ComplaintsforPacific Medical, Inc.

• Initial Complaint

  03/11/2024

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  On Thursday February 1 2024 I went to urgent care in ********** after I injured my right knee during a sport activity. Following a recommendation from the physician there, a nurse fitted me with a simple hinged knee brace. They didn't know the price of the brace, but since I have used braces before and given the simple construction of the brace, I imagined it to be around $100. Therefore, I agreed to pay the bill in case the insurance won't covered it. However, I just received the bill from Pacific Medical. They charged $675 for this simple brace!!! This is outrageous. There is no world in which a brace like this should cost as much. I googled similar orthopedic braces and the top price that I could find for the same construction was $80. More complicated braces where at the $200 range at the most. There markup is simply infuriating! My insurance already paid about half of it ($353.35) and got billed for the rest $321.65. I called to complain about the outrageous mark up but they shut me down that 'this is the price.' Since the insurance already paid way over market price, I don't think I should pay anymore.

  Business response

  03/22/2024

  Hello, 

  Insurance did not pay on the claim, they took a contractual adjustment (provider write-off) in the amount of $353.35. and applied the balance of $321.65 to the members deductible which is patient responsibility. We will offer a discount to $250.00 as a onetime goodwill adjustment, I have made the adjustment on the account in question. Should you have any further questions or concern please feel free to contact me directly. 
  

  Thank you, 

  ***********************

  Pacific Medical, Inc. 

  **********************

• Initial Complaint

  02/15/2024

  Complaint Type:

  Service or Repair Issues

  Status:

  Resolved

  More info

  I was issued a post surgical boot from my foot surgeon *****************. The boot was issued in his office, but provided by Pacific Medical. I received a bill for ****** which did not include a payment from my insurance. I contacted the insurance company and was told that Pacific Medical had billed for a boot for a flat foot condition, not a post operative one. I contacted Pacific Medical which requires very long hold times and explained. They said they would rebill. The next month I got the same bill so I contacted them again. This employee was very rude and told me its not their problem and I just had to pay the bill. I called again the next day and talked to someone else and they said they'd look into it. Another month, another bill. I called billing at the surgeons office and was told that they had coded correctly for a post surgical boot when they sent it to Pacific Medical and they were nice enough to call on my behalf. After thirty minutes of waiting they left a detailed message with the correct code, so I was hopeful that the issue would be resolved. But, I have now received another bill with an additional ***** late fee. I called and after a 41 minute hold, left a message again. I also emailed. I don't know how else to get this resolved. I don't feel that I should have to pay what my insurance will cover at one hundred percent because they can't get the correct code sent in. Any help would be appreciated.

  Business response

  02/15/2024

  Good afternoon, 

  I am looking into this and will get back to the patient by the end of the week or early next week at the latest. I have requested additional information from the field, what I have here is insufficient, but I do believe the item should be covered from what I can see, barring any policy exclusions that I am unaware of. The claim will be appealed once I receive further documentation. Should you have any questions or concern please feel free to contact me directly. 

  Best, 

  ***********************

  Pacific Medical, Inc. 

  ********************** 

  Customer response

  02/15/2024

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

• Initial Complaint

  02/14/2024

  Complaint Type:

  Customer Service Issues

  Status:

  Resolved

  More info

  08/30/2023 was date of transaction. Cant find out what medical provider sent bill to Pacific Medical *** Called multiple times and got no response Can you help me find provider that Pacific medical ***. received the bill from?Also the penalty is 2.5 times the bill. Is this legal?I will pay the $35.77 hoping that you can get me the information

  Business response

  02/15/2024

  Good morning, 

  I spoke with the patient this morning and this matter has been resolved. 

  Thank you, 

  ***********************

  Pacific Medical, Inc. 

   

   

   

  Customer response

  02/15/2024

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

• Initial Complaint

  02/05/2024

  Complaint Type:

  Sales and Advertising Issues

  Status:

  Answered

  More info

  I went to the ** for pain on my foot on 12/07/2023. They deemed that I needed a post op shoe. Later on my insurance informed me that Pacific Medical *** had try to process a claim using the wrong code for the item and Anthem obviously rejected the claim. I put my health concierge to work on this and she clearly explained to them that they need to use the correct code for the insurance or waive the charges. Weeks later I receive a predatory call followed by an email to pressure me to pay the $38 that the boot costs. Pacific Medical tried to use the excuse that Anthem refused the claim because the device is not covered which is an absolute lie. The explanation of benefits clearly states that the wrong code was used yet Pacific Medical resorts to pressure tactics to make you cough up the money. I explain to them that they need to use the right code or waive the charge as my health concierge has already explained. After that I even got an email from them discussing the code they used and still stating that this is my responsibility. To Pacific Medical, it is not my responsibility that your company is so incompetent that can't use the right code to bill your products. Additionally, it is not my responsibility if you can't get your s*** together and need to resort to the use of predatory tactics both in the **, over the phone and over email.

