Dual Diagnosis Treatment Center Inc

We are deeply sorry that Ms*** had to go through this ordeal and wish that this can be resolved immediatelyUnfortunately it is not in our controlThis matter arose from Ms***’s insurance carrier, Hi *** unwillingness to resolve a genuine dispute with Sovereign Sovereign
provided services to Ms*** and submitted the claim to Hi ***, her insurance carrier for reimbursementAfter the claim was reimbursed, Hi *** tried to collect and adjusted amount from its member, Ms***Hi *** contends that there was a corrected claim submitted by Sovereign’s billing agent at the time Medpro Sovereign has contacted the insurance company and is in the process of resolving this disputeHowever, Sovereign has no control over Hi *** taking action against its members We want to assure Ms*** that we are in contact with Hi *** and will continue to try to resolve the matter

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID ***, and have determined that this proposed action would not resolve my complaint. For your reference, details of the offer I reviewed appear below.As stated before, your admission staff was informed of my daughters current condition and was provided access and given information from the hospital and past residential programYou were told of her suicide attempts and that she would need to have one on one staffI was told by your admission staff that you would be able to accommodate these needs, I asked “are you sure” because I have been turned down by many facilities because they could not accommodate these needsYou again assured me that you could accommodate her. Then you discharged my daughter for those very reasons within or days after she arrivedYour claim that my daughter somehow had developed a new condition when she arrived is untrue and you can verify that with the documented records that you were providedYou had every opportunity to review the hospital notes, communicate with the hospital staff (doctors, psychiatrist, etc.)and talk to my daughter before my daughter was admitted just like every other program I tried to admit her tooJust because your staff failed to do their job does not excuse you from your responsibilities
Regards,
*** ***

October 14,
Re: *** ***
To whom it may concern,
Sovereign Health of California would like to respond to this complaint and inform all parties that this issue was resolved on September 3,
All moneys owed to insurance company regarding any overpayment were paid back for the amount
of $4,Check #*** was issued to
Overpayment Recovery and mailed to PO Box ***, ***, OH ***Sovereign Health of California would like to apologize for any delay
in this process but according to the companies policies and procedures regarding a due diligence, we want to make sure that the correct amounts
are being paid correctlyI have reached out to *** *** and *** *** and the insurance companies collection agency and submitted the
same responseWe appreciate your feedback and once again are happy to state that this case has been resolved
Thank you

The preadmissions assessmentprocess for patients interested in admitting to any Sovereign Health facilityhas been designed to be thorough, rigorous and timely.  Whenever possible, we attempt to speakdirectly with the patient.  When that isnot possible, we gather as much background...

information as is available from: parents,a spouse or other persons with knowledge of the admitting patient’s treatmenthistory, personal background and life history. We also collect and review all relevant prior medical and treatment records.  The next step in the assessment process is athorough review by a clinically trained member of our admissions team of all theinformation that has been collected.   Atthat point, based on the information we have been given, we can make an initialdetermination of whether or not the client is clinically appropriate foradmission to one of our facilities.  Theaccuracy of these preadmissions assessments is dependent on the accuracy of theinformation provided to us.  However, thereality of patients struggling with mental illness is that the situation isalways fluid, often volatile and a patient’s status can change in a matter ofminutes or hours.  These changes canoccur following our initial assessment and prior to admission, at the time ofadmission or at any time during the course of treatment.  This means that although a patient may beappropriate for admissions to one of our facilities at the time of the initialassessment, that suitability can change at any time and that may necessitatemoving the patient to a different level of care or even to a different facility(inside or outside the Sovereign network) in order to meet their changing clinicalneeds.

Review: Sovereign Health has decided to not reimburse us for their mistakes. Their staff at Fort Myers has admitted that we were told and promised things (acute mental health care, one on one care, suicidal ideation care, long-term care for six months or longer with no out-of-pocket expenses) that they did not have the ability to handle or deliver. All the information and hospital records were supplied to them by the facilities records department or me. On day one the admitting staff and doctor at Sovereign Health in Florida commented, “I don’t know why they sent you here, I don’t think we can help you.” Two of the counselors also had similar comments that clients are regularly promised things they have no ability to handle and or deliver. They apologized and said they don’t know why we were told such things. [redacted] the admissions coordinator was told over and over again that my daughter would need one on one care because of suicidal ideations and self harm issues, she assured me that they would be able to meet my daughters needs. [redacted] and Sovereign Health were informed more than once that my daughter was denied and or released from a number of facilities due to the level of acute mental health care needed. I stayed extra days because of what they told me to be sure they were going to be able keep my daughter. After staying extra days they told my daughter and me they would try and make it work. I hadn’t even been gone 48 hours and they sent my daughter to a mental hospital for medication evaluation, or at lest that’s what they said but after being in the mental hospital they said they did not want her back. We traveled over 3000 miles and spent nearly $3000.00 Solely on Sovereign Health’s promises to help my daughter.Desired Settlement: My desired outcome is for Sovereign Health to compensate me for my expenses incurred for my travel to and from Sovereign Health included but not limited to airfare, car rental, hotel, gas, and food.

