Centura in Colorado is vaccinating non 1B volunteers that have not stepped foot in the hospital in months and won’t be back for months. They are bypassing the rules set out by the governor and doing nothing to take care of the truly vulnerable populations in our community that should rightfully be getting the vaccine.
Complaint: [redacted] I am rejecting this response because:I have not received any evidence or assurances that the security of my patient and financial information was not breached since my invoice was sent to someone else (I was told by Centura Health that my invoice was sent elsewhere, and I received another person's invoice) These invoices have "Activation Codes" written on them that according to Centura Health are used to "view your statement, make payments, schedule appointments, and more!" These invoices also have the Patient Account Number, Responsible party, amount charged and amount due.If there is no evidence or assurances that the security of my patient and financial information have not been breached, I would like Centura Health to provide credit and patient account monitoring to provide assistance should a breach in security occur, and to increase the likelihood that it would be caught in a timely manner Sincerely, [redacted] ***
Complaint: [redacted] I am rejecting this response because: I received a phone call from Heather in Centura Health Customer Service on 3/29/apologizing for not properly posting payments from my insurance company to advising me that Centura is going to (1) refund to me $111.59, (2) remove the outstanding amounts of $and $from my account balance and comp me the $for my inconvenience, (3) recall the outstanding invoice for $($and $71.82) from the pre-collections agency Medicredit, (4) issue revised invoices from Centura Billing showing the one account at a $balance (account [redacted] ) and the other with the refund of $(account [redacted] ), (5) issue a confirmation letter that the original outstanding bill for $had been retracted from Medicredit by Centura Health, and (6) that she (Heather) would follow up with me on Friday, April 1.As of today, Tuesday April 5, none of the above items have occurred and I just received a BILL from Centura Health for $ I attempted to contact Heather at Customer Service but was only able to reach voicemail Sincerely, [redacted]
hello, My name is [redacted] ***, birth date 06/13/I was seen at [redacted] on [redacted] in [redacted] I cannot recollect specific namesBut would be happy to find out and work with you to find outOverall, the whole staff was very cold and inattentive to patients needsFeel free to call or mail whatever I should fill outBut it doesn't technically resolve my problem I'm still left without careAnd [redacted] as well as countless psychologists have been trying to help me get help Revdex.com: I have reviewed the response made by the business in reference to complaint ID [redacted] , and find that this resolution is satisfactory to me Sincerely, [redacted] ***
Thank you for the information that has been providedIn order to serve you best please provide specific details, date of service and account number this complaint refers to; we will follow up with via mail once the details of your complaint are provided.Thank you,Centura Health Dispute & Resolution Department
April 17, 2018Revdex.com EFlorida Avenue, Suite 350Denver, CO 80210RE: Case # [redacted] Consumer Info: [redacted] ***Dear Sir/Madam,We have closed this complaint and sent our detailed letter of response directly to the Guarantor.You may request a copy of that letter directly from the Consumer if needed for your filePlease send all requests and correspondence to the email address [email protected],The Centura Dispute and Resolution Department
On October 29, 2019 my husband saw a GI doctor at Saint Mary Corwin Medical Center (Centura Health). The doctor said no more than 15 words to my husband, never examined him, didn't even sit down. We then received a bill for $387.07, that is once his insurance paid roughly $200 of this bill. This is outrageous because the doctor spent no more than 4 minutes in the exam room! I am livid! We have since gone with a different GI doctor at Parkview Medical Center. What a difference! This doctor was so professional and made you feel as if you mattered. He spent about 20 - 25 minutes with my husband. Thank God that "he" was referred to us. Before this appointment I had my husband in the ER at Saint Mary Corwin Medical Center. What a joke for a doctor! He never even entered the room. He stood at the doorway, crossed his arms and ankles and told him that he had heartburn. My husband and I have "both" decided to go to Parkview Medical Center for everything that we may need. Comparing the two hospitals is like comparing night and day. This is so sad to me because I always use to think of Saint Mary Corwin Medical Center as the one and only hospital here in Pueblo that I would ever go to. This breaks my heart.
