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Complaint Details
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Initial Complaint
02/15/2024
- Complaint Type:
- Service or Repair Issues
- Status:
- Answered
I was told by the pre approval department that the orthotics ordered by the doctor were pre approved, but they in fact were not per BCBSIL. I was also told they appealed it with BCBS, but in fact it was never appealed per BCBS. They BALANCED BILLED me for $650.00 for one pair of orthotics. Tried to work it out with their billing **** manager without any resolution. In fact, rude and unprofessional!
Business response
03/01/2024
To whom it may concern.
Regarding the complaint was submitted on 02/15/2024 with ID# ********
On 10/11/23, patient ************************* visited by **********, and it was decided that orthotics should be made for her. On 10/13/23, the *** team had a curtesy call to BCBS behalf of patient to check the benefits and ******* Amaurys G on Call ref# ********* confirmed that the patient could have any number of pairs of orthotics as medically necessary with no restrictions. On 10/19/23, the patient received the first pair of her custom-made orthotics and asked for the second pair. She received the second pair on 11/09/23,the invoice sent to the insurance on the same day. On 12/02/23, we received an ERA from the insurance stating that the payment for the second pair is the patient's responsibility. I asked the *** department to contact BCBS again to verify the patient's benefits. This time, ******* ******* B stated that the patient is only allowed to have one pair per year. On 12/15/23, we appealed the case due to misquote of the benefit and haven't received a response from the insurance yet. Meanwhile, we asked **************** to contact her insurance and address her concerns to expedite their response, but she was very upset and insisted it is your job, and I wont do it. This was despite us having taken all our efforts and necessary actions.
All documents are attached in chronological order.
*********************
Medical Coding and Billing Manager
Northern Illinois Foot and Ankle SpecialistCustomer response
03/03/2024
Complaint: 21296742
I am rejecting this response because:1. I did appeal with my insurance company BCBS and their response to me was "The amount billed is more than the amount allowed for this ************************** Your provider should not bill you for any balance over what is allowed."
2. Both pairs of Orthotics were selected for me on 10/19/23 based on medical necessity. One pair for flat shoes and one pair for heels. I did not receive the first pair for weeks after the molding, it certainly was not 8 days after the custom fitting. The second pair was given to me on a follow up appointment and I never signed the "Shoe/Orthotic Benefit Verification Form as I did with the first pair. I would never have agreed to pay $650.00 for a pair of orthotics, which is why the Verification Form is not signed by me, They continue to bill me for $650.00, and on their own Verification Form it states $450.00. Bottom line, in my opinion it was very deceptive and they should not be Balance Billing over what is allowed by the insurance company which they are contracted.
3. To date nothing has been resolved by Northern Illinois Foot and Ankle.
Sincerely,
*************************Business response
03/04/2024
To whom it may concern
Regarding ******************** response
We are also Cced on her appeal result which is attached to my respond. The appeal result shows that her plan provide One pair of orthotics per year and the billed amount never be a question on this matter. because whatever charge amount is, insurances adjust it to allowed amount and then transfer it to patient's responsibility. I want to ask you please kindly open the second attachment which is the Electronic Remittance Advise that her insurance sent it to us.
But in this case we offered her our courtesy discounted price but she refused it.
The second benefit form filled on 12/06/23 after we received insurance denial, only for internal purposes. We never asked her to sign it.
Thank you
*********************;
Medical Coding and Billing Manager
Customer response
03/05/2024
Complaint: 21296742
I am rejecting this response because:The billing managers response doesnt make sense and is not telling accurate honest details. I was never given what she calls a courtesy discount because I was told my insurance approved as many pairs as medically necessary!! I want to hear from the physician on this matter. I find it hard to believe they are allowing the billing manager to behave in this unprofessional manner.
Sincerely,
*************************Initial Complaint
08/07/2022
- Complaint Type:
- Product Issues
- Status:
- Unanswered
I had multiple appointments with Northern Illinois ************************* ("NIF&A") to obtain a set of custom orthotics to replace my current set, which are 3/4 size, rigid orthotics interchangeable with all my shoes. After multiple appointments and spending $933 of my own money (not insurance reimbursed), I was provided with a full size, soft, non-interchangeable orthotic that I did not ask for. I did not take possession of the orthotics as I have no use for them. I explained my displeasure to NIF&A and they've taken no corrective action to refund me. They are also seeking payment for my final office visit on April 22 in the amount of $97.92.I am seeking i) full reimbursement for the $933 I have spent with NIF&A as I've received absolutely no value for their services or, in the alternative ii) waiver of the remaining $97.92 on my account.
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