Business

Response:

The preadmissions assessmentprocess for patients interested in admitting to any Sovereign Health facilityhas been designed to be thorough, rigorous and timely. Whenever possible, we attempt to speakdirectly with the patient. When that isnot possible, we gather as much background information as is available from: parents,a spouse or other persons with knowledge of the admitting patient’s treatmenthistory, personal background and life history. We also collect and review all relevant prior medical and treatment records. The next step in the assessment process is athorough review by a clinically trained member of our admissions team of all theinformation that has been collected. Atthat point, based on the information we have been given, we can make an initialdetermination of whether or not the client is clinically appropriate foradmission to one of our facilities. Theaccuracy of these preadmissions assessments is dependent on the accuracy of theinformation provided to us. However, thereality of patients struggling with mental illness is that the situation isalways fluid, often volatile and a patient’s status can change in a matter ofminutes or hours. These changes canoccur following our initial assessment and prior to admission, at the time ofadmission or at any time during the course of treatment. This means that although a patient may beappropriate for admissions to one of our facilities at the time of the initialassessment, that suitability can change at any time and that may necessitatemoving the patient to a different level of care or even to a different facility(inside or outside the Sovereign network) in order to meet their changing clinicalneeds.

Consumer

Response:

I have reviewed the response made by the business in reference to complaint ID [redacted], and have determined that this proposed action would not resolve my complaint. For your reference, details of the offer I reviewed appear below.As stated before, your admission staff was informed of my daughters current condition and was provided access and given information from the hospital and past residential program. You were told of her suicide attempts and that she would need to have one on one staff. I was told by your admission staff that you would be able to accommodate these needs, I asked “are you sure” because I have been turned down by many facilities because they could not accommodate these needs. You again assured me that you could accommodate her. Then you discharged my daughter for those very reasons within 3 or 4 days after she arrived. Your claim that my daughter somehow had developed a new condition when she arrived is untrue and you can verify that with the documented records that you were provided. You had every opportunity to review the hospital notes, communicate with the hospital staff (doctors, psychiatrist, etc.)and talk to my daughter before my daughter was admitted just like every other program I tried to admit her too. Just because your staff failed to do their job does not excuse you from your responsibilities.

Regards,

Review: While admitting my wife to Sovereign Health (SH) in 2013, [redacted], Staff Accountant for this company, gave me verbal assurance that our financial obligation to SH would be "only a $2,000 deductible and $1,500 out of pocket.(max)" We promptly wrote SH a check for this amount. Mr. [redacted] assured me that if I forwarded any insurance checks I received to SH I would not be charged any other fees, "with the exception of minor copays for medications and doctor's visits". This financial agreement was also explained to me by a SH representative by phone prior to admission, although I do not have that representative's name.

About a year after my wife was discharged from SH I began receiving over-payment recovery demands from my insurance company (Anthem). I forwarded these on to Mr. [redacted], who has since forwarded all my information to [redacted], SH's paralegal. Ms. [redacted] has been verbally abusive, often yelling at my wife and I on the phone. She has been misleading, telling me that I would get a letter explaining what is going on, then the next week denying ever saying that. She has instructed my wife that she is "done with our case so I won't be taking any more of your calls" after which she hung up on my wife. The next day Ms. [redacted] called me and denied hanging up on my wife. Ms. [redacted] alluded that some monies have been returned to Anthem, but refuses to tell me how much. I'm still have one more over-payment demand outstanding with Anthem in the amount of $4,77.15Desired Settlement: I am asking that Sovereign Health honor their original financial agreement and return $4773.15 to the Anthem over-payment recovery department. My wife and I are really disappointed in the business practices of this company. Mr. [redacted] has been kind, but unable to help much. Ms. [redacted] on the other hand has been deceptive, aggressive, and unprofessional. I would not have admitted my wife to this facility if I was not told by two SH employees that my sole financial responsibility would be $3,500 plus minor copays (see direct quote above). Again, I'd like Sovereign Health to show integrity with this matter and honor their financial agreement by returning $4,773.15 to the following address:

Overpayment Recovery

PO Box [redacted]

[redacted], OH [redacted]

Business

Response:

October 14, 2014

Re: [redacted]

To whom it may concern,

Sovereign Health of California would like to respond to this complaint and inform all parties that this issue was resolved on September 3, 2014.

All moneys owed to insurance company regarding any overpayment were paid back for the amount of $4,773.15. Check #[redacted] was issued to

Overpayment Recovery and mailed to PO Box [redacted], [redacted], OH [redacted]. Sovereign Health of California would like to apologize for any delay

in this process but according to the companies policies and procedures regarding a due diligence, we want to make sure that the correct amounts

are being paid correctly. I have reached out to [redacted] and [redacted] and the insurance companies collection agency and submitted the

same response. We appreciate your feedback and once again are happy to state that this case has been resolved.

Thank you

This company solicits as a means of making money, staff is very unorganized and unwilling to answer questions. They visit jails and offer legal advice to inmates which is completely illegal and make promises of getting them out of jail early if they pay to enter into their treatment program. As a nurse, I'm sick to see a company that makes claims about helping individuals with real life threatening addiction problems when all they are really after is money.

After several attempts to find out why my wife's PCP prescribed medication to control her seizures has not been refilled by Sovereign Health, I have come to learn through a helpful therapist that the medical department is overwhelmed by the number of patients being seen. This means that for an entire week my wife was without her seizure medication and put at risk needlessly.

Attempting to learn more about this situation was even worse. Phone calls are not returned and no communication has been forthcoming regarding this situation. I have yet to hear anything else about it. In the meantime, I learn about my wife's experience while she is on leave during the weekends. During the week however, she goes into a black box as far as I can tell.