ComplaintsforLenox Hill Radiology

• Initial Complaint

  08/16/2024

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  I was billed as the responsible party for an MRI Spine Lumbar WOC my daughter had on 3/7/23 at ***********************************. The balance billed after METROPLUS insurance adjustment of $442.40 was $663.60. I sent three payments monthly in May, June, July of $110.60 each, when I received a letter from Balanced Healthcare Receivables, a debt collector, indicating I had a debt of $442.40. They did not account for July payment, so the actual balance agreed when I called was $331.80. The Collector offered to settle the debt at a 20% discount, or $265.44. I paid this balance by credit card on 1/18/24, which should have left a ZERO balance. Despite this settlement, the account was remitted BACK TO LHR, and now I am being billed the EXACT AMOUNT OF THE WRITE OFF! I dont know how LHR can send this account to collections and NOT accept the settlement they made on their behalf? Instead, they are now chasing me for the amount, which is extremely unethical. I was told by an out-sourced ********** representative there was a new billing from my insurance, but this is NOT TRUE, as the *** was over a year ago and we have not received any info from the insurance to substantiate this LIE (claim). I was able to get a ledger, which shows this went in and out of collections twice and write off UNDONE. Accordingly I wish to clear my account with a ZERO balance, but my letters and calls have not been acknowledged, as I just received another bill today.

  Business response

  08/21/2024

  Dear ************,

  We have completed a thorough review to resolve your concern regarding your account balance with **********************. After researching your calls with ******************** Receivables, it is confirmed that you do not owe a balance of $66.96. Our customer service supervisor reversed the collections prompt, corrected the posting in the billing system, and adjusted off the remaining balance of $66.96, therefore, reflecting a $0.00 balance on your account. 

  Please see the attached statement showing that your account has a $0.00 balance. 

  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

  08/13/2024

  Complaint Type:

  Service or Repair Issues

  Status:

  Resolved

  More info

  i am in need of an mri. recently authorization for mri has been approved. somehow lenox hill has been made aware of my pending scan and authorization. i have used the west nyack, ny location before and was unhappy with the technician and how she spoke to me. i will not return for service there.my issue is: lenox hill has repeatedly called and sends text messages stating i am scheduled for my upcoming mri with them. i have not set up any appointments with them, i have not contacted them regarding my current testing needs. i have called at least twice to complain to them about contacting me, both times i was assured i would be removed from automatic scheduling, calls and texts. to no avail.

  Business response

  08/27/2024

  August 19, 2024

  I reviewed the complaint, and conducted an internal investigation into the matter.  We determined that our system showed that 2 exams were scheduled and then cancelled.  There were Provider Appointment Authorization Forms, therefore One Call attempted to schedule the exam.  I spoke directly to the complainant on 08/19/24, and was told they did not want to move forward with scheduling an appointment with our organization, so I confirmed that a stop order for scheduling was processed and that no further messages regarding this appointment would go out.  The complainant was satisfied with this follow-up.

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

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

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

  Customer response

  09/10/2024

  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 and the matter has been resolved.
  
  Sincerely,
  
  *******************************
  
  
  
   
  
  

• Initial Complaint

  08/01/2024

  Complaint Type:

  Product Issues

  Status:

  Resolved

  More info

  On 2/14/2024 I went to *** for my annual mammogram and sonogram. I was charged $226 and was told it was for my deductible. I thought it was strange but I was using a new insurance ** so I agreed to pay. On 4/2/24 I noticed my insurance ** never applied the 226 to my deductible so I called them to inquire. I was told by United Health that there was no deductible and LHR never should have charged me for one. The agent called LHR on my behalf and spoke with ******* and was told that they shouldn't have charged me but they still weren't paid for the sonogram and she **uldn't give a refund until that was paid by the insurance. On 5/15/24 I called my insur ** again and they called LHR and spoke with ****** of LHR who said that a wrong modifier was used and that is why they weren't paid for the sono. He agreed I was owed the 226 but had to resubmit the claim before reimbursing me. In June I found out that LHR submitted the claim again but to the WRONG insurance **. I called LHR and asked numerous times to speak with supervisor to no avail. I spoke with *** who ended up promising me that her supervisor authorized my refund that day 6/24. I have yet to receive a refund. I have been going to this facility for over 30 years (2 previous owners). They have lost me as a patient! Total in**mpetency and by reading other **mplaints it is obvious this is a pattern. They bill out for something they shouldn't and probably hope that the patient doesn't notice or just doesn't have the energy to deal with them. Why I have to wait from them to get paid for the sono has nothing to do with the fact they charged me for something they shouldn't have. To sum it up, they billed me 226 when they shouldn't have, they submitted their first claim to the insurance for sono wrong. They resubmitted the claim but send it to the wrong insurance **mpany. I am still waiting for my refund.

