BrightStar Care of Reno

We had premature babies (twins) discharged from the hospital needing a lot of home care. They would stop breathing and need to be stimulated to breathe again. We contacted Brightstar and spoke with [redacted] she came to our house and met with us she took our insurance information and told us that we did have coverage for a night nurse to come and take care of the babies. She started sending the nurse right away in May. In July she called us and told us that the insurance company had denied the claim and we told her we couldn't pay for it so we needed to stop care. We called our insurance company and they told us no claim was ever submitted and they submitted for a pre authorization on 7/15/15 which is 1.5 months AFTER we started care. We never heard from Brightstar again until 5/23/16 when they called us and told us we owe $9000 and we had to pay that day or they were sending us to collections. We have filed with our insurance company and their fraud department and they have told us that Brightstar never filed a claim or pre authorization and there are many holes in their processes. [redacted] deceived us from the beginning telling us we had coverage and never even tried to get it covered until after it we had already had care. We told her up front the only reason we were doing it was because the insurance company told her it was covered. They are trying to commit fraud and lied to us from the beginning they should not be in business their practice is deceitful and unethical.Desired SettlementWe are not going to pay the bill we have with bright star since they lied to us to get us to use their service we would like the bill written off completely or we will seek legal action. Business Response BrightStar is very sympathetic to the health issues of this client's children and we sincerely hope they continue to do well.BrightStar prides itself on the quality of its staff and the very high quality standards and business ethics to which it holds itself accountable. Since starting the business almost seven years ago we have served probably close to 1,000 clients. In all that time we have never received any formal complaint and have maintained high quality ratings from a number of independent assessment agencies as well as many very complimentary unsolicited testimonials from clients. So it is with much disappointment and surprise that we learn of this complaint, especially when the facts as stated by the complainant are unfortunately entirely wrong.This complainant is the husband of our client. The client initially requested that we come to meet them to learn of their needs for their newborns and to discuss our services. At that meeting the client stated that she had some health insurance but did not think it would cover these services. She was surprised and pleased to learn that we would be willing to try and help her get her insurance company to maybe pay something.As is the case with all our clients and is also standard across the healthcare industry, we stated that we would be happy to try and work with the insurance company for payment, but ultimately our contract was with her, not the insurance company, and that by signing the contract she would be agreeing to pay us all and any charges that the insurance company would not cover and/or pay for. We indicated that working with the insurance company to learn what level of coverage and payment they would or would not provide would likely take some time, and that we could give no guarantee that the insurance company would pay anything. Consequently this could very well mean that she would indeed be paying all charges out of pocket. We stated that, depending upon how the client would like to proceed, we were in a position to provide staff immediately. As with all clients, and again is typical throughout the healthcare industry, our offer to bill the insurance company was a courtesy only.With all the above knowledge, regardless of whether her insurance would cover anything or not, the client wanted to move forward with our services immediately and signed our self-pay contract. That contract laid out the services to be provided and their costs, and also clearly identified that the client, was responsibility and liable for payment of all charges. In addition to providing the contracted services, BrightStar also provided significant additional care-giving services at no charge. I am very pleased to say that those services were provided by [redacted] who is an outstanding, incredibly caring, very capable member of my staff. I count myself very fortunate she is leading my team.As promised, BrightStar tried to work with the client's insurance company but they denied coverage and sent letters of denial to both the client and to BrightStar. Upon receipt of our copy of the letter from the insurance company, we of course immediately contacted the client for direction. The client's husband canceled services immediately which, as per the agreement, was perfectly within their right.Given that the client also received the letter of denial for payment from their insurance company and canceled services when they learned of the denial, I find it simply impossible to understand how her husband can say that BrightStar 'never filed a claim' with their insurance company.Following this insurance denial and the client's cancelation of services, as per our agreement with the client, we invoiced her for the services previously rendered. Following submission of those invoices, we did not hear further from her or her husband. Neither did we receive any payment, nor receive any calls to discuss any factor of services, invoices, payment or contract.As the outstanding debt aged, we contacted the client on several occasions to ask for payment and unfortunately our staff member who made the calls was the recipient of much verbal abuse from the client's husband as well as his refusal to pay. With much patience, we sent copies of the invoices to the client again on several occasions asking for payment each time. Unfortunately, each time there was no reply forthcoming from the client.Finally, with the debt now being extremely old and having received no contact from the client despite our repeated attempts to collect payment, we had no choice but to move to send the debt to collections. As is our practice, before initiating that final step we contacted the client again, by phone, to inform her of this imminent action and to offer the opportunity to initiate a payment plan for the debt. Unfortunately the client's husband elected to be extremely abusive to my staff again and appeared uninterested in making any payment.Quite quickly after this call, the client's husband called back with a representative of the insurance company on the phone with him. Our director of Operations took the call. The insurance representative confirmed that she did not have any prior knowledge of the case and throughout the call she seemed to make contradictory statements as to her course of action. She indicated that she