  Business response

  02/07/2024

  Good afternoon, 

   

  I have reviewed the account in question and unfortunately the item is simply not covered by the patient's insurance (see attached EOB). We cannot change a code in order to get paid for obvious reasons. The patient also signed a Patient Product Agreement accepting financial responsibility should an item not be covered. (see attached PPA). I have waived the $25.00 late fee which would have appeared on the March statement, and we will accept the outstanding balance of $38.00 as payment in full. Please make this payment as soon as possible to avoid any further late fee charges. Should you have any further questions or concerns please feel free to contact me directly. 

  Thank you, 

  *********************** ********************

  Pacific Medical, Inc. 
  

   

  Customer response

  02/07/2024

  I attached my explainations of benefits in where anthem states ************ on this claim have been denied because the provider billed using a procedure code that it not on the fee schedule. The member is not responsible for this amount". So clearly something is off between Pacific Medical *** and Anthem. Maybe you should look into that.

  Business response

  02/07/2024

   

  Anthem is unaware that you signed the Patient Product Agreement accepting financial responsibility for the item in question if denied by insurance. Had you not signed the agreement you would not be financially responsible for the denied claim. 

  Thank you, ****
  

  Customer response

  02/08/2024

  Right, so that comes back to my original statement on how Pacific Medical uses shady business practices to get people's money. Put an agreement in front of a patient in the middle of an ER when they are worried about their health issue, get them to sign and then ransack their money. The absolute patient forward way to do things. Why make money in a responsible way when you can just trap them to sign in a vulnerable state so you can profit of the situation. Good thing that ***************** wants to follow up on how my experience was at their ER. For sure they will hear about this experience. 

  Business response

  02/08/2024

  Unfortunately, we cannot help that the item in question is not covered by your insurance, we also cannot supply free goods and services. your Dr. prescribed the item, we did not, we only provided the item your Dr. felt necessary to aid in your recovery. While most items prescribed are covered benefits, some items are not covered by insurance and become the patient's responsibility. 

  Customer response

  02/08/2024

  That doesn't change the fact that Pacific Medical engages in shady business practices as well as predatory calls and emails to their customers. There must be a reason why you only have one star in BBB and most complains kinda fall onto the same ************. You can use as many excuses as you want to justify your shady business practices if that makes you feel better but it won't change the matter of the fact. If the business practices followed by Pacific Medical were good practices with the patients in mind you would have glowing reviews.

• Initial Complaint

  12/20/2023

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  On February 17 2023 I received care from ********************* at an urgent care in Tahoe ********** for a skiing accident (concussion + fractured arm). I was concussed and had zero memory of my treatment at the urgent care, but I later was able to get a bill from ********************* and pay for it with my insurance.Months later, I get a bill in the mail from Pacific Medical **** a company who provided my sling, for $23. At this point I've apparently racked up a separate $25 late fee. If it was possible to pay up front I would have just paid $23 at the urgent care with a credit card. This billing practice is predatory and designed to force consumers into ridiculous late fees that cost more than the actual bill.I then called Pacific Medical to try to pay my bill. After a few days of not answering I got on the phone with a representative. I asked her if I could give her my insurance information to see if we could file a claim and have my insurance pick up some of the cost. She told me that the $23 was their "cash price", and if I tried to see if my insurance would cover it and the insurance would not, then the rate for the service would 6x to $145!! That is, I was given a price, but if I filed a claim with my insurance and the insurance would not pay the full amount, they would retroactively 6x the bill that I was given for literally no reason. It has to be against the law to 6x a bill retroactively just because a patient tried to pay another way, that way would not work, and they tried to pay the original way.Now I am scared to ask my insurance to pick up the tab because this predatory company will stick me with even more fees and end up charging me almost 8x what I could've just paid with a credit card at the urgent care.

  Business response

  12/21/2023

  Hello, 

   

  I have spoken with the patient, this issue has been resolved. 

   

  Thank you, 

  ***********************

  Pacific Medical, Inc. 

• Initial Complaint

  12/18/2023

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  I received a knee brace from Renown Medical Group and was billed $67.38 sometime around January/February 2023 from Pacific Medical, Inc. for the brace. I paid the bill in full on April 23, 2023. Despite paying the bill, I continued to received statements from Pacific Medical, Inc. for two months before calling to tell them it was already paid. I spoke to a man named *********************** who claimed to be in charge of the department. I emailed him a screenshot of my payment being made to the company via the company website, as well as a copy of my bank statement (all information blacked out besides the Pacific Medical charge) to prove the company that the bill was in fact paid out of my bank account. Vishal reassured me that it would be taken care of and that the statements should stop coming and to disregard them until they stop. It has now been 8 months of trying to contact them again to tell them the statements haven't stopped coming, instead they're now on red paper telling me my account is seriously delinquent. Despite several calls over the last 6 months, I cannot get ahold of anyone from Pacific Medical and no on has returned any of my voice messages. I would like them to acknowledge my payment made to them and stop sending my statement for a bill I already paid, and already proved that I paid. I do not want anything going to collections that shouldn't be and I do not want this to create further problems in the future.

  Business response

  12/21/2023

  Hello, 

   

  This account has been marked as paid in full, should you have any other questions or concerns please feel free to contact me directly. 