  Business response

  08/08/2024

  Please be advised that it is our policy to collect an estimated cost share for procedures at the time of service.  Patient benefits are confirmed via an EDI **************** Interchange) process. The cost share information is requested at the time of scheduling and/or at the time of service through a 270 real-time connection to the insurance.  A 271 response is received from the insurance which provides patient eligibility and any out-of-pocket costs for which the patient would be responsible- including Co-payment, Co-Insurance,and/or Deductible. If the insurance returns the 271 in a timely fashion,patients are notified of their estimated cost share when contacting the site to schedule services.
  
  After services are complete and the radiology report is finalized, services are coded (CPT/ICD10) and submitted to the insurance carrier.  After processing the claim, the insurance issues an Explanation of Benefits (***) which is the most accurate source for providing the patient and provider with information on how the services were adjudicated.  

  Following a thorough review of ******************** account and complaint, it has been determined that the 271 response received from the patient's insurance showed a patient responsibility amount of $226.02. Once the claim was processed and the *** received, it was discovered that the claim was denied by the payer with no patient responsibility owed. An adjustment was not properly applied to the claim by the system which caused a balance to be owed and billing statements to be automatically sent to the patient in error. We have since applied the adjustment to the claim and a refund of the time-of-service payment amount of $226.02 was sent to the patient's credit card on Friday 8/2/24. There is no balance showing on ******************** account and she will not receive any additional billing statements for this date of service. 

  System errors such as this are rare and not indicative of a recurring trend. It was only after an in-depth investigation into the patient's account and payment history that this error was discovered. With that said, this issue should have been identified, researched, and addressed when **************** contacted our customer service department. We strive to provide a positive and efficient customer service experience and this clearly was not achieved in this instance. We apologize to **************** for the delay in receiving her refund and for any inconvenience it 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.

  Customer response

  08/09/2024

  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 and the matter has been resolved.
  
  Sincerely,
  
  *****************************
  
  
  
   
  
  

• Initial Complaint

  07/09/2024

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  I went into a Lenox Hill facility to have a 3D ultrasound on 3/20/24. I was charged $306.14. I was told that a mammogram would be recommended by the provider because of my reason for coming but it would be a few hundred dollars more as well. Because of this, I declined the mammogram at that time. On 5/16 I checked my insurance website and saw that the $306.14 was not taken from my deductible because my insurance had paid that amount to Lenox Hill Radiology and that the patient responsibility was $0. I called my insurance company and they said that the 3D imaging and mammogram should have been $0. So not only did I get charged, I did not perform an exam I needed because of the price they were going to charge me additionally. My insurance company called them on 5/16 and Lenox Hill ensured them that I would receive a refund. My insurance company also called up the office to let them know I should NOT be charged for a mammogram when I went. I went on 6/24 to have the mammogram performed. Because now the mammogram would be coded differently because its a follow up visit, now it would actually be hundreds of dollars and they said I needed a different referral than the one I already had. I was confused by this because the first time I came they were going to have me do a mammogram without a referral(I only had a referral for the imaging) but this time I had a referral and they said that would not work. I also called up my insurance and had them speak to Lenox Hill billing again about the refund and they said they would process it. When asked why it seems like I have to call for it to happen they said they were waiting for the claim to be processed, which is strange because the whole reason this was drawn to my attention is because I saw that the claim was processed and that my insurance paid the total amount on 5/6. It seems like this error would have been overlooked if I had not reached out. I have still not received a refund or gotten the needed ultrasound.

  Business response

  07/09/2024

  Please be advised that it is our policy to collect an estimated cost share for procedures at the time of service.  Patient benefits are confirmed via an *** **************** Interchange) process. The cost share information is requested at the time of scheduling and/or at the time of service through a 270 real-time connection to the insurance.  A 271 response is received from the insurance which provides patient eligibility and any out-of-pocket costs for which the patient would be responsible- including Co-payment, Co-Insurance,and/or Deductible. If the insurance returns the 271 in a timely fashion,patients are notified of their estimated cost share when contacting the site to schedule services.
  
  After services are complete and the radiology report is finalized, services are coded (CPT/ICD10) and submitted to the insurance carrier.  After processing the claim, the insurance issues an Explanation of Benefits (***) which is the most accurate source for providing the patient and provider with information on how the services were adjudicated. 
  
