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Dayton and the Miami Valley

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Emergency Medicine Specialist, Inc.

Phone: (937) 436-4658Fax: (937) 436-4984

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Customer Complaints Summary

2 complaints closed with BBB in last 3 years | 0 closed in last 12 months
Complaint TypeTotal Closed Complaints
Billing / Collection Issues2
Advertising / Sales Issues0
Problems with Product / Service0
Delivery Issues0
Guarantee / Warranty Issues0
Total Closed Complaints2

Complaint Breakdown by ResolutionAbout Complaint Details

Complaint Resolution Log (2)BBB Closure Definitions
07/22/2013Billing / Collection Issues
12/09/2013Billing / Collection Issues | Read Complaint Details
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Complaint
My heath insurance says I do not owe them ANY money. They billed me and sent me to a collection agency.
I entered Kettering Medical Center's emergency room on July 7 with a heart attack. Emergency Medical Specialists provided services. They sent me a bill. Humana said I did not owe any money. I sent them a copy of the EOB showing no money was due. They did not respond. My wife left a voicemail message with no reponse. I called and they said they would talk to Humana. Humana says they were paid what their contract provides. They did not call me back after talking to Humana. They sent me to a collection agency for money I do not owe them.

Desired Settlement
Correct the bill. Stop the collection agency. Appologize for such immoral behavoir. Provide more training to clearly incompetent billing department.

Business Response
The claim was submitted to the patient's insurance company and the insurance company incorrectly processed the claim taking an unauthorized discount. We contacted Humana on 08.15.13, 10.15.13 and 11.14.13 and requested that they reprocess the claim as out of network. They have not responded and have not reprocessed the claim. In this situation since Humana has not reprocessed the claim the balance of the claim becomes the responsibility of the patient. The patient should contact their insurance company and request that the claim be reprocessed. When the patient and his wife have called into our office they were rude and condescending to staff. The billing department has processed this claim correctly. Patient should also understand that when/if Humana reprocesses the claim as out of network the patient may have a balance due depending on insurance deductibles/copays. We will allow another (4) weeks for the patient to work with Humana to reprocess claim and request that the account have no additional contact until December 19th from the collection agency.

Final Consumer Response
(The consumer indicated he/she DID NOT accept the response from the business.)
Correct the bill. Check: Humana said you resubmitted recoded bill.

Stop the collection agency. Don't know yet, since you've been paid this should be done.

Apologize for such immoral behavior. Not yet. If you are operating as part of an "In Network" hospital don't gouge patients with "Out of Network" charges. Tax cheats like sub corporations are truly foul and immoral.

Provide more training to clearly incompetent billing department. I hope you will. We contacted you three times without response before you threatened collections. You then promised two week delay before sending us to collections. You waited only two or three days.

Apologize as requested and train your people to return calls and follow through with their promises. These are very simple customer service oriented things you can and should do.

Final Business Response
The bill was submitted correctly to Humana. There is not a code for "true emergency." The CPT codes and E/M level billed properly represented the nature of the visit and the severity of the case. Since the last communication Humana has already reprocessed the claim and paid the balance due. The claim has been settled and the account balance is at zero.

Thank you.

Industry Comparison| Chart

Physicians & Surgeons - Medical-M.D., Medical Coding, Billing Service, Medical Billing Services

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BBB Business Reviews are provided solely to assist you in exercising your own best judgment. Information in this BBB Business Review is believed reliable but not guaranteed as to accuracy.

BBB Business Reviews generally cover a three-year reporting period. BBB Business Reviews are subject to change at any time.