We have reviewed and closed the consumer complaint the desired settlement has been provided to the consumerStephanie M***Customer ServiceRevenue Management
Initial Business Response / [redacted] (1000, 9, 2015/09/29) */ We've responded to the same consumer request numerous times, no additional information has been provided by consumerIf consumer will not provide additional information, we will not review the same complaint againWe are closing this complaint unless consumer provides new information; this has been address numerous timesYou may obtain copies of the correspondence directly from the consumer Initial Consumer Rebuttal / [redacted] (3000, 11, 2015/10/10) */ (The consumer indicated he/she DID NOT accept the response from the business.) The response to the Revdex.com from Centura Health, dated September 29, 2015, is not responsive to the issues(1) It does not address the fact that the explanation of benefits (EOB) from the primary insurer, United Healthcare, included a minus $adjustment for the now-disputed $charge and stated (bottom line) that patient liability for the EOB was $(See attachment: EOB_UnitedHealthcare.pdf.) (2) It does not address the fact that the secondary insurer, BlueCross BlueShield, stated in response to my inquiry about the disputed charge that there is no patient liability(See attachment: BCBS_Message.pdf.) (3) It does not address the delay in billing(See attachments: Centura_Health_Statement.pdf and Centura_Health_Itemized.pdf.) The date of payment by United Healthcare was January 3, The date of the first bill from Centura Health was December 29, Why did it take days for Centura Health to ignore the minus $adjustment by United Healthcare and unilaterally deem the charge a patient liability? Did Centura Health think I would not notice and thereby be fooled into paying the $charge that had been negated by United Healthcare? The Centura Health response to the Revdex.com, dated September 29, 2015, is unprofessional and deceitfulLet's examine the four-sentence response in detail(1) First sentence: "We've responded to the same consumer request numerous times, no additional information has been provided by consumer." Before I initiated the complaint to the Revdex.com on August 31, 2015, I received no written communication from Centura Health except for billing statementsSince I initiated the complaint, Centura Health sent me letters dated September 8, and September 29, Neither letter requested additional informationNeither letter included a return address in the letterhead or in type above the date(This is unprofessional.) Neither letter included an email address or FAX numberGiven that lack of contact information, I question the sincerity of Centura Health's request for additional or new informationMy conclusion is that written communication with "Centura Health Dispute and Resolutions" is intended to be one-way: They talk to you; you are not intended to respond or submit any documentationFurthermore, what is the point of providing more information if Centura Health does not address the information already provided? (2) Second sentence: "If consumer will not provide additional information, we will not review the same complaint again." Translation: Centura Health will ignore the information already provided and use a purported lack of "additional information" as an excuse to cease reviewing the complaint(3) Third sentence: "We are closing this complaint unless consumer provides new information; this has been address sic numerous times." Seems like I've heard this refrain before, but let me add this in responseApparently, the Centura Health definition of "numerous" is "one." The date of Centura Health's response to the Revdex.com (September 29) coincides with the date of their second letter to meObviously, I could not have received their second letter at the time of Centura Health's response to the Revdex.comThis is deceitful(4) Fourth sentence: "You may obtain copies of the correspondence directly from the consumer." I have attached the correspondence so that the Revdex.com may verify what I have said above(See attachment: Centura_Health_letters.pdf.) Now, let's discuss the letters from Centura HealthIn the letter dated September 8, 2015, Centura Health claims that, "...per United healthcare the patient does owe this charge, could go to United healthcare but tetanus, diphtheria tox and acell pertussis are patient responsibility." The letter includes no attachment to substantiate this claim, which is clearly contradicted by the EOB I received from United Healthcare, dated December 24, That EOB shows in the row addressing the vaccination an amount of $in the column labeled "(-) Plan Discounts & Adjustments" and $in the column labeled "(=) Total Amount You Owe Provider." If Centura Health can document their claim with a written statement from United Healthcare, let them do soOtherwise, they should quit misrepresenting the factsThe September letter from Centura Health also recommends, "If you believe this balance has been left in error we encourage you to contact your insurance provider." On May 21, 2015, I did contact my secondary insurance provider, BlueCross BlueShield, about coverage for the Centura Health tetanus vaccination (the BlueCross BlueShield coverage