Complaints

This profile includes complaints for Flagler Health and Wellness, LLC's headquarters and its corporate-owned locations. To view all corporate locations, see Find Local Branches.

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  Flagler Health and Wellness, LLC

  1803 S Australian Ave West Palm Beach, FL 33409

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  Flagler Health and Wellness, LLC

  980 N Federal Hwy Ste 310 Boca Raton, FL 33432-2744

The complaint text that is displayed might not represent all complaints filed with BBB. Some consumers may elect to not publish the details of their complaints, some complaints may not meet BBB's standards for publication, or BBB may display a portion of complaints when a high volume is received for a particular business.

• Initial Complaint

  Date:05/28/2024

  Type:Service or Repair Issues
  Status:

  AnsweredMore info

  Complaint statuses

  Resolved:

  The complainant verified the issue was resolved to their satisfaction.

  Unresolved:

  The business responded to the dispute but failed to make a good faith effort to resolve it.

  Answered:

  The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.

  Unanswered:

  The business failed to respond to the dispute.

  Unpursuable:

  BBB is unable to locate the business.

  My son, *******************, entered Flagler's treatment facility from 11/29-12/11/2023. They are an in network facility for his primary insurance provider (UMR) and accept their payment as payment in full. I paid UMR's required deductible of $2500 on 11/29 (receipt attached). I received a call on 12/9 requiring an additional $7500 for coinsurance payment (receipt attached), at which point his primary covers at 100%. They were provided his secondary insurance provider (who will reimburse the out of pocket of $10k), but said they do not bill secondary insurance and that ****** had a $0 balance with them. I explained that secondary needed to be billed to reimburse the out of pocket $10k. They provided me with a total bill (attached) which only reflects the $2500 deductible being paid (not the $7500 coinsurance). They would not provide a bill showing the $7500 payment. I filed the primary EOB's and the receipts for the $10k out of pocket with ***** requesting the assignment of benefits pay to Chance. Aetna could not pay to Chance, because the *** EOB's reflect a balance to Flagler, because Flagler billed incorrectly. So, ******'s out of pocket was paid to Flagler, creating a $10k overpayment to them. After many calls (attached phone logs for both) to Aetna (hours) and months worth of communication with Flagler (who will not return my calls) requesting to speak to their 3rd party billing to have the claims to his primary corrected to reflect the copay, the only answer I was given by ***** was that they would be keeping the overpayment stating "it was their portion". Flagler confirmed that he had a zero balance with them, prior to secondary being billed...and, they do not bill secondary. Yet, now that I personally billed Aetna, who has paid them directly because UMR was billed incorrectly by Flagler, they refuse to release the overpayment of the $10k. I have any/all documentation needed to prove that the Aetna secondary insurance payment was NOT due to them.

  Business Response

  Date: 06/25/2024

  Patient responsibility was collected for this case for their primary insurance, after admission it was stated a secondary insurance was available to help with billing. Upon submitting the secondary insurance to us, the secondary insurance covered expenses that were not covered under the primary insurance plan, however this did not apply to the patient responsibility. Payment was made via the secondary insurance to our company to cover charges that were not initially covered by the primary insurance and due to this being a payment from an insurance company for services, we are unable to process a refund for this scenario. We are required to collect patient responsibility in every case we have. We also cannot process a refund, when the payment was for services provided from an insurance company. This was verified with our billing company in collaboration with our collections company. 

  Customer Answer

  Date: 06/26/2024

  I received a call from ******* at Flagler on Nov 29, 2023.  He told me that my son had called their hotline and was suffering from Fentanyl withdrawals and would likely die if I did not get him on a plane to treatment, asap.  He said because he had insurance coverage I would only need to pay the $2500 deductible.  I received a call from a different Flagler representative on Dec 7th who said they needed $7500 but that the $7500 would satisfy the plans max out of pocket requirement of $10k, and insurance would pay at 100% for all charges after.  He explained that my sons portion of the treatment (after deductible was paid) was $1000 per day and this was the 9th day.  So, if I did not pay the $7500 in full today, they would have to send him home.  A payment plan was never offered only requested if I had a credit card that the $7500 could be charged to.  He was discharged from treatment on Dec 11.