  After a thorough review of ************** account and complaint,it has been determined that the 271 response we received from her insurance showed a patient responsibility amount of $306.14 which the patient paid. We received an *** from the payer on 5/30/24 showing that there, in fact, was no patient responsibility. A refund was automatically initiated in our system and was sent to ************** on 6/11/24 (check number *******). If the patient has not received the refund, we will gladly reissue a check to her.
  We apologize to the patient for any inconvenience this issue *** have caused. As previously stated, the patient responsibility amount we quote as an estimate is received directly from the patients insurance. *** ************** showed a deductible amount and it was only after we received the *** that we were able to identify the overpayment and refund the paid amount.  
  In regards to the mammogram, I will have a team member reach out to the patient to schedule an appointment and resolve any issues that *** arise.
  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

  06/25/2024

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  Had an MRI on June 19,2024. Was told it would take up to 3 days. It is almost a week and every time they say tomorrow

  Business response

  07/15/2024

  Our goal is always to provide prompt and efficient service, and it is clear that in this instance, we did not meet those expectations.  After reviewing the situation, we would like to offer some insight into the factors contributing to the delay.  There were some unforeseen issues coupled with such a high volume of cases.  To address this issue and prevent future occurrences, we are increasing staff and implementing new processes to ensure compliance and meet expectations.  We apologize for any inconvenience this situation has caused.

• Initial Complaint

  06/11/2024

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  I am being billed for a service that is covered by my insurance on the date of service. This company billed my insurance incorrectly, got a denial and then proceeded to bill me. I have called them many times and each time their said they will fix it and resubmit and that I shouldn't worry about the bill. However, they send me to collections anyway. I called my insurance and they told me they requested more information from Lenox Hill radiology that they never received. This has been going on for over a year now. Rather than billing my insurance properly again, they are sending me to collections again. This is a covered service and they need to do their job and bill correctly. They are ruining my credit score. Since last year, my credit score has gone down 100 points. I have not other outstanding bills. Additionally, I'm constantly being harassed by collection agencies.

  Business response

  06/12/2024

  After thoroughly reviewing the patient's account and complaint, it has been determined that our system failed to make an adjustment on the claim for the date of service at issue. We have since manually adjusted the correct amount and there is no balance owed. I have further placed a billing hold on **************** account so that she will not receive any further erroneous billing statements.

  System issues such as this are rare and not indicative of an ongoing trend. It was only after an in-depth investigation into the patients account and payment history that this missing adjustment was able to be located and applied correctly. With that being said, this issue should have been properly identified and addressed by our customer service department during their conversations with the patient. We have informed the appropriate management and executive leadership of this misstep so that they may provide education and training to ensure that errors of this kind do not occur going forward. We apologize to ************ for any inconvenience this issue 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

  06/07/2024

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  On 4/18/24 I appeared for an appointment for a sonogram. I was told that I had to pay $500.00 prior to the appointment and the facility accepts Care Credit (non interest credit card). When I arrived, I had to use my credit card, to no fault of my own. The system was not working properly on Lenox Hill's end. I confirmed this with Care Credit after my appointment. On 4/19/24 I called and asked if they could refund my credit card and charge my Care Credit card so I can pay it off with no interest. I was told to email the receipt of payment. On 4/25/24, I followed up via email with no response. On 4/26/24 I called Lenox Hill billing department asking if they received proof of payment and I was told yes, but now I have to wait until they receive the explanation of benefits. I have called every Friday since 4/26/24 asking if they received the **** Today, 6/7/24, they told me they received the **** however they cannot refund my credit card and charge the Care Credit and apologized for the misinformation I received. There is nothing they can do. I called their office 5-6 times prior to today and everyone told me "wait until the *** comes in, they have not received it." At no time was I told I could not have my credit card refunded and Care Credit charged.

  Business response

  06/25/2024

  After a thorough review of the patient's account and complaint, it has been determined that ************************** was incorrectly advised that we could not refund her credit card and charge her Care Credit card. We have initiated a refund to the account and will contact the patient for payment once the refund is processed. We apologize to ************************** for the erroneous information she received. We have notified management in our *************************** so that they may provide appropriate training and education to ensure that this issue does not recur going forward. 