supplements Medicare)The latest response, dated June 19, 2015, includes the following, "Thank you for your recent inquiryI have contacted the provider and advised her there is no patient liability and they cannot be charging youShe states she does show that on the Medicare summary noticeIf the provider is still billing you please contact us again." This implies that the Centura Health representative could see that the Medicare summary showed that the tetanus vaccination was not a patient liabilityAgain, it appears that Centura Health is misrepresenting the facts The Centura Health letter dated September 29, 2015, is much the same, again claiming, "The Explanation of Benefits we received from your insurance has deemed this balance as the patient's responsibility." Again, there is no substantiation of this claimCentura Health also admits that they are governed by contracts with insurance providers: "As stipulated by Centura's contracts with the insurance providers we must bill the patient for anything deemed as patient responsibility." The question is, who does the deeming? The BlueCross BlueShield EOB for the associated Centura Health office visit includes the following statement: "Your health care provider has agreed to accept assignment of Medicare benefitsThis means you are not responsible for the difference between the Medicare-approved amount and the actual charge." Thus, it appears that Centura Health may be violating their agreements with Medicare and the insurance companiesAlso, the Centura Health letter states, "This letter is being sent as a final clarification on the account, and to help you settle your open balance." Centura Health considers this to be the final clarification, but ultimately, that may have to be decided by someone who has the authority to force compliance with their contracts and agreements The Revdex.com has requested that I specify what issues were not addressed and how I and the Centura Health can reach a middle groundI believe I have documented the fact that there is no patient liability for the disputed chargeCentura Health claims that there is patient liability but, thus far, has not provided documentation for the claimIf they can do so, let them provide it and prove their claimUnless there is agreement on the facts, I don't see a path to a middle ground Final Consumer Response / [redacted] (4200, 15, 2015/11/05) */ (The consumer indicated he/she DID NOT accept the response from the business.) In its response to the Revdex.com dated 10/22/2015, Centura Health again shows a disregard for the truthThey said, "We have review the consumer's concerns, a resolution letter has been sent directly to consumer." Besides the poor grammar ("We have review ..." and sentences separated by a comma), note the claim that "a resolution letter has been sent directly to the consumer." Since the past tense is used, one might conclude that the letter had already been deposited in a USPS Mailbox on Oct 22, In fact, the letter was postmarked Oct27, Thus it appears highly doubtful that Centura Health actually sent the letter on Oct22, as they claimRecall that in Centura Health's response to the Revdex.com dated 09/29/2015, they claimed to have responded to my request numerous times when, in fact, at that date they had responded only onceTheir second response was postmarked Oct1, In my response to the Revdex.com dated 10/13/2015, I challenged Centura Health to provide documentation for their claim that "per United healthcare the patient does owe this charge, could go to United healthcare but tetanus, diphtheria tox and acell pertussis are patient responsibility." In Centura Health's latest response, they have failed to provide any documentation for that claimAll we have is their word, which, as I have indicated above, is suspectI have attached their latest response, including their letter, the first page of a "Transaction List" covering the services provided on 11/11/that they attached to the letter, and the envelopeNote that I have removed my social security number, birthdate, and services for dates other than 11/11/from the transaction listI am also attaching, again, the explanation of benefits (EOB) dated December 24, that I received from my primary insurer, United Healthcare Centura Health, in their latest response, makes undocumented claims that are contradicted by the written documentation I have providedIn particular, they say that, "The reason for denying Tdap was not a covered charge." This is also claimed in their transaction list under item as "DEN RSN: COCharges not covered." This information is directly contradicted by the EOB, which gives no reason code regarding the TDAP vaccineAgain, the EOB makes a minus $adjustment for the vaccine, which is not acknowledged in the transaction list (01/03/ADJ AUMD ADJ UNITED WEST MCR PPP 0), gives $as the amount not covered for the TDAP vaccine, and $as the total amount owed the provider for the TDAP vaccineIn their letter of September 29, 2015, Centura Health claimed, "The Explanation of Benefits we received from your insurance has deemed this balance the patient's responsibility." Centura Health has failed to produce this documentIn its absence, I must conclude that Centura Health is not telling the truth Final Business Response / [redacted] (4000, 20, 2015/12/23) */ We have review the consumer's concerns, a resolution letter has been sent directly to consumerIf you would like a copy of correspondence please contact the consumerThank you
