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Family Health and Wellness Reviews (1)

Review: I became a patient at Dr. [redacted] office in 2011. I had insurance (Blue Cross) when I started receiving care at his office. I have come to realize that his office uses a separate company for billing purposes. One day I received a bill that was larger than normal, so I called Dr. [redacted]'s office to resolve the matter, and they proceeded to refer me to their billing company, Clinical Practice Solutions, Inc., which I contacted but offered no help. The issue was that I changed places of employment, and so my insurance changed as well. However, the billing office was apparently never notified of my switch of insurance, and are trying to hold me responsible for the full amount of the bill, even though I was covered by the new insurance (also Blue Cross) at the time of treatment. When I brought this to the attention of the representative at Clinical Solutions, they informed me that since so much time had passed since the original time of service that they would not resubmit my claim to my insurance company. I have since tried to call and resolve the issue several times, but I receive no response. I believe since I was covered at the time of treatment that I should not be held responsible for the full amount of the bill. They seem to be apathetic to my situation and the fact that they made a mistake that needs to be rectified, and I do not want to be sent to collections over the matter. Clinical Practice Solutions is located in Georgia, and their phone number is (770) 841-9565. Furthermore, Family Health and Wellness charged me $50 for missing an appointment which I was unaware that I had. When I called the office about the charge, they informed me that they would waive it, yet on the next bill I received it was still present.

Product_Or_Service: Medical Care

Account_Number: [redacted]Desired Settlement: DesiredSettlementID: Other (requires explanation)

I would like them to stop billing me. If they can obtain the payment from the insurance company that covered me at the time, that would be ideal, however I do not expect to be held responsible for a mistake that they refuse to correct, and being sent to collections would be outrageous.

Business

Response:

When patient came to our office as a new patient in 2010 he gave us a copy of his BCBS insurance card.

Claims were filed and paid for 2010 with the policy # showing on the card.

I got a call from his wife on 1-21-13 after they had received numerous statements. I called her back but was not able to speak with her. I left a message that I was returning her call and that the claims were being rejected for 10-14-11, 11-8-11, 12-9-11 and 8-23-12 stating policy not in effect.

In the interim the patient did send us 7 payments towards his outstanding balance which cleared the 10-14-11 balance. I assumed that since he was paying he realized that the BCBS was not in effect and that the balance was his responsibility. We continued to bill him each time statements were sent out.

On 11-8-13 I got a call from [redacted] @ Anthem who stated that we never filed claims to them. I advised that we had filed the claims under the policy that we had on file and that the pt never provided us any “new” Anthem info. I also stated pt has received multiple statements and has not contacted us with that new policy #. Was asked to file the claim and I advised that if I file now it will be denied for timely since we had not filed under the “new” policy number . We are participating and only have one year to file.

When we were advised of this complaint I went on the Anthem Blue Cross website and printed out a confirmation of the policy number we had been provided in 2010. Per Anthem website this policy was termed on 4-30-11.

The state of California splits BCBS policies between Anthem Blue Cross and Blue Shield of California. Since the Anthem website confirmed the term date of 4-30-11 I got on the Blue Shield website as well and that had the same term date of 4-30-11.

I placed a call to Anthem Blue Cross today to confirm the conversation with [redacted] @ Anthem was documented and spoke with [redacted]. He confirmed conversation notes and advised that [redacted] had contacted member and advised him that he needed to contact our office and set up a payment plan since they did not provide the correct ID # in time. She called him on 11-8-2013 after we hung up.

We file claims all the time when patients call with new information. The problem was this patient never provided the new information. If he had, it would have been entered on his account and a claim would have been filed if submitted to us within a year.

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Description: Dentists, Physicians & Surgeons - Family Practice

Address: 1528 Plumas Ct Ste 100, Yuba City, California, United States, 95991-2973

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