ComplaintsforFort Worth Renal Group

• Initial Complaint

  11/10/2022

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  During the time I received the services from this provided I reached my out of pocket expense threshold. I have instructed them to bill my insurance. The other providers that sent me bills were instructed as well and have been paid. This provider continues to refuse to bill my insurance and sends me bills. I notified them of this complaint.

  Business response

  11/16/2022

  After investigating patient complaint, for **** services 7-11-2021 to 07-14-2021 we confirmed claims were submitted and accepted by patients insurance **** on 7-22-2021.Patients Insurance processed and approved the claims as patient responsibility due to the patient's $2800 individual deductible not being met. **** posted $505.20 to the patient's responsibility and sent a statement to the patient on 08-05-2021. 
  
  The **** billing department is always happy to assist patient in resolving their insurance difficulties.   **** 1st billing contact with the patient was on 09-21-2021, and at that time patient stated she was waiting on the insurance money and a statement from the hospital. The patient billing representative explained to the patient that doctors charges were separate from the hospital. 
  
  The patient was sent a 3 more monthly statements Oct, Nov, and Dec 2021. The patient was contacted again on 12-10-2021 at which time, patient stated her insurance had sent her a statement stating she had met her deductible requesting **** reprocess her bill with ****.  **** put the patient's account on hold and sent to revenue cycle management for research. 
  
  The revenue cycle management team called patients **** insurance on her behalf 01-06-2022 and **** confirmed to **** that the claims were processed correctly as the patient's responsibility because the patient had not met her deductible until 08-11-2021 and her out-of-pocket was met on 9/30/2021. 
  
  The patient was sent monthly statements from Jan 2022 to Nov 2022, with no other contact from the patient, until she called **** Nov 9 stating she will report **** to the BBB.
  
  As a result of the patient call to **** we again called **** 11-14-2022 and after being on the phone with the patient's **** plan for 3hrs, **** finally found the **** claims and **** was told that our claims were not a part of the patient's $2800 deductible nor a part of the patient's out-of-pocket deductible and FWRB was advised to should call the local **** claim office because a different department initially processed the claims.
  
  **** again called **** on 11-15-22 and gave the **** representative all the information that was obtained from the patient's home **** plan, the claims were sent back for review and **** was advised the patients insurance may possibly reprocess to pay at 100% insurance responsibility.   The patients insurance indicated the review will take about ***** days.  As an additional courtesy to the patient, **** will follow up with the patients insurance in 15 days.    While we understand insurance is a frustrating process for all, we always encourage patients to timely assist in communicating with their insurance plan if they are having difficulties.   The contract for payment is between the patient and their insurance and we are happy to assist in resolution and we often need the patient to participate in the resolution.  Once the patients insurance reprocesses the claim **** will review the **** results and patients billing from **** will reflect her insurance final determination.

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