I attached letters I sent to Centura regarding their incorrect/unclear billing The other letters are cut and pasted below Centura needs to clean up their billing, send out correct statements and make sure their records are correct- To Whom It May Concern: I, [redacted] , received a Notice of Denial of Payment (NDP) dated 11/17/ The NDP cites "Member Self Directed Out of Network" for services provided September through 28th, by Centura Home Care However, they were approved as in-network both by Centura and Porters Adventist Hospital, who has my complete insurance information, before services commenced Please check your recordsThank you for your assistance in this matter I look forward to your response.Jan- I have reviewed a statement dated December 28, for the above-referenced amount Date of Service is listed as 10/22/and Type of Service Received indicated is Out-PatientMy records show I did not take Mrs [redacted] to Porters on that date, neither did her son We are the only two people who would have taken her to an appointment Please check your records, determine the correct Date of Service and re-send the billJan- Porter Adventist HospitalP.OBox 561430Denver, CO 80256- Re: [redacted] [redacted] [redacted] [redacted] [redacted] [redacted] [redacted] To Whom It May Concern:Enclosed please find check #for $to cover the first five (5) charges listed abovePlease send an expanded service description for the Account #PA [redacted] - $which has a Date of Service of 11/12/ On that particular day, Mrs [redacted] was a patient at [redacted] Care As far as I know, she never left the facilityThank you for your attention to this matterI sent another letter on February via Centura's website regarding incorrect bill
Mr [redacted] has been in contact with our agency in regards to his billing issuesThey are working closely with him to resolve all issues that he's encountered during the course of his careWe are hoping that both parties are satisfied with the resolutionPlease let us know if you need anything additional on thisThank you,Centura Dispute & Resolution Department
This consumer complaint has been reviewed and we have responded to the consumer directly by letterIt is closed at this timeIf you require a copy of the letter please request it directly from the consumer. Stephanie ***Customer ServiceRevenue Management
Clicked on the link above to review the original complaint details...it did not openThe information contained in this communication is lacking the details that are needed to respond, does the consumer have an account number, the specific Entity/Location where services were renderedPlease provide
this information to allow us to respond appropriately
Initial Business Response /* (1000, 8, 2015/11/09) */
We have review the consumer's concerns for Mrs***, a resolution letter has been sent directly to consumerIf you would like a copy of correspondence please contact the consumerThank you
Initial Consumer Rebuttal /* (2000, 10,
2015/11/17) */
(The consumer indicated he/she ACCEPTED the response from the business.)
It was agreed to drop the charges for the Dr fees
hello, My name is *** ***, birth date 06/13/I was seen at *** *** *** *** on *** in *** ***I cannot recollect specific namesBut would be happy to find out and work with you to find outOverall, the whole staff was very cold and inattentive to patients needsFeel free to call or mail whatever I should fill outBut it doesn't technically resolve my problem I'm still left without careAnd *** *** *** as well as countless psychologists have been trying to help me get help.
Revdex.com:
I have reviewed the response made by the business in reference to complaint ID ***, and find that this resolution is satisfactory to me
Sincerely,
*** ***
Complaint: ***
I am rejecting this response because:Per response, complaint is still openI will accept when they have finished proper investigation
Sincerely,
*** ***
Initial Business Response /* (1000, 8, 2015/07/24) */
We have completed a thorough review of the consumer's complaint and will be closing this caseA detailed letter is being sent directly to the consumerYou may obtain a copy of the letter directly from the consumer if required for your
file
Revdex.com:
I have reviewed the response made by the business in reference to complaint ID ***, and find that this resolution is satisfactory to me
Sincerely,
*** ***
Initial Business Response /* (1000, 10, 2015/09/22) */
Good Morning,
We have review the consumer's concerns, a resolution letter has been sent directly to consumerIf you would like a copy of correspondence please contact the consumerThank you
Initial Consumer Rebuttal /* (3000, 12,
2015/09/28) */
(The consumer indicated he/she DID NOT accept the response from the business.)
I sent over the request in the past to MRO and they were not able to locate the recordsI need to know that if I send this request, are they going to truly have the record?
Final Consumer Response /* (4200, 16, 2015/10/06) */
(The consumer indicated he/she DID NOT accept the response from the business.)
