ComplaintsforLakeside Allergy Asthma and Immunology, LLC

• Initial Complaint

  11/29/2022

  Complaint Type:

  Billing Issues

  Status:

  Resolved

  More info

  On 3/16/22 I scheduled a teledoc appointment with the receptionist. I told her that I'd be paying out of pocket, not using my insurance and she said ok, the out of pocket cost for my visit would be $100. I paid over the phone and was emailed a receipt. On 11/23/22, I received a call from the office telling me there's a overdue balance of $94 for my visit on 3/16/22 because the receptionist at the time billed my insurance by mistake. I told them that I should not be responsible to pay for a mistake their office made. I paid the amount I was told I was due on 3/16/22 and that should be it. At this point I called my medical insurance rep and a 3 way phone call with myself, the *********** medical insurance rep ensued. The medical insurance rep proceeded to inform me that in their system they see two bills sent from them by the office. One for 3/16/22 that I didn't authorize and another on 3/28/22 that I wasn't even aware of until yesterday. According to the insurance rep, both bills totaled $388. The doctor then says that the receptionist charged me incorrectly on 3/16/22 and that his out of pocket office visit cost is actually $150, not $100. I ask him why wasn't I told this before now in which he had no answer. I asked him to explain why I am being charged for a "visit" on 3/28/22 when all I did was call into the office and provide him an update on my symptoms per his request. He nor the receptionist made me aware that this phone call would incur an additional cost to me. He had no answer. The doctor then demanded that I send him an additional $200. $50 for the "visit" on 3/16/22 that they now say I charged incorrectly for and for the "visit" on 3/28/22 that I never made a formal appointment for nor was I informed of an additional charge that would occur. I do NOT believe I should pay this office any remaining money. on 3/16/22, they billed my insurance, when I told them NOT to, they told me my out of pocket cost was $100, and now there's this new charge for 3/28/22?

  Business response

  12/09/2022

  I have reviewed the complaint filed by the patient and and understand her points. Here I would like to use this opportunity to respond. 

  First, in our practice, like other medical practices, while taking care of patients, we accept payment for the service. The majority of our patients come with their medical insurance, and we try our best to follow insurance plan's decision to assess whether or not and how much a patient should be charged a fee. A small percentage of our patients are self pay without insurance and we use a standard self pay fee schedule to collect payment. 

  This patient's specific complaint involve the care we did for her on 3/16/2022 and 3/28/2022. But we started to take care of her on 1/8/2020. Before 3/16/2022 this year, she has had three visits on 1/8/2020, 2/19/2020, 3/27/2020, all under the **** insurance plan. (1) When she made the new appointment for 3/16/2022 this year, she presented her new insurance plan information (insurance name, member ID etc.) of Aetna to our office. Therefore, we follow our normal procedure of sending a claim to ***** after her visit on 3/16/2022 (I personally was not aware of that she wants to be seen as a self pay, as she stated, until later when she started to complaint about the payment). It is my understanding that our office staff collected an estimate of $100 from her for the visit of 3/16/2022 but later insurance's assessment was higher than $100 (about $194 for the visit) so that our office staff told her that she has a balance of $94 for the visit of 3/16/2022. (2) On 3/28/2022, patient called and described her episode of allergy symptoms at the time. After collecting her medical story or medical history, with the medical assessment, she was prescribed medication to her pharmacy for the treatment. The visit was then recorded as a telemedicine visit with the claim sent to her insurance. The insurance later issue an assessment of $194 toward to her deductible as it did for the previous visit. 

  I only started to be aware of patient's complaint until recently when she called our office. While talking to patient on the phone, she stated that she wants to use self pay instead of her *************** for the service. While on a 3 ways phone communication with her and her ***************, I asked Aetna staff whether they allow us to change her service from insurance to self pay. The Aetna staff said yes, and she will make a note and we can use self pay instead of her insurance for those visits. Our current self pay fee schedule is $150 for each follow up visit. Therefore our office staff assess a total of $300 ($150X2) for her 3/16/2022 and 3/28/2022 visits. She has already paid $100 estimate during her 3/16/2022 visit. 

  Above is my response to her complaint based on my understanding of the event. I want to appoligize for any possible miscommunication and any inconvenience the event caused to her. I also understand the financial burden this event may put on the patient. Therefore, for this specific case, we will be flexible and will let patient herself to decide whether or not and how much to pay for the remaining balance. I will notify our staff not to send her any further invoice for above two visits. If any question or concern, please let me know. 

  Customer response

  12/12/2022

   
  Better Business Bureau:
  
  I have reviewed the response made by the business in reference to complaint ID ********, and find that this resolution is satisfactory to me.
  
  Sincerely,
  
  *****************************

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