Business ProfileforGeneral Surgical Associates, Inc.

I will upload everything below. I reached out to ******* ****** first to see if they help figure out a resolution, I will include their response. Please note that because I was trying to avoid this you will notice the date on the letter is from May but I am submitting this information today, 06/11/23, because no resolution has been made.

05/15/2023

To whom it may concern;

I am requesting assistance in resolving an insurance/billing issue that has only recently begun
and been brought to my attention. To start off, the reason that this has only just recently begun
is because the office of General Surgical Associates did not even begin sending statements until
the past 2-3 months (I just received a statement this last weekend that noted it was the 2nd
statement sent but I know it had to have been the 3rd. The statement date was 05/08/23 and I
received it on 05/13/2023. I have the statement if you need to see it). Please keep in mind this is
for a service from nearly a year and a half ago and because no one had attempted to contact
me via phone or to send a statement making I was entirely unaware there were any ‘issues’
with the service provided to me being paid by my insurance company.

The office of General Surgical Associates is stating that I owe the entirety of a balance,
$1,378.92, which was for an emergency surgery performed on 12/13/2021 at Fairfield Medical
Center (FMC). They state the entire balance is my responsibility because “I did not provide them
with my current health insurance information and they were billing the wrong insurance
company and that it is my fault for not updating their office”. That is not only false but it is
contradicted by the fact that FMC has confirmed via email, along with the conversation I had
with the Office Manager via phone that -FMC shares and shared all of my health information with General Surgical
Associates which was provided and verified on 12/13/2021 at FMC, this would have
included my health insurance data so that they could bill my health insurance company.

This is also backed up additionally by facts stated within my letter mailed via certified
mail on 05/04/2023; Every other provider who billed for services/care from that same
procedure, at the same facility and on the same day(s) billed my insurance company, the
insurance provided to them BY FMC, and ALL of their claims were processed, accepted
and paid.

It is ironic that General Surgical Associates states I didn’t provide them with the correct
insurance information yet they were able to and did bill my correct health insurance company.
The reason my insurance company is denying their claim is because General Surgical
Associates did not submit the claim to my health insurance within the contractually
agreed upon time period.

The fact is that General Surgical Associates did have access to my correct health insurance
information and that is proven by the fact that they did utilize my correct health insurance!
General Surgical Associates did submit their claim to my health insurance and my health
insurance denied their claim because of their failure to submit the claim within the contractually
agreed upon time period. The agreement between them, the provider, and my health insurance
company. The reason General Surgical Associates was not paid is solely due to their errors and
their errors only.

I refuse to pay for a bill that would have been paid for by my health insurance company, 100% ,
had General Surgical Associates only done their job and submitted the claim to my health
insurance company in the contractually agreed upon time period. It is not my fault they did not
perform their job duties correctly.

I also find it highly unethical that;

1) They blatantly refuse any responsibility for their error and the consequence of their actions, or
lack thereof, fall upon me.

2) They are attempting to collect funds from me that are 4 times the amount that they would
have been paid from my health insurance company! Again, a contractually agreed upon
amount in which General Surgical Associates would have agreed to in order to be an in-network
provider.

3) One could argue, was their error an intentional one? Was it a purposeful delay in submission
to my insurance company so that they could make more money from me, the patient, in hopes
that I would give in to their bullying and threats of being sent to a collection agency. They state I
have been sent to a collection agency and I requested they remove me from that agency and
make sure any reporting has been retroactively corrected.
_________________________________________________________________________
I am going to include the certified letter that I mailed via USPS on 05/04/2023 to General
Surgical Associates. The Certified Mail was signed for as received on 05/05/2023. The
practice/business owner has not responded to that communication and the practice left a
voicemail (on 05/10/2023) to collect the debt discussed within this letter and on 5/13/2023 I
received another statement, this actions lead me to conclude they do not wish to resolve the
matter so I am requesting further assistance to help find a resolve.

Below is confirmation that they did receive and sign for the letter I sent on 05/04/2023;
Below is the letter I mailed on 05/03/2023 (4 pages total for the letter)

This is a snippet of the statement from General Surgical Associates. You can see they didn’t
even bill me until 3/28/2023. The paper statement which I have at home even states the billing
age is just a few days over 40 days.

Lastly, below is the EOB that I am now able to see on my insurance provider’s website. Here
you will it states that not only was the claim not submitted within the contractual timeframe but
also,