I have submitted the request to the corresponding agency that supposedly has my medical records and was told that they do not have themI don't understand why obtaining these records is so difficult for Centura to doNo one gives me a straight answer or won't return my callsAll I want are these records and it seems like Centura just wants to continue to give me the runaroundI have filled out several medical record releases and sending another one for the same place that claims they don't have the records is just another slap in the faceIf this continues, then I may need to contact other avenues to get this resolved
Final Business Response /* (4000, 18, 2015/10/19) */
We've responded to the same consumer request numerous times, no additional information has been provided by consumerIf consumer will not provide additional information, we will not review the same complaint againWe are closing this complaint unless consumer provides new information; this has been address numerous timesYou may obtain copies of the correspondence directly from the consumer
The person that the Consumer refers to (Heather) did resolve this issue, there were two refund checks processed to the consumer on 04/06/16, we have closed this complaintYou may want to obtain details directly from the consumer
Complaint: [redacted] I am rejecting this response because:I have not received any evidence or assurances that the security of my patient and financial information was not breached since my invoice was sent to someone else (I was told by Centura Health that my invoice was sent elsewhere, and I received another person's invoice) These invoices have "Activation Codes" written on them that according to Centura Health are used to "view your statement, make payments, schedule appointments, and more!" These invoices also have the Patient Account Number, Responsible party, amount charged and amount due.If there is no evidence or assurances that the security of my patient and financial information have not been breached, I would like Centura Health to provide credit and patient account monitoring to provide assistance should a breach in security occur, and to increase the likelihood that it would be caught in a timely manner Sincerely, [redacted] ***
Complaint: [redacted] I am rejecting this response because: I received a phone call from Heather in Centura Health Customer Service on 3/29/apologizing for not properly posting payments from my insurance company to advising me that Centura is going to (1) refund to me $111.59, (2) remove the outstanding amounts of $and $from my account balance and comp me the $for my inconvenience, (3) recall the outstanding invoice for $($and $71.82) from the pre-collections agency Medicredit, (4) issue revised invoices from Centura Billing showing the one account at a $balance (account [redacted] ) and the other with the refund of $(account [redacted] ), (5) issue a confirmation letter that the original outstanding bill for $had been retracted from Medicredit by Centura Health, and (6) that she (Heather) would follow up with me on Friday, April 1.As of today, Tuesday April 5, none of the above items have occurred and I just received a BILL from Centura Health for $ I attempted to contact Heather at Customer Service but was only able to reach voicemail Sincerely, [redacted]
hello, My name is [redacted] ***, birth date 06/13/I was seen at [redacted] on [redacted] in [redacted] I cannot recollect specific namesBut would be happy to find out and work with you to find outOverall, the whole staff was very cold and inattentive to patients needsFeel free to call or mail whatever I should fill outBut it doesn't technically resolve my problem I'm still left without careAnd [redacted] as well as countless psychologists have been trying to help me get help Revdex.com: I have reviewed the response made by the business in reference to complaint ID [redacted] , and find that this resolution is satisfactory to me Sincerely, [redacted] ***
Thank you for the information that has been providedIn order to serve you best please provide specific details, date of service and account number this complaint refers to; we will follow up with via mail once the details of your complaint are provided.Thank you,Centura Health Dispute & Resolution Department
April 17, 2018Revdex.com EFlorida Avenue, Suite 350Denver, CO 80210RE: Case # [redacted] Consumer Info: [redacted] ***Dear Sir/Madam,We have closed this complaint and sent our detailed letter of response directly to the Guarantor.You may request a copy of that letter directly from the Consumer if needed for your filePlease send all requests and correspondence to the email address [email protected],The Centura Dispute and Resolution Department
On October 29, 2019 my husband saw a GI doctor at Saint Mary Corwin Medical Center (Centura Health). The doctor said no more than 15 words to my husband, never examined him, didn't even sit down. We then received a bill for $387.07, that is once his insurance paid roughly $200 of this bill. This is outrageous because the doctor spent no more than 4 minutes in the exam room! I am livid! We have since gone with a different GI doctor at Parkview Medical Center. What a difference! This doctor was so professional and made you feel as if you mattered. He spent about 20 - 25 minutes with my husband. Thank God that "he" was referred to us. Before this appointment I had my husband in the ER at Saint Mary Corwin Medical Center. What a joke for a doctor! He never even entered the room. He stood at the doorway, crossed his arms and ankles and told him that he had heartburn. My husband and I have "both" decided to go to Parkview Medical Center for everything that we may need. Comparing the two hospitals is like comparing night and day. This is so sad to me because I always use to think of Saint Mary Corwin Medical Center as the one and only hospital here in Pueblo that I would ever go to. This breaks my heart.
