ComplaintsforYanke Bionics, Inc.

• Initial Complaint

  04/12/2023

  Complaint Type:

  Product Issues

  Status:

  Answered

  More info

  Date of service: 11/23/2022 Being billed for $963.00 for an AFO brace that should have been covered in full by insurance (deductible and out of pocket max had both been met for the year). Was told by Yanke Bionics that prior authorization was taken care of, and brace was covered in full by insurance. Picked up brace and was told that nothing was owed. In December of 2022 received an EOB from insurance stating claim was denied because no prior authorization was submitted by Yanke Bionics. Called Yanke Bionics (in December) to ask about claim, they said they would look into it. Did not hear back from them until March when I received a bill for full amount of $963.00. Yanke Bionics has NOT tried to resolve the problem. I have spoken several times to ******* and each time she says that there is nothing they can do. I offered to return brace in December, and they told me it was past the 30-day return period. I again offered to return the brace in March when I received my bill but was told at that time that it was past the 10-day return period. I have spoken to my insurance company and at no time has there been an appeal sent in from Yanke Bionics to try and get the claim rectified nor have they called my insurance to speak with a representative. Not only did they fail to do their job in obtaining a prior authorization (when I was told everything was done), but they failed to call and file an appeal that would have covered the brace in full according to the representative at my insurance. Account # ******

  

  Business response

  04/21/2023

  [BBB transcription, see attachment]

   

  In reference to the above complaint letter we received, the patient was seen in our office for a brace, insurance benefits were checked and no auth  was required. Patient signed form stating that verification of benefits does not guarantee payment. Please see the section from the form below.  Insurance denied as patient responsibility. We exhausted all our appeal rights for medical necessity. We did offer patients a 50% discount which they declined. Also notified patient that they could appeal with their insurance as well.

  Customer response

  04/24/2023

   I am rejecting this response because: Yanke Bionics did not check with my insurance about needing a prior authorization as they stated. If Yanke Bionics would have called or even checked with the insurance company they would have known that a prior authorization was needed for anything over $500.00. Yanke Bionics simply went onto my insurance portal and saw that I had met my deductible and out-of-pocket and assumed that no prior authorization was needed. I was told at the time of both visits in November the brace was covered in full and authorization was taken care of. Front desk personnel at Yanke Bionics told me that I would not owe anything for the brace, because they checked my out-of-pocket and deductible and everything was met.

  In response to Yanke claiming I signed a paper saying I would pay what the insurance company did not cover, If Yanke Bionics had handled my claim properly from the beginning and obtained a prior authorization, then I would have not owed anything and claim would have been paid. Claim was only denied because prior authorization was never done. I should not be held responsible to pay for Yanke Bionics mistake.

  As for Yanke exhausting all appeal options, they NEVER submitted an appeal or contacted my insurance company inquiring about an appeal. I actually called my insurance company multiple times to see what could be done since Yanke Bionics failed to do so. When I called Anthem on March 24, 2023 they stated that Yanke Bionics could send in a appeal for medical necessity. My insurance company had me print off and email a "Designation of Authorized Representative to Appeal" form to Yanke, because it needed to be attached to the appeal. I called ******* at Yanke that same day and informed her that she could file an appeal. I emailed the form and confirmation number I received from Anthem and told her she would need to send any supporting medical records for necessity to my insurance company. I did not hear back from ******* until April 6, 2023 when she called and stated "bad news, I only had 60 days from the date of service to file an appeal". Since Yanke did not send the appeal at any point she said it was now my responsibility to file an appeal. I called Anthem to have the appeal information emailed to me. I also called and left a voicemail on April 6, 2023 for ******* to call me because I needed any medical records they had to support the appeal, but I never received a return call.

  As for them saying they offered to deduct 50% off the $963.00, they were wanting me to pay $481.50. My insurance, if everything was handled correctly by Yanke Bionics would have only allowed and paid $544.83. Therefore, Yanke Bionics was not giving me a 50% discount. Yanke would have only had to write off $63.33, and I would have paid the bulk of their mistake. Again I would have had to pay NOTHING if the claim was handled correctly.

  I have confirmation numbers for every call that I have made to my insurance company. Yanke Bionics has not been able to provide any confirmation numbers or prior authorization/denials to support their claim that they have exhausted every avenue. I have gone above and beyond to help Yanke Bionics in trying to resolve this matter, when they have done nothing to rectify their mistake in not getting prior authorization. I am disgusted in their lack of professional consistency in getting this matter taken care of properly and in a timely manner.
  
  

  
  

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