ComplaintsforPrivia Medical Group

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Initial Complaint
09/12/2023
Complaint Type:
Product Issues
Status:
Resolved
The complainant verified the issue was resolved to their satisfaction.
I overpaid my doctor (wonderful doctor by the way) several months ago. I have been trying to get a refund since then, and I keep getting the run around! I call multiple times a month, and it's always a different excuse as to why I have not been refunded my money. I'm sick of it!
Customer response
09/18/2023
Better Business Bureau:

I finally received my refund from Privia Medical Group.

Regards,

*******************
Initial Complaint
09/12/2023
Complaint Type:
Billing Issues
Status:
Unanswered
The business failed to respond to the dispute.
Privia Medical Group has record keeping errors. They have ONE account number for our family, but seem to have unique accounts within that account number for each of my daughters based on their birthdays. It seems I pay my bill and they credit it to the wrong "sub account" if that makes sense. They have been incorrectly billing me, and also issue me refund checks for over a year now. I thought this was finally resolved but apparently not. To explain, I received a CHECK FROM THEM due to a credit on the account dated 2/15/23 for ****** and thought this was finally resolved. Then in JULY of 2023 I received a statement with a balance of ****** for services from 2/2 OF 2022! Now in August I receive ANOTHER STATEMENT for ****** that includes additional services from January of 2023. All of these charges are from services PRIOR TO THEM ISSUING ME A CHECK FOR HAVING A CREDIT ON THE ACCOUNT! Their record keeping is entirely inaccurate. They must be investigated. I have tried to call and talk to them but their "Supervisor" is never available and their "system" is always reported to be down.
Initial Complaint
01/26/2023
Complaint Type:
Billing Issues
Status:
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.
I saw one of the physicians in the Privia Medical group and paid cash for the appointment. They then CHARGED MY INSURANCE TOO! This isnt the first time they had done this and they assured me that it wouldnt happen again. If you ask me I dont think Im the only person this has happen to and it is extremely shady.
Business response
02/06/2023
Thank you for reaching out. Our Billing Team for your market has reviewed your 2022 encounters and a.) do not have record (notification from you) that you are self pay; and b.) do not see evidence that a billing adjustment should be due to you. Your encounters have been billed to the insurance plan provided and a Billing Representative will contact you this week to discuss benefits applied by your insurance company.
Initial Complaint
07/26/2022
Complaint Type:
Customer Service Issues
Status:
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.
I have tried for over a year now to remove my father as the primary person on my medical account. I have filled out new paperwork, had office staff call, I have called several numbers I was given, and also spoke to someone when paying my bill about making myself the only person on my account. I am almost 30 years old and need to remove my father from my account. The information billed to me is confidential and I do not consent to others having access to it. I dont know what else to do. They will not remove him and I am out of ways to request this.
Initial Complaint
05/04/2022
Complaint Type:
Billing Issues
Status:
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.
11-21-2021 I paid a medical **** 1 time in the amount of $51.86 to ***************** LLC via web portal on NextMD. The receipt is attached.11-22-2021 I saw the charge go through on my checking account 12 times when it was only meant to go through 1 time. The bank statement is attached.11-22-2021 I called USAA to dispute these multiple transactions, 11 out of the 12, as I still intended to pay the initial ****. I don't recall who I spoke with, but 10 of the 11 extra charges were credited back to my checking account, and that dispute case has since closed and the amounts permanent. Credits are shown on another separate bank statement attached.11-29-2021 ***************** LLCs billing Privia Medical Group, called me to inform me of the transactions being posted several times (clearly a mistake). I informed them I had already spoken with my bank and had them credited back. This was the first time I spoke with the merchant.12-1-2021 I noticed I still had an extra charge that needed to be credited back, as they had only credited back 10 and not 11. Over the next few months, I worked with USAA to get this remaining charge fixed but eventually was told they could not do anything and I would need to deal with the merchant. Details of this are in the dispute letter file attached.4-13-2022 Called Privia Medical Group about this situation and was told to email all of this information to them, which I did. They told me to call in a week to give them time to receive the email.5-3-2022 I have called to check on the status several times since 4-13-2022 which is also detailed in the dispute letter attached. I have dealt with this billing company before and it took around 8 months before I finally got a refund/billing adjustment only after filing a complaint. I will continue to call them about this matter but am filing this to ensure action is taken.
Business response
06/22/2022
The patient did receive 11/11 credits back to the account. 10 of the credit transactions on 11/23/2021 and 1 additional on 12/14/2021. While this may be an oversight by the patient, based on the proof the patient has provided, they have paid the 1 charge (posted to the account - stands at $0.00) and 11 incorrect payments were disputed and credited back to the account.