We have reviewed and closed the consumer complaint the desired settlement has been provided to the consumerStephanie M***Customer ServiceRevenue Management
Initial Business Response / [redacted] (1000, 9, 2015/09/29) */ We've responded to the same consumer request numerous times, no additional information has been provided by consumerIf consumer will not provide additional information, we will not review the same complaint againWe are closing this complaint unless consumer provides new information; this has been address numerous timesYou may obtain copies of the correspondence directly from the consumer Initial Consumer Rebuttal / [redacted] (3000, 11, 2015/10/10) */ (The consumer indicated he/she DID NOT accept the response from the business.) The response to the Revdex.com from Centura Health, dated September 29, 2015, is not responsive to the issues(1) It does not address the fact that the explanation of benefits (EOB) from the primary insurer, United Healthcare, included a minus $adjustment for the now-disputed $charge and stated (bottom line) that patient liability for the EOB was $(See attachment: EOB_UnitedHealthcare.pdf.) (2) It does not address the fact that the secondary insurer, BlueCross BlueShield, stated in response to my inquiry about the disputed charge that there is no patient liability(See attachment: BCBS_Message.pdf.) (3) It does not address the delay in billing(See attachments: Centura_Health_Statement.pdf and Centura_Health_Itemized.pdf.) The date of payment by United Healthcare was January 3, The date of the first bill from Centura Health was December 29, Why did it take days for Centura Health to ignore the minus $adjustment by United Healthcare and unilaterally deem the charge a patient liability? Did Centura Health think I would not notice and thereby be fooled into paying the $charge that had been negated by United Healthcare? The Centura Health response to the Revdex.com, dated September 29, 2015, is unprofessional and deceitfulLet's examine the four-sentence response in detail(1) First sentence: "We've responded to the same consumer request numerous times, no additional information has been provided by consumer." Before I initiated the complaint to the Revdex.com on August 31, 2015, I received no written communication from Centura Health except for billing statementsSince I initiated the complaint, Centura Health sent me letters dated September 8, and September 29, Neither letter requested additional informationNeither letter included a return address in the letterhead or in type above the date(This is unprofessional.) Neither letter included an email address or FAX numberGiven that lack of contact information, I question the sincerity of Centura Health's request for additional or new informationMy conclusion is that written communication with "Centura Health Dispute and Resolutions" is intended to be one-way: They talk to you; you are not intended to respond or submit any documentationFurthermore, what is the point of providing more information if Centura Health does not address the information already provided? (2) Second sentence: "If consumer will not provide additional information, we will not review the same complaint again." Translation: Centura Health will ignore the information already provided and use a purported lack of "additional information" as an excuse to cease reviewing the complaint(3) Third sentence: "We are closing this complaint unless consumer provides new information; this has been address sic numerous times." Seems like I've heard this refrain before, but let me add this in responseApparently, the Centura Health definition of "numerous" is "one." The date of Centura Health's response to the Revdex.com (September 29) coincides with the date of their second letter to meObviously, I could not have received their second letter at the time of Centura Health's response to the Revdex.comThis is deceitful(4) Fourth sentence: "You may obtain copies of the correspondence directly from the consumer." I have attached the correspondence so that the Revdex.com may verify what I have said above(See attachment: Centura_Health_letters.pdf.) Now, let's discuss the letters from Centura HealthIn the letter dated September 8, 2015, Centura Health claims that, "...per United healthcare the patient does owe this charge, could go to United healthcare but tetanus, diphtheria tox and acell pertussis are patient responsibility." The letter includes no attachment to substantiate this claim, which is clearly contradicted by the EOB I received from United Healthcare, dated December 24, That EOB shows in the row addressing the vaccination an amount of $in the column labeled "(-) Plan Discounts & Adjustments" and $in the column labeled "(=) Total Amount You Owe Provider." If Centura Health can document their claim with a written statement from United Healthcare, let them do soOtherwise, they should quit misrepresenting the factsThe September letter from Centura Health also recommends, "If you believe this balance has been left in error we encourage you to contact your insurance provider." On May 21, 2015, I did contact my secondary insurance provider, BlueCross BlueShield, about coverage for the Centura Health tetanus vaccination (the BlueCross BlueShield coverage supplements Medicare)The latest response, dated June 19, 2015, includes the following, "Thank you for your recent inquiryI have contacted the provider and advised her there is no patient liability and they cannot be charging youShe states she does show that on the Medicare summary noticeIf the provider is still billing you please contact us again." This implies that the Centura Health representative could see that the Medicare