  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

  05/17/2024

  Complaint Type:

  Service or Repair Issues

  Status:

  Resolved

  More info

  I have been trying since November of 2023 to get Lenox Hill Radiology to successfully submit their claim for Mammography Screening on October 13, 2023, to my insurer, Cigna.Although Lenox Hill Radiology is in the Cigna network and though Lenox Hill has told me on multiple occasions that they have submitted or will submit the claim, no such claim has been received by *****. Lenox Hill took a $197.22 payment on the day of service for estimated patient responsibility, but services should be completely covered under my Cigna policy, because the visit was for completely covered mammography screening. However,because Lenox Hill has not filed the claim, there is no Explanation of Benefits. And without an E.O.B. Lenox Hill won't refund the $197.22. I have talked to Lenox Hill on numerous occasions as well as to Cigna. Cigna has also called Lenox Hill directly at least twice to give them the claims address. But still nothing. Lenox Hill Radiology has a grade of "F" with the Better Business Bureau, for just this sort of thing, and I don't really know what else to do to try to get back the $197.22 payment. In addition, Lenox Hill is now billing me for an additional $98.78. I talked to Lenox Hill most recently today and they said they now have the correct address to file their claim with ***** and they will process the claim in ***** days. But they have told me similar things over and over since November 2023, so I am also filing this complaint. Can you help?

  Business response

  05/23/2024

  Please be advised that it is our policy to collect an estimated cost share for procedures at the time of service.  Patient benefits are confirmed via an EDI **************** Interchange) process. The cost share information is requested at the time of scheduling and/or at the time of service through a 270 real-time connection to the insurance.  A 271 response is received from the insurance which provides patient eligibility and any out-of-pocket costs for which the patient would be responsible- including Co-payment, Co-Insurance,and/or Deductible. If the insurance returns the 271 in a timely fashion,patients are notified of their estimated cost share when contacting the site to schedule services.
  
  After services are complete and the radiology report is finalized, services are coded (CPT/ICD10) and submitted to the insurance carrier.  After processing the claim, the insurance issues an Explanation of Benefits (EOB) which is the most accurate source for providing the patient and provider with information on how the services were adjudicated. 
  
  After a thorough review of the patients account and complaint, it has been identified that the 271 response we received from ************* insurance on the 10/13/23 date of service showed an amount to collect of $197.22, which the patient paid. A claim was submitted to Cigna Evicore on 10/19/23 and an EOB was received on 10/27/23 showing a denial for non-covered services. There were numerous calls with ***** and attempts to reprocess the claim which were all unsuccessful. After further research, a claims processing error was discovered on Cignas end. We contacted Cigna on 5/15/24 and they acknowledged their system error and are currently reprocessing the claim. We have been advised that it could take up to 60 days for them to process it. As the 271 estimate from ***** stated that there was a patient responsibility, we cannot refund any payments until an EOB is received from Cigna stating that no balance is owed. ************** can contact Cigna for the status of the claim and with any questions regarding its processing.      
  We apologize for the delay in this claim getting processed.
  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

  06/03/2024

  Better Business Bureau:
  
  I have reviewed the response made by the business in reference to complaint ID# ********, and have determined that my complaint has NOT been resolved because:

  Unfortunately, this is exactly the explanation that Lenox Hill Radiology has been giving me since November 2023, and the situation is still not resolved.

  Lenox Hill says they submitted a claim to Cigna on 10/19/23 and that the claim was denied through an EOB on 10/27/23. However, there is no record of that with *****, either through my online account or when I call and talk to Cigna customer service. Cigna has no record of any claim from Lenox Hill for the 10/13/23 date of service. And I certainly have not received this supposed EOB. I have asked Lenox Hill if they can provide me a copy of that denial, but they have not. If a claim really was filed back in October and it was denied, I would have received an EOB reflecting that denial from Cigna.
  

  Similarly, Lenox Hill says they spoke to Cigna on 5/15/24 and that the claim will be refiled and that the problem was due to a system error of Cigna's. However, I talked to Cigna today (6/3/24) and they can't find any record of Lenox Hill contacting them about this. There is no claim number, no trace whatsoever in the Cigna system of anything related to the 10/13/23 date of service. When I asked Lenox Hill to provide me with some reference, they said they spoke to "************** on 5/15/24 at 5:10 PM." Again, when I ask ***** about that, they have no idea who ************** is or any other record of contact from Lenox Hill about anything.
  

  Can Lenox Hill provide a reference number or a claim number or something that I can take to Cigna so that they can find this in their system and advise me of the status?

  Finally, Cigna processes claims within days or at most a week or two with all my other providers, so I can see no reason why this should take another 60 days. As you can see from the notes I uploaded, I have been trying assiduously to resolve this for months and months and months.