Customer response
06/22/2022
Complaint: ********

So based on the statements provided, the oversight was on my end with USAA since they had reversed the credit that was put back on my account in December (taking it back in February). Did the business receive the $51.86 when USAA took it out of my account in February? If not, then USAA took the money out for themselves and kept it and the complaint would be forwarded to their business.

Regards,

****** ****
Business response
06/23/2022
Patient called customer service on 5/3/22 and it was explained at that time that Privia does not have an additional payment on the account and that the account balance/claim balance was $0. Based on the description from the patient's bank statement for the 2/24 transaction ("DC DSP TEMP CR REV") this would seem to be a reversal by USAA for the temporary credit they had placed on one of the prior duplicated transactions. However, Privia does not have record of that payment or a credit balance available to refund.
Customer response
06/24/2022
Complaint: ********

I am rejecting this response because:
I was accidentally charged 12 times for 1 transaction. USAA made an error in disputing the transactions and only disputed 10. We then disputed the remaining 11th transaction in December. While USAA was investigating and trying to aquire funds from Privia Medical Group for the error, they provided a temporary credit to my account for the remaining 11th charge until they received the funds from Privia Medical Group. However, Privia Medical Group sent a request for more documentation and information meaning they did not send the funds over. Upon failing to receive these additional documents, they did not send funds for the remaining transaction so USAA took their temporary credit back. I spoke with a supervisor from USAA and since the dispute was rejected, Privia never sent any funds for that last 11th transaction like you are claiming. The temporary credit was from USAA until they received funds, and since they did not receive any, they took the temporary credit back. USAA has notes and records of all of this, never receiving funds for the 11th missed disputed charge. This is an error on Privia's part for a technical error that overcharged me, the patient, and refusing the refund a lingering extra charge despite documentation and evidence submitted. I will upload the dispute for the December charge that was rejected, which proves the merchant did not send any funds to USAA for the charge in dispute. ONCE A DISPUTE HAS BEEN ACCEPTED AND FUNDS WERE RECEIVED BY THE MERCHANT IN DISPUTE, THE TEMPORARY CREDIT BECOMES PERMANENT. THIS DID NOT OCCUR, BECAUSE FUNDS WERE NEVER RECEIVED BY THE MERCHANT.

Regards,

****** ****
Initial Complaint
05/03/2022
Complaint Type:
Billing Issues
Status:
Resolved
The complainant verified the issue was resolved to their satisfaction.
My wife had a medical service performed by **** ***** ****** **********-****** MEDICAL GROUP on 3/22/2022. She was charged $937 for the medical supplies (receipt attached). Then the group billed our insurance company for the same medical supplies. Our insurance company processed this claim and reimbursed the provider in the amount of $955. Please see attached explanation of benefits. The electronic check was issued and cleared on 3/28/2022. When we became aware of double charges we requested a refund in the amount of $937. The group refused this refund claiming the the group have not received money from the insurance company. Insurance company rep contacted this group twice and provided electronic check number, amount, and the date is was cleared. This group still refused to refund our money. We are seeing assistance with getting our refund from this medical group. Thank you
Business response
05/13/2022
Our Customer Experience team has reviewed all calls received from the patient's husband.

Upon reviewing the patient's account and all of the phone calls placed to our Customer Experience team, we have found that this claim is still in the adjudication process with the primary insurance. We have not received an EOB from the insurance company nor have we received payment from the insurance company as of yet. The EOB attached to the complaint was provided by the patient, not by the primary insurance. We can not process transactions based on an EOB provided by the patient. And, per ******'s refund policy, we can not issue a refund as there is an open claim on the account and the amount the patient is requesting is not available as a credit on the account.

