the clients and completely out of your control when you are at the dr ******* as not information on the cost of the brace is given. This is charged by them directly, not the manufacturer.A call to their customer line only got me a standard response " this is the price, we can't change it"My similar case was resolved by BBB successfully and the manufacturer reduced my bill from $140 to $62. I wonder if you can assist on this instance again. Obviously, I'm trying to escalate this issue with their billing with no success.

  Business response

  07/31/2023

  Dear BBB,
  
  Thank you for forwarding this complaint to us so we can do our best to educate and resolve this issue. Unfortunately, we have no record in our system of receiving a concern from this patient on the medical or the billing side of our practice.  This patient was billed at the same rate as all our patients, which is required by law, and is based on the ******** fee schedule.  It was the insurance companies contracted rate that determined the reimbursement rate for the specific brace.  The rate is determined by the specific **code which the brace is listed under.  Braces have different **codes,determined by ******** and are all paid at different rates.  The rate that GSOS bills has no reflection on what the insurance company agrees to pay (ie If contracted rate for specific **code/brace is $200 dollars and we bill $400 or $1000 the payment is $200 for the **code/brace). In this specific instance it appears the contracted rate was sent to the patient as a part of the plan's un-met deductible.  This is why the patient has a balance. 
  
  It appears previously this same issue has arisen with this patient.  We will resolve the issue by writing off the amount and let the insurance company know so the deductible will go back to the previous patient balance.  We cannot legally have the insurance believe the patient paid this money towards deductible. 
  
  Sincerely,  
  
  GSOS DME  
  
  ***********************

  Customer response

  07/31/2023

   
  Complaint: 20352901
  
  I am rejecting this response because: I have not been contacted by the company, other than by a second exact bill. Second, I do not have any record of any other billing issue with this company. Third, when I contacted the billing department I was clearly dismissed and not offered any sort of further action. I have a hard time believing a product sold at less than $50 to be sold by them at 5 times the consumer cost, is not considered abuse on the part of the this company. The patient is never advised on the high cost of the product and due to the urgency of the situation, totally taken advantaged by the company. 

  I will contact them tomorrow to solve this issue. I'm not asking a write off for the billing, just a fair practice. A 20% mark up would be about $10 more. A 100% would be $100 cost. Most retailers would never up charge as much, why is a clinic treating emergencies do, because they can and abuse and rip off the consumers. It is abuse and insurance fraud. Justifying the guidelines by ******** does not make it right. A conversation with my insurance and after further investigation, it was told to me that the cost is set by the company providing the service, not the insurance.
  
  Sincerely,
  
  *********************

*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. ↩