American Esoteric Laboratories

Complaint[redacted] in [redacted], Alabama, was purchased by American Esoteric Laboratories (AEL) and since that time I have had several conversations with their reps about my statements. I was on dialysis for six years and then almost five years ago I received a kidney transplant. I have to have my blood checked monthly to monitor my kidney function. My medical expenses were covered by [redacted] and [redacted] for most of the time. Three years following a transplant, [redacted] no longer is available so my [redacted] became my primary. I notified AEL, from whom I have my monthly labs drawn. They continued to bill [redacted] even though I called monthly to tell them. During this time I also told them to correct my mailing address. Neither of these was promptly done. The mailing address is still incorrect. My main concern was a statement for $375. The amount was overdue and I was afraid it would be referred for collection. I was told that this would NOT happen. I had paid all of my other monthly statements in full as they were received. Months went by and I called several times about this amount, went back and forth with AEL and [redacted] and had decided to just go ahead and pay the $375 because it had become such an overwhelming monthly chore. I spoke with a rep last week about this and told her that I would mail $75 and the balance would be paid $100 per month until it was paid-in-full. She did not inform me of what had been done. To my chagrin, I received a letter from a collection agency Friday of last week!! I called and spoke with a supervisor today and put the balance on a credit card. My main complaints are that AEL did not follow through with their promise of no collection referral, did not follow through with getting back in touch with me, and basically hid the referral from me. I am very troubled that this will happen to guiltless others who do not have the means to pay the amount due.Desired SettlementPlease inform AEL that this report was presented to the Revdex.com and that it is on file. Maybe this will compel AEL to look at and restructure their training procedures. Business Response Reviewed account listed and found the following: The account listed above was billed to [redacted] of Alabama [redacted] primary. On 07/24/2013, AEL received a payment of .14 cents from [redacted] and a contractual adjustment was applied for $151.86. The remaining balance of 499.00 was billed to the patient on 07/25/2013. On 08/02/2013, Ms. [redacted] called AEL Memphis customer service to get a status on the account. During this call account activity was explained and the patient made payments on other AEL accounts currently patient billing. Thursday, 09/19/2013, AEL received correspondence from [redacted] to bill [redacted] OF [redacted] due to no existing contract in place between AEL and [redacted] of [redacted]. A claim was generated on 09/23/2013 and mailed. [redacted] paid on 10/14/2013 99.56 with no contractual allowance. The patient was billed 399.44 on 10/16/2013. There was no response from the patient in October or November. The patient called December 3, 2013 for an account status and indicated [redacted] would be called for an explanation as to why charges were not paid in full. Shortly thereafter on 12/10/2013, a payment of $24.44 was received from the patient. (I am unable to ascertain why a payment in this amount was remitted). Reviewing the patient's payment history, there was not a payment applied to the account in January 2014, which could have triggered installment billing and due to the absence of a payment plan, the account aged through the billing cycle process and was ultimately submitted to an outside collection agency for recovery on 02/20/2014. On 02242014, a $75.00 payment was received from Ms. [redacted] and reported to the collection agency. There was no further direct patient communication contact on the account between 12/04/2013 and 03/02/2014. Monday, 03/03/2014, a payment in the amount of $300.00 was received via credit card payment, which paid the account in full. The account was also noted detailing the conversation with the patient on that day underscoring the patient's dissatisfaction of being turned over to an outside collection agency. The patient spoke with several AEL Memphis customer service representatives, but there was never a payment plan noted on the account. Additionally, payment plans require a payment be applied to the account monthly. The patient was mailed patient statements of account status on 07/25/2013,10/16/2013,11/15/2013 and a final notice on 01/15/2014. However, reviewing the address on the complaint against the address in the AEL system, I am unable to confirm with certainty the patient received any AEL statements. The address on file is [redacted] and the address on the complaint is [redacted] A call to [redacted] agency today, March 5, 2014 confirms the account is paid in full. In addition, there has been no adverse affect on the patient's credit rating in connection with this account (XXXXXXXX) to any local or national credit bureaus. Lastly, it is being recommended that in addition to an apology letter to the patient for not possibly explaining the installment plan process properly or fully and to accommodate the potential issue that the patient did not receive patient statement s in a timely manner; if at all to utilize the payment in full discount, it is recommended the patient be discounted $75.00 (20% of billed