ComplaintsforCommunity Radiology Associates Inc.

• Initial Complaint

  04/16/2024

  Complaint Type:

  Billing Issues

  Status:

  Resolved

  More info

  Community Radiology has fraudbills. charged my insurance for services they did not render and have been sending me bills as well. I have called them four times to resolve this and am still receiving bills.

  Business response

  04/23/2024

  After an in-depth review of the patient's account and complaint, it was identified that Ms. ********* was scheduled to have a Breast Ultrasound on 12/29/23 which was canceled on the date of service. Unfortunately, this code was included when the claim was sent out to her insurance. Her insurance processed the claim and there was a coinsurance amount for that procedure which caused a balance to show on the patient's account. This was a clear error and we have since voided that charge and resent the claim to the insurance without the incorrect code. There is no balance currently showing on Ms. *********'s account for that procedure. We apologize for any inconvenience this issue may have caused. 

  There is currently a balance of $2.92 from the 3/26/24 date of service for which Ms. ********* may still receive billing. She can contact our customer service department if she has any questions regarding that patient responsibility amount. 

   

  We are committed to creating a seamless process that promptly escalates patient inquiries through the BBB to the appropriate management or executive levels within our company and tracking those inquiries through completion.
  
  We greatly appreciate your assistance and cooperation in achieving a resolution.

  Customer response

  04/23/2024

  
  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,
  
  ******** *********

• Initial Complaint

  02/01/2024

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  The business continues to mail me bills and threats of collections after I have supplied proof of payment.

  Business response

  02/09/2024

  This is to confirm that we have reviewed and responded to all aspects of Ms. ******** complaint.

  After a thorough review of the patient's account, it was determined that there were two visits for which the patient was being billed (9/20/22 and 10/3/23). Each visit had a patient responsibility of $64.19. Ms. ****** made a payment and the system applied it to the 10/3/23 date of service as opposed to the 9/20/22 date of service. As a result, we moved the payment to cover the older date of service but there is still an amount due of $64.19. We apologize for any confusion the dates on the statements may have caused. 

  We are committed to creating a seamless process that promptly escalates patient inquiries through the BBB to the appropriate management or executive levels within our company and tracking those inquiries through completion.
  
  We greatly appreciate your assistance and cooperation in achieving a resolution.

• Initial Complaint

  04/27/2023

  Complaint Type:

  Product Issues

  Status:

  Answered

  More info

  I went to CRA for two MRIs (ordered by my doctor). They told me my insurance company told them I had not met my deductible and I had to pay more than $900 for my scans. So I did. Then found out they filed a claim with my insurance company and were paid for the service. So they COMMITTED FRAUD. THEN they said I had to pay out of pocket for the service I was scheduled to have the following day! I just called them and they not only are not immediately refunding my money, they were rude. I am NEVER going to them again.

  Business response

  05/04/2023

  This letter is a response to the above referenced complaint.  We have reviewed all aspects of Ms. *****’ complaint and summarized in the below response.

  Please be advised it is our policy to collect the patients estimated cost share at the time of service.  The patients’ benefits are confirmed via an EDI (Electronic Data Interchange) process. The information is requested at the time of scheduling and/or at the time of service through a “270” real-time connection to their insurance.  Based on their coverage a “271” response is received providing the patients eligibility and out of pocket cost share including Co-payment, Co-Insurance, and/or Deductible.
  
  Patients are notified of their estimated cost share at the time of scheduling services (if scheduled by the patient), if the insurance returns the 271 in a timely fashion during the scheduling process.
  After services are complete and the radiology report is finalized, services are coded (CPT/ICD10) and submitted to the insurance carrier.  The explanation of benefits “EOB” is the “source of truth” that provides the patient and provider of how the services adjudicated. 
  
  After thorough review of Ms. *****' account, Ms. *****' overpaid at TOS for 3/29/2023 date of service in the amount of $873.74.   
  
  Our refund turnaround is 15 business days and it is apparent we did not meet this goal.  We have issued Ms. *****' a refund in the amount of $873.74 on 5/3/2023 to the address on file. 
  
  We are committed to creating a seamless process that promptly escalates patient inquiries through the BBB to the appropriate management or executive levels within our company, tracking such an inquiry through completion.
  
  We apologize for the delay in resolving this inquiry and greatly appreciate how you worked with us on this complaint.

   

  Regards,

  Laura ***** ***

  Quality Assurance Manager

  Customer response

  05/05/2023

  
  Complaint: ********  
  I am rejecting this response because:

  At the time of receiving preauthorization for my scans, CRA should have also received notice that the service would be covered. They apparently did so because they submitted a claim as well as taking my money. I still have not received anything from them - this charge is fraudulent.

