SSM St. Claire Health Center

Mr*** reported to ** *** *** *** (as a walk in) with a condition that he stated had been present for several months but was experienced with increasing severity in the past week. When a patient presents to the ER we are required by law to evaluate his/her condition and make sure the patient is stable before discharge Our registration staff and our clinical staff has no training in the insurance or "contractual" side of this process. They are trained to refrain from making statements about insurance coverage or networks because they have no expertise in this matter. Insurance companies do hold their member responsible for knowing where to obtain services within their covered network. The back of Mr*** insurance card states "Customers: your plan may limit or exclude out-of-network (OON) benefits. Check your plan documents for precertification or other requirements that may apply to the services from OON providers." Mr*** is encouraged to submit a member appeal to his insurance company asking them for forgiveness of the network requirements and a reprocess of *** *** ***'s claim for additional payment. We are required by law to bill the patient for the amount indicated as patient responsibility by the insurance carrier. *** processed this claim to show $as the patient's deductible, $as co-insurance and $as Non-covered charges and PR (patient responsibility) - the total is $6938.98. Mr*** has been offered an interest free Payment Plan through *** *** and SSM at $for months. He is also eligible to apply for Financial Assistance upon request. *** ***Patient Liaison SSM Health

We did not receive notification of this complaint on 10/30/17. We will investigate and respond today (11/7/17). Please update the notification email address to: [redacted]. This will forward any concerns received to our team email box to ensure that concerns are received and responded to...

in a timely manner.Thank you,[redacted]Supervisor- Patient Account SupportSSM Health[redacted]

Dear Sir, We received complaint  number [redacted] from our patient stating he did not receive a billing statement for services provided on May 10, 2017, and his account was turned over to collections. He also stated this effected his credit negatively.  One statement was mailed...

to the address listed on this complaint. We received return mail from this address .The phone number provided at time of service is no longer a working number. To date we have not been able to contact the patient. Several unsuccessful attempts have been made to contact the patient via e-mail, and the phone number provided on this complaint.. SSM Health billing policy is to send account with no contact information to our outside collection agency, so they may further research contact information for the patient.  We are willing to return  the account from collections and offer all payment options that are available with SSM Health. We kindly request that the patient contact us at [redacted], so we may discuss his account with him.   [redacted]Patient Liason

Complaint: [redacted]
I am rejecting this response because: I was told I was in network, and now they're saying they don't have conversations with patients about whether or not they're in-network. That's a bunch of bogus. I did have a conversation with the woman in charge of admitting who promised me I was in-network. And I've been in hospitals before and they normally check with your insurance before they run these really extensive, expensive tests. The guy who took me to get an MRI also said I should be covered. They did have conversations with me about my coverage. If she would have told me that I'm not covered, I could have walked back out and looked up other options. 
Sincerely,
[redacted]