Complaints

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:06/16/2025

  Type:Order Issues
  Status:

  UnresolvedMore 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.

  Better Business Bureau:
  
  I have reviewed the response made by the business in reference to complaint ID ********, and have determined that this proposed action would not resolve my complaint.  
  
  I am writing to formally dispute the balance billed to the patient listed above for services rendered on the reference date. According to the explanation of benefits provided by the patient's insurance carrier, the anesthesia services were covered at 100% and no patient responsibility should have been incurred. 

  Despite this, the patient was charged an amount which constitutes balance billing. as you are aware, balance billing for covered services is not only inappropriate, but in many cases illegal, depending on state laws and network agreements.

  while we understand your office may disagree with the payment amount set by the insurance plan, any such disagreement should be addressed directly with the insurance carrier through a fee schedule appeal, not by billing the patient. additionally, asking patients to sign forms acknowledging out of network care does not waive their rights under federal or state consumer protection laws, particularly when the service is ultimately covered by insurance.

  its also worth noting that the  insurance did not reject payment, but processed it under the terms of the plan. As **************** is affiliated with the facility and the provider group, we are requesting the patient be fully refunded for the overpayment.

  if this matter is not resolved promptly, we are prepared to escalate the issue to the *****************************

   
  Regards,

  
  
  
   

  
  

  Business Response

  Date: 06/20/2025

  COMPLAINT ID ********

  Mr. ******* ****** underwent a colonoscopy with Dr ******************** on June 6th,2024. 

  The surgical services were provided by Gastroenterologist Dr ********************.  This surgical service was considered IN NETWORK, as Dr ******************** has a contract with ****/*** SHARED SERVICES and subject to a previously agreed in network fee for service schedule. During surgery (colonoscopy), ancillary services are provided by other companies, and each one has independent relationships with the ***************** Companies. Some have contract (services are considered IN NETWORK), others do not have any contract (services are considered OUT of NETWORK and not subject to any fee schedule). 

  For this particular case, Mr. ******** colonoscopy, anesthesia was provided by an Anesthesiologist from EMORY ANESTHESIA GROUP, LLP, not by Dr ********************.     

  EMORY ANESTHESIA GROUP, LLP does not have any contract with ****/*** SHARED SERVICES and consequently is not bound to any contract fee schedule.       

  EMORY ANESTHESIA GROUP, LLP offers a special financial arrangement for patients, to help them to avoid a large and expensive anesthesia bill (in the range of $ 4,000.00).  Patients are usually offered in advance, before the surgery is scheduled, the possibility of paying a flat fee of $630,00 as the only patient responsibility with the anesthesia company.   But the ****************** reserves the right to pursue a full payment, out of network, from the Insurance Company.

  Obviously in this particular case UHC, the ***************** Company, unilaterally and illegally, set an anesthesia fee of $248.28 for anesthesia services as full payment.  EMORY ANESTHESIA GROUP, LLP rejected the payment as they do not have any previously agreed contract.

  Patient was fully aware of the anesthesia services cost and decided voluntarily to pay the anesthesia fee proposed by *****.  Doctor ********************' office was as only an intermediary during this transaction

  We hope this explanation clarifies this issue