ComplaintsforImmediate Health Associates

• Initial Complaint

  08/22/2024

  Complaint Type:

  Billing Issues

  Status:

  Resolved

  More info

  Urgent care is charging me based on them mis-filing a medical claim. Spoke with my insurance provider who claims they've never received the bill from ****** and verified that I was covered by my insurance and should have no due balance. I've tried resolving this for 6 months with ****** Urgent care to no avail. Below is my information I've gathered through those attempts I've gotten multiple claim numbers from aetna validating my coverage including w/ ****** on the call as a participant to no avail but to be talked to like it's my fault they can't file a claim properly even w/ directly talking with the insurance provider. ********** ****** group id *******-**** ************* ***** ********* ********** ********** ************ dispute claims number for ***** ********** reference number - 07/15/2024 ********* ****** reference number ********** ***** *

  Business response

  09/04/2024

  Mr. ******* was seen at our ****** Urgent Care, (*** ** ********* *** ************ ** *****), on 12.06.22.  At the visit Mr. ******* presented an ***** ID card for his form of coverage. 

  According to the ***** ID card, Mr. ******* had a $45.00 co-pay for Urgent Care visits.  Therefore, $45.00 was collected at the visit.  Mr. ******* was treated and incurred an office visit charge - ***** - $165.00.  This was billed to ***** insurance with the ID# Mr. ******* provided at the visit - **********

   Below is a very long list of this claim's history and our attempts to resolve the claim for the patient.

  
  -12.12.22 - ***** electronic denial for patient not eligible for benefits
  -03/2023 - ***** electronic denial for patient not eligible for benefits
  -05.25.23 - ***** stated they don't have the claim on file and for us to resubmit
  - 10.05.23 - ***** stated they don't have the claim on file and for us to resubmit
  - 02.13.24 - ***** stated they don't have the claim on file and for us to resubmit
  - 04.26.24 - Our office spoke to ***** customer service representative - **** (ref#*********/ph# ###-###-####) - **** advised the patient was not eligible at the time of service. **** advised her system showed the patient was covered under ***** Insurance - ID# *********** and we should try it for payment
  - 04.30.24 - Both ***** and ***** denied visit date 12.06.22 for patient not covered at time of service
  - 05.01.24 - Statement was mailed to patient advising both ***** and ***** have denied his visit for 12.06.22
  - 06.05.24 - Statement was mailed to patient advising both ***** and ***** have denied his visit for 12.06.22
  -06.10.24 - The patient contacted our billing's customer service department. Mr. ******* advised our office that he had previously appealed this with ***** and he thought it was taken care of. The patient requested we refile the claim. Advised with our multiple prior attempts, I would need a direct ***** contact to submit an additional copy of the claim to. I received a call from ***** at ***** (call ref# FR-*********). ***** asked that we fax a copy of the claim and proof of prior/timely filing to fax# ###-###-####.  The claim and proof of our timely filing was faxed to the number provided on 06.10.24.
  - 06.17.24 - ***** electronically denied date of service 12.06.22 for patient not eligible again.
  - 7.10.24 - Statement was mailed to patient advising both ***** and ***** have denied his visit for 12.06.22
  - 07.15.24 - ***** * from *****, (call ref# *********) called and advised they don't have date of service 12.06.22 on file.  So, our office faxed and mailed the claim and proof of timely filing to ***** again.
  - 07.19.24 - ***** from ***** (call ref# ********) called and said they were still trying to locate the claim
  - 07.29.24 - ****** from ***** called and asked for the claim to be resent. Our office again faxed and mailed a copy of the claim and proof of timely filing.
  - 07.31.24 - ***** finally issued a "paper" denial, instead of an electronic denial, stating we had waited too long to file our claim, so their office would not be making payment. EVEN THOUGH WE PROVIDED SEVERAL COPIES OF PROOF OF TIMELY FILING!!!!
  - 08.14.24 - Statement was mailed to patient advising both ***** and ***** have denied his visit for 12.06.22.  This is the final statement before the account is handed over to our Collection company.

  
  Attached is a copy of the ***** ID card provided, a copy of the claim form, a copy of our proof of timely filing, and a copy of ******* timely filing denial.

  
  As a last effort for the patient, I did speak to ***** again on 08.28.24.  I spoke to ****, (call ref# *********).  **** was advised of the complete saga for this claim. **** asked that I again fax our claim and proof of timely filing to fax ###-###-#### for reprocessing.  I did this on 08.28.24.  We have yet to receive a response from *****.

  
  We have gone above and beyond what is required of our office to try and resolve this claim for the patient.  It's very upsetting for our office to put this much effort for a patient and then have them blame us for their insurance's mistakes.

  
  Please let me know if there is any additional information needed.

  
  Thank you,
  ***** ********* / Billing Director / ###-###-####

  Customer response

  09/04/2024

  Speaking with ***** they declined ever receiving the claim attempts.At the end of the day I shouldn't be penalized for a miscommunication between these two businesses for something I should owe no money for. The two businesses should have to resolve their disputes between each other not force me to pay due to their discrepancies.
  
  Regards,
  
  ***** *******

  Business response

  11/04/2024

  It appears the matter has been resolved. The insurance company has paid, and our patient has been refunded. 

  Customer response

  11/06/2024

  I accept the business's response to resolve this complaint.
  
  Regards,
  
  ***** *******

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