  
  
  Sincerely,
  
  Karin *****

  Business response

  05/08/2023

  This communication is in response to the most recent response from the patient. As advised in our original response, we obtain the patient time of service out of pocket expense information from the patients insurance through Electronic Data Interchange (EDI). At the time of service, the insurance communicated that the patient had $1543.50 remaining towards their deductible and also 10% coinsurance for MR/CT exams. The estimated cost for her exams was 923.74 which is what was collected based on the deductible information provided at time of service by the patient's insurance.

  The procedure authorization process is handled by a different team and is separate from our EDI connection process. Due to this, the pre-authorization process would not have provided us with the out-of-pocket expense, only that the service was authorized to be performed. 

  The refund was issued to the patient on 5/3/2023 and was sent regular mail. Please wait 5-7 business days from the time it was sent to receive the payment. If you do not receive your check via mail by 5/11/2023, please contact me at ###-###-####.
  
  Again, we apologize for the delay in resolving this inquiry and greatly appreciate how you worked with us on this complaint.
  
  Regards,
  Laura ***** ***
  Quality Assurance Manager
  

• Initial Complaint

  02/17/2023

  Complaint Type:

  Service or Repair Issues

  Status:

  Resolved

  More info

  On 12/30/2022, I went to a Community Radiology Associates (***** *** ******* ****** ** ****** ******* **). I was asked to pay $100.88 because I had not met my deductible by the time I made the appointment. Fair enough. I charged the amount on my credit card. By the time my health insurance company processed the claim, on 01/31/2023, I had met my deductible. My insurance company paid 100% of the allowable amount. See uploaded claim. A few days later, I called CRA to ask for a refund. I was told they had not received the check yet, but my refund would be issued "immediately and automatically" after the check was received. Fair enough. On 02/13, I called my insurance company to find out when CRA was paid. I was informed the check was cashed on 02/08. I then called CRA to find out the status of the refund. Clearly, the refund was not issued "immediately." It turns out it would not be issued "automatically" either. The agent told me she would have "to issue a request to the refund department." I asked that the full refund ($100.88) be credited to my credit card. As of today, my credit card has not been credited. There is not even a "pending" refund. The contradictory information I received from 2 CRA agents points to a problem -- at best, a need for better training. A more nefarious interpretation is that it is a business model. Whatever the reason, the issue is the same: CRA needs to refund me the full amount I paid them on 12/30/2022. Thank you for your mediation. (Note: Aharonian, Artin, MD is the radiologist who wrote the report. The payment was made to White Oak Imaging, not to the radiologist.)

  Business response

  03/03/2023

  This is to confirm we have fully responded and reviewed all aspects of Ms. ******** complaint. We issued a refund to her in the amount of $100.88 on February 27, 2023 back to her credit card.  The patient was contacted on March 3rd, 2023 and account resolution was confirmed with the patient.
  
  We are committed to creating a seamless process that promptly moves BBB (and similar consumer complaint agencies) to the appropriate management or executive levels within our company and tracks them through completion. We greatly appreciate how you worked with us on this complaint.

  Customer response

  03/03/2023

  
  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,
  
  ******** ******

• Initial Complaint

  12/06/2022

  Complaint Type:

  Billing Issues

  Status:

  Resolved

  More info

  Community Radiology accepts United Healthcare BUT they want the differance between what United Healthcare paid them for the medical codes that they summited with Unitedhealthcare and what they were paid by United Healthcare. Community Radiology is under contact to provide services for United Healthcare (see their web site) and should not be billing me the member just because they are not happy with United Healthcare's payments. My account# is ************ on the bill for $1603 at Community Radiology. My date of birth is 3/8/1949. Community Radiology IS NOT HONERING THEIR CONTACT with United Healthcare. For code ***** insurance paid $575.05, they wanted $2,032.00. For code ***** insurance paid $138.95 they wanted $285.00. NOW they have sent me, the insurance MEMBER, a bill for $1603 because they are not happy with the payments from United Healthcare, Yes, I did report this to United Healthcare BUT the bill is still there. A United Healthcare rep. contacted them BUT they just informed them that they want more money and would not remove the bill.

  Customer response

  12/08/2022

  NOW Comunity Radiology Has increased the amount from $1,603.00 to ********. They are ignoring ************* care and are trying to rob me. Why have insurance when a company like Community Radiology IS FLAT OUT IGNOING THEIR CONTRACT TO GO THROUGH UNITED HEALTHCARE??? They are obligated to work with and accept the amount *************care pays them for the medical codes they give to *************care. PLEASE help me.

  Customer response

  01/03/2023

  (The consumer indicated he/she DID NOT accept the response from the business.)
  I received yet another letter from Community Radiology Assssociates today (1-3-2023). The letter is dated 12/20/2022. It looks like I am still in the "middle" of the process that should only be between United Healthcare and Community Radiology. It says "For further information on the processing of this "new" claim, please contact your insurance company. Once your claim is processed, you will receive an expalnation of benefits from your insurance". "Please allow ***** days for your insurance claim to be processed".
  I don't see where ANYTHING has been resoved???? How much longer will Community Raiology be involving me in what should be between them and United Healthcare????????? The "new" claim is now over 6 months old!!!!!!!!!!!!