The Care Center advised the patient that they charged the $937 upfront because they had received a denial for the procedure and did not think that the insurance was going to cover this DOS. She then advised that the claim is still in the adjudication process and we are awaiting the primary insurance's decision as well as any payments. *** ********** was informed that the adjudication does usually take 30-45 days and that he must allow us time for the claim to process and for any payments from insurance to be received. *** ********** was not satisfied with this information and informed the care center employee that his insurance has paid already and we have received their payment.

However, when reviewing the claim in ******, it is shown as being billed to primary status and is still awaiting adjudication. This was explained to *** ********** numerous times. *** ********** is still convinced that we have received a payment from his insurance; which we have not at this time.

He has been advised that once the claim has been processed and payment has been received from the primary insurance, we can then request a refund for any credits that remain on the account.

Customer response
05/13/2022
Complaint: ********

I am rejecting this response because:
The response provides totally inaccurate and false information. First, the Carefirst (our insurance carrier) customer rep contacted this group twice and provided electronic check # ********* that paid this claim and was cleared on 3/28/2022. second, the carefirst customer rep conveyed to us the group wrongfully charged us on the first place, because the right procedure was "pay and bill" that covers medical supplied in this case and carefirst has never denied the coverage. third, the group did receive moneys because the refund has been already issued.
We are just amazed how badly this group being managed and how much false information is given to its patients.

Regards,

**** **********
Business response
05/13/2022
We regret the patient has incomplete or misleading information from the insurance company. Electronic payments are made (for multiple claims) on one transaction and require accompanying reporting from the payor for recipients to be able to apply the amounts to the correct claims. We explained the process to the patient multiple times and let them know that, on average, that takes 30-45 days. If the patient has received the refund it is because payment was received from the insurance company and applied based on accompanying reporting (EOB from the payor to ******) in between the time research on this complaint was completed by our customer experience department and our response communicated to BBB. We will also point out that if the patient has received the refund by this time, then resolution of this request fell within the timeline we initially told the patient to expect (30-45 days). We believe this matter to be closed.
Customer response
05/16/2022
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.

Regards,

**** **********
Initial Complaint
03/07/2022
Complaint Type:
Billing Issues
Status:
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.
This company claimed to be within my insurance, did not bother to check prior to an appointment and took a credit card to book. The doctor they had me telehealth with was not even the doctor I chose. They charged over $200 for a quick phone call and when my insurance denied it and told them to send it to the behavioral health coverage, they did not. This company did not even **** me, they simply charged my card without my permission and without notifying me. This is not healthcare, this a scam with no care or respect for patients. Charging someones card without their knowledge is fraud.
Business response
03/30/2022
This complaint has been received and shared with our Customer Experience team for review.

Thanks,

***********************, CIA
Senior Director of Audit & Compliance
Business response
03/30/2022
The patient inquired with Privia's Customer Experience Team previously on this matter and received this response below. If services are provided outside the scope of an annual wellness visit, those services can and should be billed.

The response provided to the patient's initial concern is as follows:

"I have heard back from your care center! After review, they have informed all three of your claims have been refiled with BCBS. Please allow ***** business days for reprocessing. At this time, there is no patient responsibility. Once the claims have been fully processed, you will receive an updated EOB(Explanation of Benefits) that will inform of any remaining patient responsibility, insurance payments, and/or insurance adjustments."

Additionally, BCBS then processed the claims as follows:

Claim #******** - this claim was resubmitted and the preventative visit did not transfer any patient financial responsibility. However; the patient had various immunizations which did have patient responsibility assigned to them as part of her deductible. (Total amount $142.41

Claim #******** - this claim was coded as a general panel screening and there were various blood tests completed that transferred patient responsibility as part of her deductible. (Total amount $254.65)

Total amount owed by the patient is $397.06.

