We have review the consumer’s concerns, a resolution letter has been sent directly to consumer. If you would like a copy of correspondence please contact the consumer. Thank you
Initial Business Response /* (1000, 9, 2015/09/29) */
We've responded to the same consumer request numerous times, no additional information has been provided by consumer. If consumer will not provide additional information, we will not review the same complaint again. We are closing this...
complaint unless consumer provides new information; this has been address numerous times. You may obtain copies of the correspondence directly from the consumer.
Initial Consumer Rebuttal /* (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 $83 adjustment for the now-disputed $83 charge and stated (bottom line) that patient liability for the EOB was $10. (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, 2014. The date of the first bill from Centura Health was December 29, 2014. Why did it take 360 days for Centura Health to ignore the minus $83 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 $83 charge that had been negated by United Healthcare?
The Centura Health response to the Revdex.com, dated September 29, 2015, is unprofessional and deceitful. Let'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 statements. Since I initiated the complaint, Centura Health sent me letters dated September 8, 2015 and September 29, 2015. Neither letter requested additional information. Neither 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 number. Given that lack of contact information, I question the sincerity of Centura Health's request for additional or new information. My 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 documentation. Furthermore, 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 response. Apparently, 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 me. Obviously, I could not have received their second letter at the time of Centura Health's response to the Revdex.com. This 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 Health. In 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, 2013. That EOB shows in the row addressing the vaccination an amount of $83.00 in the column labeled "(-) Plan Discounts & Adjustments" and $0.00 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 so. Otherwise, they should quit misrepresenting the facts. The September 8 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 inquiry. I have contacted the provider and advised her there is no patient liability and they cannot be charging you. She states she does show that on the Medicare summary notice. If 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 liability. Again, 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 claim. Centura 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 benefits. This 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 companies. Also, 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 ground. I believe I have documented the fact that there is no patient liability for the disputed charge. Centura Health claims that there is patient liability but, thus far, has not provided documentation for the claim. If they can do so, let them provide it and prove their claim. Unless there is agreement on the facts, I don't see a path to a middle ground.
Final Consumer Response /* (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 truth. They 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, 2015. In fact, the letter was postmarked Oct. 27, 2015. Thus it appears highly doubtful that Centura Health actually sent the letter on Oct. 22, 2015 as they claim. Recall 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 once. Their second response was postmarked Oct. 1, 2015.
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 claim. All we have is their word, which, as I have indicated above, is suspect. I have attached their latest response, including their letter, the first page of a "Transaction List" covering the services provided on 11/11/13 that they attached to the letter, and the envelope. Note that I have removed my social security number, birthdate, and services for dates other than 11/11/13 from the transaction list. I am also attaching, again, the explanation of benefits (EOB) dated December 24, 2013 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 provided. In particular, they say that, "The reason for denying Tdap was not a covered charge." This is also claimed in their transaction list under item 53 as "DEN RSN: CO96 Charges not covered." This information is directly contradicted by the EOB, which gives no reason code regarding the TDAP vaccine. Again, the EOB makes a minus $83 adjustment for the vaccine, which is not acknowledged in the transaction list (58 01/03/14 ADJ AUMD ADJ UNITED WEST MCR PPP 0), gives $0.00 as the amount not covered for the TDAP vaccine, and $0.00 as the total amount owed the provider for the TDAP vaccine. In 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 document. In its absence, I must conclude that Centura Health is not telling the truth.
Final Business Response /* (4000, 20, 2015/12/23) */
We have review the consumer's concerns, a resolution letter has been sent directly to consumer. If you would like a copy of correspondence please contact the consumer. Thank you
We have reviewed and closed the consumer complaint the desired settlement has been provided to the consumer. Stephanie M[redacted]Customer ServiceRevenue Management
Complaint: [redacted]
I am rejecting this response because: I understand the letter perfectly, the company is not understanding my responses, obviously. They say they have up to a year to bill me, but I was told differently by one of their representatives. Also, the main point of my complaint was the treatment of my account...not giving me time, as I contacted them several times (as I had no choice on time, since it took the insurance company 2 months to answer my appeal, and then I had to wait a while on the dr's office to respond as well), and just sending my account to a credit agency...no payment plan, no explanation or anything. That is not the right treatment for a patient, who is trying hard to do the right thing in all these situations. They obviously do not care, as stated in BOTH letters I received (dated same day, saying exact same thing...if that doesn't show how unorganized their billing office is, then I don't know what is...how ridiculous). They need to make sure everyone is on the same page in what is being told, what is being sent and to show that they truly are "passionate about their patients."
Sincerely,
[redacted]
I apologize for the length of time it has taken for us to respond. We received resolution on 8.22.16, and are following up with the consumer. Thank you!