   

   

   

   

   

  In order for the BBB to appropriately process your response, you MUST answer the question above.

  
  Sincerely,
  
  *****************************
  
  
  
  
   
  

  Business response

  07/02/2024

  As of today (7/2/24), we still have not received a response from the patient's insurance. Due to the prolonged time period required to resolve this issue, I have initiated a refund of $197.22 to the patient as a courtesy. Once the claim is processed, if the *** shows that a patient responsibility is owed, we will send a billing statement to the patient. Please allow 5-7 business days for the refund to arrive via check.  We apologize to ************** for the length of time it has taken to get this claim processed.

  Customer response

  07/11/2024

  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 and the matter has been resolved.
  
  Sincerely,
  
  *****************************
  
  
  
   
  
  

• Initial Complaint

  04/17/2024

  Complaint Type:

  Billing Issues

  Status:

  Unresolved

  More info

  Lenox Hill Radiology billing department keeps sending me bills for the amount of $42.27. According to my insurance company I owed only $201.11, which I paid at the reception. I contacted Lenox Hill Radiology at least 5 times myself. ***************** called them back in February, they still cannot resolve the problem and now threatening me to send a collection agency after me. I want them to stop harassing me and apologize.

  Business response

  05/02/2024

  We have thoroughly reviewed all aspects of *** ************ complaint.
  
  Please be advised that it is our policy to collect an estimated cost share for procedures at the time of service.  Patient benefits are confirmed via an EDI **************** Interchange) process. The cost share information is requested at the time of scheduling and/or at the time of service through a 270 real-time connection to the insurance.  A 271 response is received from the insurance which provides patient eligibility and any out-of-pocket costs for which the patient would be responsible- including Co-payment, Co-Insurance,and/or Deductible. If the insurance returns the 271 in a timely fashion,patients are notified of their estimated cost share when contacting the site to schedule services.
  
  After services are complete and the radiology report is finalized, services are coded (CPT/ICD10) and submitted to the insurance carrier.  After processing the claim, the insurance issues an Explanation of Benefits (***) which is the most accurate source for providing the patient and provider with information on how the services were adjudicated. 
  
  Through researching the patients account, it was identified that the 271 response we received from the insurance on the date of service (2/13/23) showed a patient responsibility of $201.11 which the patient paid.Once the claim was processed by the payer, the *** we received showed that the patient responsibility was $158.84; $42.27 less than the original estimate the insurance had quoted. We subsequently generated a refund and a check was sent to the patient on 4/24/23. This check was cashed on 5/2/23.
  The insurance then submitted an adjustment on 8/28/23 which showed the original patient responsibility quoted on the 2/13/23 date of service ($201.11). This has led to the balance showing on the patients account of the previously refunded amount of $42.27. As a result, we have found no wrong doing on the part of Lenox Hill Radiology and the billing statements sent to the patient are valid.
  The ***s are attached for reference.
  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

  05/05/2024

  Better Business Bureau:
  
  I have reviewed the response made by the business in reference to complaint ID# ********, and have determined that my complaint has NOT been resolved because:

  [Your Answer Here]

  Lenox Hill Radiology claimed:

   > We subsequently generated a refund and a check was sent to the patient on 4/24/23. This check was cashed on 5/2/23. 

  Please provide a copy of the cashed check with the information who cashed it.

  I have not received and I have not cashed this check. I have double-checked my checking account and I have not found any deposits in the amount of $42.27 in the last 18 months. I also checked the specified date, I have not deposited or cashed any check on 5/2/2023.
  

  Lenox Hill Radiology must investigate who cashed their check. It was not me.

  In order for the BBB to appropriately process your response, you MUST answer the question above.

  
  Sincerely,
  
  ***********************************
  
  
  
  
   
  

  Business response

  06/06/2024

  Unfortunately, we cannot provide additional information than has already been provided as it would not be secure to include such transaction information on a public platform. The patient's bank should be able to locate the check with the check and transaction numbers listed in our previous response. 

  Customer response

  06/17/2024

  Better Business Bureau:
  
  I have reviewed the response made by the business in reference to complaint ID# ********, and have determined that my complaint has NOT been resolved because:

  [Your Answer Here]

  > The patient's bank should be able to locate the check with the check and transaction numbers listed in our previous response. 

  That is the problem. I checked with my bank. There is no such transaction. I had ************************************************************ a copy of my bank statement. One more time: I have not received the check and I have not deposited it.