charges) and this amount be refunded/charged back to Ms. [redacted]'s credit card. Account XXXXXXXX is still pending a response from [redacted] and there is not patient billing or responsibility in connection with this account at this time.Consumer Response (The consumer indicated he/she DID NOT accept the response from the business.)I read the response from AEL and I would like to clarify a couple of items. I question why [redacted] of [redacted] was billed. After contacting my [redacted] of [redacted] rep, I told your rep the reason AEL had not been paid. I told her that [redacted] of [redacted] should be billed because the lab work was done in [redacted] not [redacted] With reference to the payment of $24.44, I told your rep that I would go ahead and pay that amount because it seemed to be the copay for other tests run at the same time as the one which was in question. I do not appreciate the negative statement that there was no response from me a couple of months concerning the balance of this statement. I was told that it was being handled and that it would NOT be turned over for collection. I awaited a call from your rep. Having not heard, I called to speak with your rep (who by-the-way I am sure could see that the account had been referred) about the $375, decided to go ahead and begin paying on the amount so I sent $75. I told her I would send $100 each month thereafter until it was paid. Furthermore, I do not want the $75 credit that was offered. That was not my intention with this complaint. My intention, as previously stated, was to make AEL aware of the lack of training and/or supervision with reference to their reps and consider restructuring procedures.Final Business Response After the review of this account for Ms. [redacted], many issues appear that have been addressed internally for the coaching and training of our internal teams. AEL strives to make all transactions as easy as possible but this particular accession simply did not fall into line. Regretfully on this account processes were put into place then were not followed through to ensure accurate billing. We have taken steps to correct this process.To answer the latest question via the Revdex.com rebuttal, [redacted] of [redacted] was filed only after AEL received notice that we were to do so from [redacted] Since the disablement of the [redacted] program, it is common for us to see this type of confusion as [redacted] moves through this unusual transition. At one time it was clear that all services performed in a certain state were always billed to that state but that is no longer the policy from the [redacted] plans. It is now required per [redacted] policy to bill the state in which the Physician is registered with their National Provider Identification, even when the Physician no longer lives or works in that state. This has caused much confusion and controversy for all parties.This situation has been turned over to the AEL Compliance officer and she is to follow this account as well as past accounts to determine why the process did not work as well as to work with [redacted] to properly adjudicate claims going forward.Again, we apologize for the inconvenience this situation has caused and we are making all efforts to correct the issues going forward.

I received a bill about 5 months for $808.00 ago, called AEL to find out why they didn't know. So I asked them to refile the claim on my two insurances [redacted] they said they would. Now 5 months later I get the same bill again. I called them and asked them whats going on they said that they hadn't received payment from insurance [redacted] and that I would have to pay bill. I told them I also had [redacted] the customer service rep. Named [redacted] said they Could not file with [redacted] because [redacted] had not responded. I told her I have 2 insurances for years and they both pay all the time and will pay if they file the claim correctly. She said she don't think the claim was filed properly. I asked that they refile again she just said someone would probably call me back which has not happen. Account number XXXXXXXX-X has also incorrectly sent bill in [redacted] name which he has never signed any paper work or been to the office I had the lab work done. Account number again is XXXXXXXX-XProduct_Or_Service: Laboratory WorkAccount_Number: XXXXXXXX-XDesired SettlementFile the charges to my insurance company. They bill is over 6 months old, may be too late for payment. If they don't pay write bill off because claim was not submitted in a timely manner. I have 2 insurances [redacted]Business Response To Whom it May Concern:AEL filed the claim two times to [redacted] with no response either time. These were both sent electronically, first on 04/22/2013 and again on 07/26/2013. Both batches were accepted by [redacted] but we never received a response back. We are now past the filing deadline and due to [redacted] not responding we have no proof that we did file a claim in a timely manner. On the [redacted] website no claim shows up for 04/15/2013, without the [redacted] explanation of benefits, we are unable to file a claim to [redacted] We have removed [redacted] from the account. The lab requisition had him listed as the policy holder(which he is the policy holder for the [redacted] policy). I have spoken to the patient and advised her that we have taken [redacted] off her account and written off the entire balance.I am sending her a statement that shows her account does have a zero balance.