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 once I receive the $10 check and the accounting errors on my son's account are resolved.
Sincerely,
[redacted]
Good afternoon, we have received your dispute and are currently researching further into your concern. Once more information is obtained, the findings will be communicated to you.Thank you,Centura Health Disputes
Final Consumer Response /* (2000, 8, 2015/07/11) */
I would like to retract this complaint. I contacted Wageworks and found the error was primarily with their process. I also contacted Avista and found that a computer glitch caused the distribution of collection letters to several...
customers,which Avista was in the process of clearing up. I have resolved this matter with Avista, however, if my credit is affected, I will submit a new complaint. The manager assisting me was very understanding and helpful.
Mr. [redacted] has been in contact with our agency in regards to his billing issues. They are working closely with him to resolve all issues that he's encountered during the course of his care. We are hoping that both parties are satisfied with the resolution. Please let us know if you need anything...
additional on this. Thank you,Centura Dispute & Resolution Department
Good Morning,
We have review the consumer's concerns, a resolution letter has been sent directly to consumer. If you would like a copy of correspondence please contact the consumer. Thank you
Good Morning, We have review the consumer’s concerns, a resolution letter has been sent directly to consumer. If you would like a copy of correspondence please contact the consumer. Thank you
Within the content of the letter sent to consumer explained that Centura has one year to bill her, which did occur. We are following up with...
consumer directly as she is not understanding the letter and its content as explained in great detail.Thank you kindly,Centura Health Dispute & Resolution Department
Complaint: [redacted]
I am rejecting this response because: Your name of Centura Health is CLEARLY marked on the side of the emergency room that I visited. I understand from your website that you are a partner with the [redacted]. If the [redacted] or [redacted] group were being responsive to my MULTIPLE requests for my money back, I wouldn't have even had to go through the nightmare of filing this complaint with the Revdex.com. You have chosen a HORRIBLE group to attach your name with.As with all items related to this claim, I highly doubt that you will be responding to this rejection, stating that the Larking Group has my $87, but you clearly have some ownership with this fiasco as this is YOUR emergency room.
Sincerely,
[redacted]
We have received this complaint and are in the process of resolving it once we have obtained additional information from the Consumer. Once we have completed all of the necessary steps in addressing this complaint our final determination and resolution will be communicated to the Consumer by letter.
We have review the consumer’s concerns, a resolution letter has been sent directly to consumer. If you would like a copy of correspondence please contact the consumer. Thank you
Initial Business Response /* (1000, 9, 2015/09/29) */
We've responded to the same consumer request numerous times, no additional information has been provided by consumer. If consumer will not provide additional information, we will not review the same complaint again. We are closing this...
complaint unless consumer provides new information; this has been address numerous times. You may obtain copies of the correspondence directly from the consumer.
Initial Consumer Rebuttal /* (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 $83 adjustment for the now-disputed $83 charge and stated (bottom line) that patient liability for the EOB was $10. (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, 2014. The date of the first bill from Centura Health was December 29, 2014. Why did it take 360 days for Centura Health to ignore the minus $83 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 $83 charge that had been negated by United Healthcare?
The Centura Health response to the Revdex.com, dated September 29, 2015, is unprofessional and deceitful. Let'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 statements. Since I initiated the complaint, Centura Health sent me letters dated September 8, 2015 and September 29, 2015. Neither letter requested additional information. Neither 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 number. Given that lack of contact information, I question the sincerity of Centura Health's request for additional or new information. My 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 documentation. Furthermore, 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 response. Apparently, 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 me. Obviously, I could not have received their second letter at the time of Centura Health's response to the Revdex.com. This 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 Health. In 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, 2013. That EOB shows in the row addressing the vaccination an amount of $83.00 in the column labeled "(-) Plan Discounts & Adjustments" and $0.00 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 so. Otherwise, they should quit misrepresenting the facts. The September 8 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 inquiry. I have contacted the provider and advised her there is no patient liability and they cannot be charging you. She states she does show that on the Medicare summary notice. If 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 liability. Again, 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 claim. Centura 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 benefits. This 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 companies. Also, 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 ground. I believe I have documented the fact that there is no patient liability for the disputed charge. Centura Health claims that there is patient liability but, thus far, has not provided documentation for the claim. If they can do so, let them provide it and prove their claim. Unless there is agreement on the facts, I don't see a path to a middle ground.
Final Consumer Response /* (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 truth. They 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, 2015. In fact, the letter was postmarked Oct. 27, 2015. Thus it appears highly doubtful that Centura Health actually sent the letter on Oct. 22, 2015 as they claim. Recall 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 once. Their second response was postmarked Oct. 1, 2015.