Regards,

--

***********************, CIA

Senior Director of Audit & Compliance

Business response
03/30/2022
This complaint has been received and shared with our Customer Experience team for review.
Thanks,
***********************, CIA
Senior Director of Audit & Compliance

Customer response
03/30/2022
Complaint: 16848944

I am rejecting this response because:

Regards,

*****************************
Initial Complaint
01/04/2022
Complaint Type:
Billing Issues
Status:
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.
I had my annual physical on September 2020 that is required by my insurance. Insurance covers this physical so I shouldn't have to pay anything. About 3 months later I received a $691 ****. I called South Coast and they stated that since my blood work detected anemia, my physical was coded under diagnostic instead of prevention. Per my online appointment, I specifically stated annual physical checkup for insurance. I ended up filing a claim and received a $400 ****. Filed another claim and received $0 balance statement sometime around September 2021. I just received a $397 **** from Previa Medical Group on 12/27/2021 for my same annual physical from September 2020. I shouldn't be charged for this.
Business response
01/18/2022
Can you please send this and all future complaints to *******************************************? I do not handle compliance or BBB complaints.
Business response
03/30/2022
The patient inquired with Privia's Customer Experience Team previously on this matter and received this response below. If services are provided outside the scope of an annual wellness visit, those services can and should be billed.

The response provided to the patient's initial concern is as follows:

"I have heard back from your care center! After review, they have informed all three of your claims have been refiled with BCBS. Please allow 30-45 business days for reprocessing. At this time, there is no patient responsibility. Once the claims have been fully processed, you will receive an updated EOB(Explanation of Benefits) that will inform of any remaining patient responsibility, insurance payments, and/or insurance adjustments."

Additionally, BCBS then processed the claims as follows:

· Claim #******** - this claim was resubmitted and the preventative visit did not transfer any patient financial responsibility. However; the patient had various immunizations which did have patient responsibility assigned to them as part of her deductible. (Total amount $142.41

· Claim #******** - this claim was coded as a general panel screening and there were various blood tests completed that transferred patient responsibility as part of her deductible. (Total amount $254.65)

Total amount owed by the patient is $397.06.

Regards,

--

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

Senior Director of Audit & Compliance
Initial Complaint
04/30/2021
Complaint Type:
Billing Issues
Status:
Resolved
The complainant verified the issue was resolved to their satisfaction.
Privia MEdical GRoup ***-***-**** acct ****** **** ******* I had 2 charges for Date of Service: 12/4/20. My insurance company paid the charges. MY EOB lists more payment than Privia has credited leaving me a 42 dollar balance. I have contacted them by phone twice (IN February and March)and sent a written letter(in March) Both phone conversations acknowledged there was a problem but I am still being billed the 42 dollars first charge : date of service 12/4/20 EOB information from my insurance company Billed: 1143 Insurance Discount Amount 466.51 Paid amount: 676.49 Privia statement: Billed: 1143 Receipt from insurance: 629.14 Discrepancy : 47.35 less than what was paid 2nd charge : date of service 12/4/20 EOB information from my insurance company Billed: 1143 Insurance Discount Amount 804.76 Paid amount: 338.24 Privia statement: Billed: 1143 Receipt from insurance: 314.56 Discrepancy : 23.68 less than what was paid ;
Business response
06/07/2021
Due to HIPAA compliance, we are limited on what we can convey. I can let you know that the issue has been resolved and we have reached out to the patient.

Thanks

*********
Customer response
06/08/2021
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.

Regards,

**** *******
Initial Complaint
04/29/2021
Complaint Type:
Billing Issues
Status:
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.
I received a bill for an OBGYN visit which is normally covered by my insurance. After calling my doctors office, I they informed me that billing was handled by a 3rd party (****** Medical Group). I called my insurance company, who then informed me to call ******. Unfortunately ******'s phone number is dead. You are greeted by hold music, no matter what extension you choose, followed by a hang up or disconnection. I have been attempting to contact this company to get this bill resolved with no luck at all! I am warning this company that any use of my medical records are a direct violation of my HIPPA Rights. If this account is forwarded to a collection agency, I will seek recourse to the fullest extent allowed by law. I will also seek damages and provide evidence of ******'s negligence in this matter. A billing company that has personal, private, medical information should be much more accessible and transparent. I should not have to jump through hoops of fire!!
Business response
04/29/2021
Due to HIPAA privacy regulations, we are limited in what information we can share with you. However, we can tell you that in this case, the claim in question has been fully adjudicated by the payer and there is no liability out to the patient.

If the complainant signs a HIPAA Authorization permitting us to disclose her information to the BBB, we can provide additional details regarding this issue.

Thanks

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

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