summary showed that the tetanus vaccination was not a patient liabilityAgain, it appears that Centura Health is misrepresenting the facts The Centura Health letter dated September 29, 2015, is much the same, again claiming, "The Explanation of Benefits we received from your insurance has deemed this balance as the patient's responsibility." Again, there is no substantiation of this claimCentura Health also admits that they are governed by contracts with insurance providers: "As stipulated by Centura's contracts with the insurance providers we must bill the patient for anything deemed as patient responsibility." The question is, who does the deeming? The BlueCross BlueShield EOB for the associated Centura Health office visit includes the following statement: "Your health care provider has agreed to accept assignment of Medicare benefitsThis means you are not responsible for the difference between the Medicare-approved amount and the actual charge." Thus, it appears that Centura Health may be violating their agreements with Medicare and the insurance companiesAlso, the Centura Health letter states, "This letter is being sent as a final clarification on the account, and to help you settle your open balance." Centura Health considers this to be the final clarification, but ultimately, that may have to be decided by someone who has the authority to force compliance with their contracts and agreements The Revdex.com has requested that I specify what issues were not addressed and how I and the Centura Health can reach a middle groundI believe I have documented the fact that there is no patient liability for the disputed chargeCentura Health claims that there is patient liability but, thus far, has not provided documentation for the claimIf they can do so, let them provide it and prove their claimUnless there is agreement on the facts, I don't see a path to a middle ground Final Consumer Response / [redacted] (4200, 15, 2015/11/05) */ (The consumer indicated he/she DID NOT accept the response from the business.) In its response to the Revdex.com dated 10/22/2015, Centura Health again shows a disregard for the truthThey said, "We have review the consumer's concerns, a resolution letter has been sent directly to consumer." Besides the poor grammar ("We have review ..." and sentences separated by a comma), note the claim that "a resolution letter has been sent directly to the consumer." Since the past tense is used, one might conclude that the letter had already been deposited in a USPS Mailbox on Oct 22, In fact, the letter was postmarked Oct27, Thus it appears highly doubtful that Centura Health actually sent the letter on Oct22, as they claimRecall that in Centura Health's response to the Revdex.com dated 09/29/2015, they claimed to have responded to my request numerous times when, in fact, at that date they had responded only onceTheir second response was postmarked Oct1, In my response to the Revdex.com dated 10/13/2015, I challenged Centura Health to provide documentation for their claim that "per United healthcare the patient does owe this charge, could go to United healthcare but tetanus, diphtheria tox and acell pertussis are patient responsibility." In Centura Health's latest response, they have failed to provide any documentation for that claimAll we have is their word, which, as I have indicated above, is suspectI have attached their latest response, including their letter, the first page of a "Transaction List" covering the services provided on 11/11/that they attached to the letter, and the envelopeNote that I have removed my social security number, birthdate, and services for dates other than 11/11/from the transaction listI am also attaching, again, the explanation of benefits (EOB) dated December 24, that I received from my primary insurer, United Healthcare Centura Health, in their latest response, makes undocumented claims that are contradicted by the written documentation I have providedIn particular, they say that, "The reason for denying Tdap was not a covered charge." This is also claimed in their transaction list under item as "DEN RSN: COCharges not covered." This information is directly contradicted by the EOB, which gives no reason code regarding the TDAP vaccineAgain, the EOB makes a minus $adjustment for the vaccine, which is not acknowledged in the transaction list (01/03/ADJ AUMD ADJ UNITED WEST MCR PPP 0), gives $as the amount not covered for the TDAP vaccine, and $as the total amount owed the provider for the TDAP vaccineIn their letter of September 29, 2015, Centura Health claimed, "The Explanation of Benefits we received from your insurance has deemed this balance the patient's responsibility." Centura Health has failed to produce this documentIn its absence, I must conclude that Centura Health is not telling the truth Final Business Response / [redacted] (4000, 20, 2015/12/23) */ We have review the consumer's concerns, a resolution letter has been sent directly to consumerIf you would like a copy of correspondence please contact the consumerThank you