  Business response

  02/16/2023

  Please see attached response to complaint 18935475. 

  Customer response

  02/17/2023

   
  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,
  
  *******************************

• Initial Complaint

  09/16/2022

  Complaint Type:

  Product Issues

  Status:

  Answered

  More info

  On 6/3/22 I went to the Community Radiology Rose Hill location for an ultrasound. The cashier had me pay upfront for my procedure. I used my Care Credit card for an amount of $301.78. When my insurance processed the claim, my deductible had already since been met and their payment was higher than they projected. My Explanation of Benefits (which I have emailed them on 3 occasions) shows my copayment is $100. I have been requesting a refund. I spoke to someone who said they were going to issue a $69 refund. I said - absolutely not, that's unacceptable. I overpaid by $201.78. That is the refund I am requesting. I am still waiting for my refund.

  Business response

  12/01/2022

  Business Response /* (1000, 20, 2022/11/09) */ Contact Name and Title: Kathleen ******** Sr Mgr Contact Phone: (XXX)XXX-XXXX Contact Email: *****************@RadNet.com This is to confirm we have reviewed all aspects of Ms. Junker's complaint. Please be advised it is our policy to collect the patients estimated cost share at the time of service. The patients' benefits are confirmed via an EDI (Electronic Data Interchange) process. The information is requested at the time of scheduling and/or at the time of service through a "270" real-time connection to their insurance. Based on their coverage a "271" response is received providing the patients eligibility and out of pocket cost share including Co-payment, Co-Insurance, and/or Deductible. Patients are notified of their estimated cost share at the time of scheduling services (if scheduled by the patient), if the insurance returns the 271 in a timely fashion during the scheduling process. After services are complete and the radiology report is finalized, services are coded (CPT/ICD10) and submitted to the insurance carrier. The explanation of benefits "EOB" is the "source of truth" that provides the patient and provider of how the services adjudicated. In this case a contractual adjustment was overlooked during the electronic posting of the payment from Ms. Junker's insurance in the amount of $131.98. We have corrected this and a refund has been processed and mailed to her home address. I have contacted Ms. Junker and explained the issue and informed her the check has been mailed out. We are committed to having created a seamless process that promptly escalates patient inquiries on behalf of the patients and any organization including the BBB to the appropriate management or executive levels within our company, to track, document, train and educate internally to avoid future occurrences of this nature. We greatly appreciate how you worked with us on this complaint.

• Initial Complaint

  12/01/2021

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  Service Date 08/03/2021 at Community Radiology GermantownP atient Account # XXXXXXXXXXXX Patient Name: ***** ******* Received a bill on 09/21/2021 for the above account number showing a balance of $99.43, which was incorrect and did not show correct payment amounts. I called Community Radiology on 10/06/21, talked to Gerome. He asked me to send the explanation of benefits and credit card payment information to ***************************. I emailed all documents on 10/06/21 (enclosed) with explanation as given below: 1. Explanation of Benefits (EOB): It shows two bills submitted by Community Radiology. The insurance compnay allowed $153.36, the member's responsibility was $50 and paid the remaining balance of $103.36. 2. Claim Detail: It shows GEHA made a total payment of $103.36 after adjustments for 2 claims by check#XXXXXX to Community Radiology Associates. 3. Credit Card statement: The patient made a payment of $50 (see highlighted payment to Germantown Imaging), while the entered amount on the statement is $0.57. As such, the patient's responsibility is $0 after all payments made by the insurance and patient. Instead of correcting the bill after getting all documents, they sent the same bill in October. I forwarded my email again to them. Now today again I received the same bill without any corrections. They need to make correction in the bill, but they are not paying attention to supporting documents sent by me.

  Business response

  02/08/2022

  Business Response /* (1000, 9, 2021/12/16) */ ***Document Attached*** Please be advised we have reviewed this inquiry in entirety. The patient had a total of seven exams performed on the date of service in question. We have attached the explanation of benefits that correlates with this date of service reflecting that the patient had a responsibility of $149.43 for these services. $50 was paid at time of service therefore the patient is being billed in the amount of $99.43. Consumer Response /* (3000, 11, 2021/12/18) */ (The consumer indicated he/she DID NOT accept the response from the business.) The bill sent to me by Community Radiology (attached again) is different from the three bills provided by community radiology. The invoice sent to me does not show the payment made by the patient. They have submitted three bills for the same visit. The patient liability is $50 for X-rays no matter how many x-rays are done during the visit. This is fradulent to send three different bills on the name of three different providers for the same visit visit for X-rays at Community Radiology. Since community radiology sent three different bills to the insurance on three different names, insurance does not know if it is for the same visit and they must have charged three copayments. The community Radiology must send one bill for all X-rays done at the facility during the visit rather than sending three different bills.

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