  After his discharge, I called ***** to provide his secondary insurance information.  ***** informed me that they do not file secondary insurance and that my son did not have a balance due so there would be no reason for them to file claims to secondary anyway.  In order for secondary insurance to be filed, I/my son would have to submit to *****.  I asked repeatedly for a bill from Flagler for the full costs with the receipts of the $2500 deductible and $7500 max out of pocket.  I submitted the one that they provided when filing this claim, which does not reflect the $7500 payment.  When I spoke with *****, she said "that's just the way they break out the coinsurance on their side" and assured me that ****** had a zero balance, regardless of the balancing showing on my copy.  I questioned that saying how will secondary be able to reimburse him his out of pocket ($2500/$7500) if both are not listed on the bill.  She suggested that submit the primary insurance (UWR) ***'s with the receipts proving his payment.  She said she does not have a bill format that will itemize the portion that he paid. 

  This is where the problem begins and ends.  Flagler billed the primary insurance not reflecting his paid coinsurance.  So the *** that the secondary insurance had to pay from looks "as if" Flagler was still owed money.  They in fact were not.  It was a zero balance on his account, they do NOT bill secondary insurance (nor would they have a reason to if the balance is $0) so even though the $2500/$7500 receipts were provided to his secondary insurance with primary insurance ***'s, it makes the ***'s read that there was a balance due with Flagler.

  Flagler did not bill primary correctly.  Flagler was not owed any money from secondary.  ******************* only paid Flagler because they bill primary incorrectly.  Flagler should refile ******'s claims correctly to UWR to create correct ***'s reflecting the out of pocket he paid...or, they need to reimburse the over payment to Chance. Again, his balance was $0 before secondary (that they refused to bill) was ever filed.

  Customer Answer

  Date: 06/26/2024

   
  Complaint: 21759872
  
  I am rejecting this response because:  I received a call from ******* at Flagler on Nov 29, 2023.  He told me that my son had called their hotline and was suffering from Fentanyl withdrawals and would likely die if I did not get him on a plane to treatment, asap.  He said because he had insurance coverage I would only need to pay the $2500 deductible.  I received a call from a different Flagler representative on Dec 7th who said they needed $7500 but that the $7500 would satisfy the plans max out of pocket requirement of $10k, and insurance would pay at 100% for all charges after.  He explained that my sons portion of the treatment (after deductible was paid) was $1000 per day and this was the 9th day.  So, if I did not pay the $7500 in full today, they would have to send him home.  A payment plan was never offered only requested if I had a credit card that the $7500 could be charged to.  He was discharged from treatment on Dec 11.
  After his discharge, I called ***** to provide his secondary insurance information.  ***** informed me that they do not file secondary insurance and that my son did not have a balance due so there would be no reason for them to file claims to secondary anyway.  In order for secondary insurance to be filed, I/my son would have to submit to *****.  I asked repeatedly for a bill from Flagler for the full costs with the receipts of the $2500 deductible and $7500 max out of pocket.  I submitted the one that they provided when filing this claim, which does not reflect the $7500 payment.  When I spoke with *****, she said "that's just the way they break out the coinsurance on their side" and assured me that ****** had a zero balance, regardless of the balancing showing on my copy.  I questioned that saying how will secondary be able to reimburse him his out of pocket ($2500/$7500) if both are not listed on the bill.  She suggested that submit the primary insurance (UWR) ***'s with the receipts proving his payment.  She said she does not have a bill format that will itemize the portion that he paid. 
  This is where the problem begins and ends.  Flagler billed the primary insurance not reflecting his paid coinsurance.  So the *** that the secondary insurance had to pay from looks "as if" Flagler was still owed money.  They in fact were not.  It was a zero balance on his account, they do NOT bill secondary insurance (nor would they have a reason to if the balance is $0) so even though the $2500/$7500 receipts were provided to his secondary insurance with primary insurance ***'s, it makes the ***'s read that there was a balance due with Flagler.
  Flagler did not bill primary correctly.  Flagler was not owed any money from secondary.  ******************* only paid Flagler because they bill primary incorrectly.  Flagler should refile ******'s claims correctly to UWR to create correct ***'s reflecting the out of pocket he paid...or, they need to reimburse the over payment to Chance. Again, his balance was $0 before secondary (that they refused to bill) was ever filed.
  
  Sincerely,
  
  ***************************