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 claim. All we have is their word, which, as I have indicated above, is suspect. I have attached their latest response, including their letter, the first page of a "Transaction List" covering the services provided on 11/11/13 that they attached to the letter, and the envelope. Note that I have removed my social security number, birthdate, and services for dates other than 11/11/13 from the transaction list. I am also attaching, again, the explanation of benefits (EOB) dated December 24, 2013 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 provided. In particular, they say that, "The reason for denying Tdap was not a covered charge." This is also claimed in their transaction list under item 53 as "DEN RSN: CO96 Charges not covered." This information is directly contradicted by the EOB, which gives no reason code regarding the TDAP vaccine. Again, the EOB makes a minus $83 adjustment for the vaccine, which is not acknowledged in the transaction list (58 01/03/14 ADJ AUMD ADJ UNITED WEST MCR PPP 0), gives $0.00 as the amount not covered for the TDAP vaccine, and $0.00 as the total amount owed the provider for the TDAP vaccine. In 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 document. In its absence, I must conclude that Centura Health is not telling the truth.
Final Business Response /* (4000, 20, 2015/12/23) */
We have review the consumer's concerns, a resolution letter has been sent directly to consumer. If you would like a copy of correspondence please contact the consumer. Thank you
We have reviewed and closed the consumer complaint the desired settlement has been provided to the consumer. Stephanie M[redacted]Customer ServiceRevenue Management
Complaint: [redacted]
I am rejecting this response because: I understand the letter perfectly, the company is not understanding my responses, obviously. They say they have up to a year to bill me, but I was told differently by one of their representatives. Also, the main point of my complaint was the treatment of my account...not giving me time, as I contacted them several times (as I had no choice on time, since it took the insurance company 2 months to answer my appeal, and then I had to wait a while on the dr's office to respond as well), and just sending my account to a credit agency...no payment plan, no explanation or anything. That is not the right treatment for a patient, who is trying hard to do the right thing in all these situations. They obviously do not care, as stated in BOTH letters I received (dated same day, saying exact same thing...if that doesn't show how unorganized their billing office is, then I don't know what is...how ridiculous). They need to make sure everyone is on the same page in what is being told, what is being sent and to show that they truly are "passionate about their patients."
Sincerely,
[redacted]
I apologize for the length of time it has taken for us to respond. We received resolution on 8.22.16, and are following up with the consumer. Thank you!
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 once I receive the $10 check and the accounting errors on my son's account are resolved.
Sincerely,
[redacted]
Good afternoon, we have received your dispute and are currently researching further into your concern. Once more information is obtained, the findings will be communicated to you.Thank you,Centura Health Disputes
Final Consumer Response /* (2000, 8, 2015/07/11) */
I would like to retract this complaint. I contacted Wageworks and found the error was primarily with their process. I also contacted Avista and found that a computer glitch caused the distribution of collection letters to several...
customers,which Avista was in the process of clearing up. I have resolved this matter with Avista, however, if my credit is affected, I will submit a new complaint. The manager assisting me was very understanding and helpful.
Mr. [redacted] has been in contact with our agency in regards to his billing issues. They are working closely with him to resolve all issues that he's encountered during the course of his care. We are hoping that both parties are satisfied with the resolution. Please let us know if you need anything...
additional on this. Thank you,Centura Dispute & Resolution Department
Good Morning,
We have review the consumer's concerns, a resolution letter has been sent directly to consumer. If you would like a copy of correspondence please contact the consumer. Thank you
Good Morning, We have review the consumer’s concerns, a resolution letter has been sent directly to consumer. If you would like a copy of correspondence please contact the consumer. Thank you
Within the content of the letter sent to consumer explained that Centura has one year to bill her, which did occur. We are following up with...
consumer directly as she is not understanding the letter and its content as explained in great detail.Thank you kindly,Centura Health Dispute & Resolution Department
Complaint: [redacted]
I am rejecting this response because: Your name of Centura Health is CLEARLY marked on the side of the emergency room that I visited. I understand from your website that you are a partner with the [redacted]. If the [redacted] or [redacted] group were being responsive to my MULTIPLE requests for my money back, I wouldn't have even had to go through the nightmare of filing this complaint with the Revdex.com. You have chosen a HORRIBLE group to attach your name with.As with all items related to this claim, I highly doubt that you will be responding to this rejection, stating that the Larking Group has my $87, but you clearly have some ownership with this fiasco as this is YOUR emergency room.
Sincerely,
[redacted]
We have received this complaint and are in the process of resolving it once we have obtained additional information from the Consumer. Once we have completed all of the necessary steps in addressing this complaint our final determination and resolution will be communicated to the Consumer by letter.