  Thank you, 

  ***********************

  Pacific Medical, Inc. 
  

• Initial Complaint

  12/18/2023

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  I was double billed for a medical device. I paid cash for the device at *************** my insurance (Tricare) was billed, and then I was sent a bill. I have tried to contact Pacific Medical **** for over a week to speak with a representative unsuccessfully. It goes voice mail every time. I have left messages and no call is returned. I even tried the Espaola extension and that extension just hangs up on me. I received only 1 bill from them and it states it is overdue and penalties have been applied and will be sent to collections.

  Business response

  12/20/2023

  Good morning, 

   

  I have reached out to the patient and am waiting to hear back. 

   

  Thank you, 

  ***********************

  Pacific Medical, Inc. 

• Initial Complaint

  12/14/2023

  Complaint Type:

  Order Issues

  Status:

  Answered

  More info

  On 10/30/23 I was given a shoulder sling at my in-network hospital. I could not move my arm or sign anything so a paper was given to a family member to sign for the sling. Unbeknownst to me, they signed a form that said I could be billed for this out of network item. My insurance does not cover out of network anything. I now have a $148 dollar bill to pay for a $23 item when I went to an in network hospital to begin with. DOES NOT SEEM FAIR to do this to patients in pain. I called the company when I figured this out and they said to call back later. I called back twice and left a message once and sent a message on the contact us form -- all during business hours. No response yet.

  Business response

  12/19/2023

  Good morning, 

   

  The notes on the account indicate that the patient was sent a questioner from their insurance, the insurance is waiting for the questioner to be returned prior to processing the claim. Please contact your insurance for further information. Should you have any further questions or concerns please let us know. 

  Bet regards, 

  ***********************

  Pacific Medical, Inc. 

  Customer response

  12/19/2023

  I am rejecting this response because:  I have contacted my insurance representative and they are not paying this claim from Pacific Medical because Pacific Medical is out of network for me (even though I went to an in-network hospital as previously noted).  I already communicated my insurance representative's response to Pacific Medical's *********************** via email at Fri, Dec 15, 8:51?AM.
  

  Business response

  12/20/2023

  Hello, 

   

  We are a cotracted provider. Please have your representative contact me directly if you have further questions. As I stated the insurance company is looking to see if a third party has liability, Some kind of accident or something of that nature. Please contact them about the questioner. 

   

  Thank you, 

  *********************;
  

  Pacific Medical, Inc. 

• Initial Complaint

  11/28/2023

  Complaint Type:

  Product Issues

  Status:

  Resolved

  More info

  My daughter was seen in the ** 9/9/2023 for a broken arm. The ** offered an arm sling. They did not disclose pricing or who the supplier was. Surprise to me when I received a bill in the mail for $148, with an insurance adjustment of $69.27 with a remaining balance of $78.73. A quick ****** search of the part number for the sling, $23.00. How are they able to upcharge that much just because you have insurance? I could have gone to my local ******* and picked one up for $10-$15. I am more than happy to pay the $23.00 this arm sling shows it costs online.

  Business response

  11/28/2023

  Good afternoon, 

  I have reviewed the claim in question. As stated, the amount of $78.73 was applied to the patient's deductible which is patient responsibility per their insurance policy. An online purchase is a very different, simpler transaction than billing one's insurance. Insurance billing requires many different items, patient records to prove medical necessity, specific forms are also required, among other things. That being said we are willing to accept $50.00 as payment in full as a onetime goodwill adjustment. I have also attached the signed Patient Product Agreement, which clearly states that the patient was under no obligation to accept the item in question and could go to any vendor of their choice. If there are any further questions or concerns, please feel free to contact me directly. 

  Best regards, 

  ***********************

   Pacific Medical, Inc. 

  **********************

   

  Customer response

  11/28/2023

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

• Initial Complaint

  11/20/2023

  Complaint Type:

  Customer Service Issues

  Status:

  Resolved

  More info

  On 07/14/2023 I was wrongly billed a statement for service fees that should have been directed to VA ************** as every other bill regarding my Achilles surgery was. Pacific Medical continues to attempt to collect from me what they know should be billed to VA. I have spoken to them before after getting the run around regarding a separate service bill. I have spoken to the twice previously and have left three different voicemails with them that have yielded no response back from them with an attempt to resolve this issue, but rather I received another bill statement NOTICE being told that I will be charge a $25 late fee on top of the $360.18 balance due for account number ********. This company is purposely avoiding following up with me to correct this long-running error on their part and I am beyond frustrated with their unprofessionalism. Again, they are supposed to be billing VA ************** regarding any and all charges, but refuse to do so.

  Business response

  11/28/2023

  Good afternoon,

  I have reviewed the account in question. Unfortunately, the VA will NOT cover DME, they have their own DME so they will not pay a separate provider for such things. Pacific Medical, Inc. at this time is willing to accept $280.00 for all items received as a onetime goodwill adjustment and waive any late fee charges. Should there be any further questions please contact me directly. 

  Thank you, 

  ***********************

  Pacific Medical, Inc. 

  **********************

   

  Customer response

  11/28/2023

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

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