could not see all the notes on the account and that she did not see any initial claim. Our director informed her that our office had records of the claim submitted as well as the denial letters from her company. In addition our Director informed the representative that we were aware that the insurance company's letters of denial had been sent to the client as well as to us and that the client's husband was also aware of the denial when he canceled services from us. Throughout this call the insurance representative was entirely unprofessional and quite rude. Additionally, even when specifically requested by our Director, the representative would not escalate the call to a supervisor. After considerable discussion and multiple attempts at clarification by our Director, the insurance representative indicated that she would open a case with her fraud department. The insurance representative seemed entirely unclear in her verbal explanation of any reasoning as to why she felt any fraud had occurred and she would not state what fraud she identified or suspected. Thus we cannot comment on what, if anything the insurance company will do and I await the outcome of any action the insurance company may or may not take. It should be noted also that BrightStar has filed a formal complaint with the insurance company regarding the customer service representative during the above noted call for her lack of professionalism and refusal to provide accurate and specific information as well as her refusal to escalate the call to any supervisor.Considering we have not received any payment from either the client or the insurance company for our services, I am unable to even speculate how anyone could say that any fraud has occurred, save perhaps attempted fraud by the client in signing a self-pay agreement with us while having no actual intention of paying: We provided services in good faith that were actually delivered almost a year ago. I have long since paid my employees for the work they performed in the provision of the services and I now have to carry a significant debt because the client will not pay as agreed in the contract.I reiterate: the client signed an agreement which clearly and specifically stated she would be liable for all charges. We attempted to bill the insurance company on behalf of the client and they denied coverage or payment. We then sought payment from the client, who has continually refused to pay us.We have been extremely patient and have given the client significantly longer to settle the account than most organizations would. It appears that it was only when the client's husband knew the account was going to collections did he do anything.BrightStar has operated fairly, equitably and ethically. We are extremely proud of our staff, we are very proud of the help we have given to the countless clients we have served and we are proud of the support, albeit for a short time, that we gave the children of this client. We hold our reputation very dear and very high. We remain in contact with the client, and continue to try and get settlement of the outstanding debt. We sincerely hope it does not have to result in a collections process. We note that the complainant has threatened legal action. We are prepared should he move forward on that course. For all the reasons stated above, we believe we would prevail in any such case.Thank you for the opportunity to address this complaint and to set the record straight. We continue to focus on delivering the very best service, from the very best staff, to our moConsumer Response (The consumer indicated he/she DID NOT accept the response from the business.)He is lying in the statement that we knew it wasn't covered by insurance and decided to move forward. We only moved forward because the director of operations told us it was covered we have several witnesses to her making this statement. We were up front and said we would not use the care unless it was covered by insurance and they told us it was so we moved forward. They did not submit anything to insurance until 2 months after we started receiving care when insurance denied we stopped immediately. They never told the caregiver we had stopped care and she showed up at our house we told her we couldn't continue anymore and she left. We just found out they are billing us for her showing up to our house even though we had no way to contact the caregiver Bright Star was supposed to. They say they bill insurance as a courtesy that is wrong that is how they get paid and they knew that was the only way we would continue forward. This business should be thoroughly investigated for fraud and unethical practices. They never once sent us a bill they called us on 5/24/16 told us to pay them $8000 or we were going to collections the next day, that in itself is illegal. We have asked them to provide proof of sending bills and making phone calls to us and they haven't. We have asked them to provide proof that they called for a pre authorization prior to beginning service and they can't. The insurance company is also investigating them for fraud. We will not pay a dime on this bill. And we don't want other families who are going through difficult times with a sick loved one to be swindled by this company. Final Consumer Response (The consumer indicated he/she DID NOT accept the response from the business.)We will not pay any fees for these services because we were lied to in order to get us to sign the contract. We have contacted our insurance company and they have not received any paperwork from Bright Star. We have emails stating that they tried to contract with our insurance company and that is also a lie. As a matter of fact our insurance company did a nationwide search to see if they were contracted with Bright Star at all and they have never received anything from any of the Bright Star franchises to try and become a provider. The insurance company believes as well as us that they have probably told many clients that they are a contracted provider to get them to sign the contract but in all actuality never even tried to start the process. We are in the process of getting medicaid and medicare to start an audit on Bright Star of Reno. We also have bills showing that they are trying to get us to pay for days when we didn't even have service! That is 100% fraud. We have filed with the attorney general of Nevada and the department of health of Nevada. We don't want anyone else to be lied to swindled by these people. Final Business Response I am very proud of my small business and of the many jobs I have been able to create and sustain. More importantly though, is the fact that I am even more proud of the truly wonderful, compassionate, caring and capable staff I have. For it is they who truly make a difference in the lives of each and every one of our clients, each and every day. I know that I run a business with very high ethics and very strong morals. I stand by my previous statements and I look forward to updating this case with the final outcome.