My deductible and out-of-pocket expenses had been met for the year. I had proof. They failed to refile the claim and put me in collections for $28.45.I called the billing office and informed them that my deductible had been met for the year and the $28.45 they were billing me for would have to come back to me. I have receipts for said expenses and even offered to prove my claim and the man refused to listen to me. I asked him to refile the claim, as that is what my insurance told me to tell them, and he refused. So, instead of working with me, the company turned me over to collections. I will mail the collection department my proof and if it is taken any further, I will contact my lawyer. When I have blood drawn I will request which lab the blood will go to. This place will nickel and dime people. I have asked doctors why they use these types of independent labs and I was told that they don't want the responsibility of making sure the people in the clinic were licensed. AEL is completely taking advantage of this. I will refuse blood work.Desired SettlementRemove my bill from collections. I have contacted your office and tried to negotiate the $28.45 bill.Business Response The claim was submitted to [redacted] as requested and AEL received an EOB on 10/8/2014. The total amount billed was 184.80. The claim was processed in network with 156.35 being adjusted as contractual obligation. The approved amount of 28.45 was applied to deductible. The patient statements were queued on 10/21/2014, 11/20/2014 and 12/22/2014. A collection notice was queued on 1/19/2015 and the account went to collections on 3/5/2015.During this time there is no record of a call coming in to AEL. In addition, the complaint stated that Ms [redacted] spoke to a man who refused to refile a claim for her. AEL has no male representatives that could have taken a call from her.Today, the EOB was verified, [redacted] called to see what information could be obtained and have had the account pulled from the collection company. The [redacted] EOB is very clear in applying this 28.45 to deductible and the EOB was posted correctly. [redacted] states today that the 2014 deductible had not been met at this time of this claim and the EOB is correct. The patient does owe the balance but if she pays the balance on line could receive the 20% discount making her total amount due if paid online of 22.76.

I PAID A BILL AND THEY KEEP BILLING ME AND SENT MY INFO TO A COLLECTION PLACE. ORIGINAL BILL PAID ELECTRONICLY W/ CHECK NUMBER 6056. [redacted] PLACE DOES NOT KNOW ANYTHING ABOUT IT.Product_Or_Service: [redacted] LAB REQUESTOrder_Number: PEXXXXXXX-XDesired Settlement[redacted] PLACE SHOULD BE WARNED OF THIS PRACTICE. MAILING SHOULD STATE PAID IN FULL.COPY OF LAB RESULT, IF THERE REALLY IS ONE SHOULD BE SENT TO PATIENT.Business Response Lab orders were received on two dates of service for Patient [redacted], DOB [redacted] Both orders were received and test results completed and reported to the ordering physician.On the first date of service, 10/24/2013, tests were ordered by [redacted] with client [redacted] A claim was filed with the insurance information that was provided [redacted] and the claim was paid leaving a co-pay amount of $12.00. A statement was sent to the patient for this accession (PEXXXXXXX) and a check # 6056 in the amount of 12.00 was posted to this accession closing the accession to a zero balance.On the second date of service, 11/13/2013, tests were ordered by [redacted] with client [redacted] A claim was filed with the insurance information that was provided [redacted] and the claim was paid leaving a co-pay amount of $12.00. A statement was sent to the patient for this accession (PEXXXXXXX) on 12/10/2013, 1/9/2014 and 2/10/2014 without response. The accession balance of 12.00 was sent to collections per company process on 3/13/2014.This patient insurance plan applies a co-pay fee to each laboratory encounter (different date of service). The accounts have been handled correctly.Consumer Response (The consumer indicated he/she DID NOT accept the response from the business.)First test was requested by a doctor I visited, it was authorized. Second request was requested by an unknown person.