  A copy of my bank statement was sent to *************************** on June 4th, 2024. I have attached the copies one more time.

  I DO NOT owe any money to ********************* Radiology my balance should be $0.00. Please prove that I deposited the check. Contact me personally at my cell: ************ or email a copy of the check to my personal email address: **********************.

   

  In order for the BBB to appropriately process your response, you MUST answer the question above.

  
  Sincerely,
  
  ***********************************
  
  
  
  
   
  

• Initial Complaint

  04/03/2024

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  I had a CT Scan completed at the ************ location on 2/19/2024. I was charged $****** for services and paid via **** debit. This is not showing up on my Cigna. I called the billing and they claim they billed Cigna on 2/22 however, whoever entered my info mustve done it wrong and it was sent to the wrong address. I am now in need of an MRI and ********************* is telling me for that I will owe them over 800 dollars. I have a 1000 dollar deductible and have paid ****** of that already but because they didnt bill correctly, ***** cannot update. They claim they will rebill to the correct address however it can take 45 business days. I cannot wait this long for this to be resolved. This needs to be expedited because their incompetence is delaying my further medical care. This has already been over 6 weeks.

  Business response

  04/19/2024

  This is to confirm that we have reviewed all aspects of *** ********** complaint.
  
  Please be advised that it is our policy to collect an estimated cost share for procedures at the time of service.  Patient benefits are confirmed via an EDI **************** Interchange) process. The cost share information is requested at the time of scheduling and/or at the time of service through a 270 real-time connection to the insurance.  A 271 response is received from the insurance which provides patient eligibility and any out-of-pocket costs for which the patient would be responsible- including Co-payment, Co-Insurance,and/or Deductible. If the insurance returns the 271 in a timely fashion,patients are notified of their estimated cost share when contacting the site to schedule services.
  
  After services are complete and the radiology report is finalized, services are coded (CPT/ICD10) and submitted to the insurance carrier.  After processing the claim, the insurance issues an Explanation of Benefits (EOB) which is the most accurate source for providing the patient and provider with information on how the services were adjudicated. 
  
  Upon review of the patients account for the 2/19/24 date of service, we have identified that the patient made a $433.50 payment based off of the patient responsibility information we received from her insurance (Cigna) on the 271 response. The 271 also showed a total deductible of $1,000.00.
  
  Around the same time that the claim was submitted to Cigna, there was a major cyberattack on Change Healthcare, the platform used by the insurance to process claims.This has caused a delay in claims processing for Cigna and many other payers and has led to this specific claim not yet being processed. Therefore, when the patient attempted to set up a new appointment, the estimate from the payer showed a deductible amount that did not reflect the previous payment made on the 2/19/24 date of service.
  
  We are currently working with the insurance to get the 2/19/24 date of service resolved but, in the meantime, we have placed an override on *** ********** account to include the previous payment on our end. We have also placed a note on her account advising that the previous amount quoted was incorrect and to provide ********************** with an updated patient responsibility estimate of $386.97.
  
  While researching this complaint, it was noticed that an authorization is required for the procedure being requested by the patient. Once that authorization is obtained, the patient is free to schedule her exam.
  
  We apologize to ********************** for the delay she experienced in scheduling services and any inconvenience caused by this situation.
  
  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

  04/22/2024

  Better Business Bureau:
  
  I have reviewed the response made by the business in reference to complaint ID# ********, and have determined that my complaint has NOT been resolved because:

  [Your Answer Here]

   I am currently on the phone with Cigna 4-22-24 and they are telling me that the claim still has not been sent to the proper channel therefore, Im still waiting for this to be resolved. I have never in my life dealt with such a matter. I want this to be resolved as soon as possible as again, this is effecting my ability to get my other imaging and as of right now I am still out over ****************************************** Cigna. Although I appreciate the reflection of what I owe 386 dollars however, that is not accurate at this point how that I have paid more toward my deductible. 

   

   

   

  In order for the BBB to appropriately process your response, you MUST answer the question above.

  
  Sincerely,
  
  *******************************
  
  
  
  
   
  

  Business response

  05/02/2024

  After speaking with **********************, I contacted Cigna at ************** on 4/30/24 and spoke with **** (reference #****) who informed me that the claim was set to process within the next ***** hours. I also confirmed with **** that the deductible amount will show as applied at that time. I relayed this information to ********************** and gave her the call details so that she can follow up if necessary. 

  Thank you for your assistance and patience in resolving this issue. 

*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. ↩