I attached letters I sent to Centura regarding their incorrect/unclear billing The other letters are cut and pasted below Centura needs to clean up their billing, send out correct statements and make sure their records are correct- To Whom It May Concern: I, [redacted] , received a Notice of Denial of Payment (NDP) dated 11/17/ The NDP cites "Member Self Directed Out of Network" for services provided September through 28th, by Centura Home Care However, they were approved as in-network both by Centura and Porters Adventist Hospital, who has my complete insurance information, before services commenced Please check your recordsThank you for your assistance in this matter I look forward to your response.Jan- I have reviewed a statement dated December 28, for the above-referenced amount Date of Service is listed as 10/22/and Type of Service Received indicated is Out-PatientMy records show I did not take Mrs [redacted] to Porters on that date, neither did her son We are the only two people who would have taken her to an appointment Please check your records, determine the correct Date of Service and re-send the billJan- Porter Adventist HospitalP.OBox 561430Denver, CO 80256- Re: [redacted] [redacted] [redacted] [redacted] [redacted] [redacted] [redacted] To Whom It May Concern:Enclosed please find check #for $to cover the first five (5) charges listed abovePlease send an expanded service description for the Account #PA [redacted] - $which has a Date of Service of 11/12/ On that particular day, Mrs [redacted] was a patient at [redacted] Care As far as I know, she never left the facilityThank you for your attention to this matterI sent another letter on February via Centura's website regarding incorrect bill
Mr [redacted] has been in contact with our agency in regards to his billing issuesThey are working closely with him to resolve all issues that he's encountered during the course of his careWe are hoping that both parties are satisfied with the resolutionPlease let us know if you need anything additional on thisThank you,Centura Dispute & Resolution Department
This consumer complaint has been reviewed and we have responded to the consumer directly by letterIt is closed at this timeIf you require a copy of the letter please request it directly from the consumer. Stephanie ***Customer ServiceRevenue Management
Clicked on the link above to review the original complaint details...it did not openThe information contained in this communication is lacking the details that are needed to respond, does the consumer have an account number, the specific Entity/Location where services were renderedPlease provide
this information to allow us to respond appropriately
Initial Business Response /* (1000, 8, 2015/11/09) */
We have review the consumer's concerns for Mrs***, a resolution letter has been sent directly to consumerIf you would like a copy of correspondence please contact the consumerThank you
Initial Consumer Rebuttal /* (2000, 10,
2015/11/17) */
(The consumer indicated he/she ACCEPTED the response from the business.)
It was agreed to drop the charges for the Dr fees
hello, My name is *** ***, birth date 06/13/I was seen at *** *** *** *** on *** in *** ***I cannot recollect specific namesBut would be happy to find out and work with you to find outOverall, the whole staff was very cold and inattentive to patients needsFeel free to call or mail whatever I should fill outBut it doesn't technically resolve my problem I'm still left without careAnd *** *** *** as well as countless psychologists have been trying to help me get help.
Revdex.com:
I have reviewed the response made by the business in reference to complaint ID ***, and find that this resolution is satisfactory to me
Sincerely,
*** ***
Complaint: ***
I am rejecting this response because:Per response, complaint is still openI will accept when they have finished proper investigation
Sincerely,
*** ***
Initial Business Response /* (1000, 8, 2015/07/24) */
We have completed a thorough review of the consumer's complaint and will be closing this caseA detailed letter is being sent directly to the consumerYou may obtain a copy of the letter directly from the consumer if required for your
file
Revdex.com:
I have reviewed the response made by the business in reference to complaint ID ***, and find that this resolution is satisfactory to me
Sincerely,
*** ***
Initial Business Response /* (1000, 10, 2015/09/22) */
Good Morning,
We have review the consumer's concerns, a resolution letter has been sent directly to consumerIf you would like a copy of correspondence please contact the consumerThank you
Initial Consumer Rebuttal /* (3000, 12,
2015/09/28) */
(The consumer indicated he/she DID NOT accept the response from the business.)
I sent over the request in the past to MRO and they were not able to locate the recordsI need to know that if I send this request, are they going to truly have the record?
Final Consumer Response /* (4200, 16, 2015/10/06) */
(The consumer indicated he/she DID NOT accept the response from the business.)
I have submitted the request to the corresponding agency that supposedly has my medical records and was told that they do not have themI don't understand why obtaining these records is so difficult for Centura to doNo one gives me a straight answer or won't return my callsAll I want are these records and it seems like Centura just wants to continue to give me the runaroundI have filled out several medical record releases and sending another one for the same place that claims they don't have the records is just another slap in the faceIf this continues, then I may need to contact other avenues to get this resolved
Final Business Response /* (4000, 18, 2015/10/19) */
We've responded to the same consumer request numerous times, no additional information has been provided by consumerIf consumer will not provide additional information, we will not review the same complaint againWe are closing this complaint unless consumer provides new information; this has been address numerous timesYou may obtain copies of the correspondence directly from the consumer
The person that the Consumer refers to (Heather) did resolve this issue, there were two refund checks processed to the consumer on 04/06/16, we have closed this complaintYou may want to obtain details directly from the consumer