St. Clare Hospital

I have left four messages for a supervisor in the Finance Department and have not received one return call. Unbelievable!

I happened to call Billing in October to find out why I had not gotten a bill since 2021. The gal I spoke with casually mentioned I have a credit and did I want a refund. Of course I said yes. Was told I would receive a refund check in 4-6 weeks which is an unbelievably long time. That was on October 27th. Today is December 14th and was just told the checks were sent yesterday! Last week when I called I was also told the checks just went out. I have tried calling a supervisor but just getting voice mail. The reps you speak with try to be helpful but they don't sign the checks or forward them. Their hands are tied. This is really unacceptable. I shouldn't be calling every week. I am sure they will now blame the holiday season for delayed mail delivery!

Review: My son went for a routine physical exam and associated bloodwork. My son was covered under my health insurance policy at the time of his office visit. Our insurance company is Anthem Blueshield. Because there is only a Dean Clinic in our area we see the doctors there. My employer/insurance company has an agreement with Dean Health Care to bill us using the Anthem Blue Shield billing rates. After receiving several bills of varying amounts for this physical exam I started looking into why we were being billed for a wellness visit which is suppose to be fully covered under my insurance policy. The first response I got from the provider (SSM Healthcare, the billing agency the Dean Clinic uses), was that the claim was refused by Anthem Blueshield because my son visited the clinic prior to being insured. I am 100% certain that my son was covered at the time since he was listed on my policy for at least 2 years prior to the time he visited the doctor. I believe this bill is for bloodwork he had done at the St Clare Hospital (associated with the Dean Clinic). After getting numerous bills (not all for the same amount but could never get an answer regarding what the bills were for), and numerous phone calls to St Clare, SSM Healthcare, Anthem Blue Shield and insurance advocate at my employer this issue has not been resolved after almost one year. Now we are getting bills from the collection agency even though the latest word from Anthem Blueshield is that they have never received a claim for this bill. SSM Healthcare said they would resubmit but nothing has been done to resolve this issue and now that this bill has been sent to the collection agency and will hit my son's credit report because it hasn't been paid. I can't get a straight answer from anyone involved. One of the reasons they said we were billed is because we got billed at the Dean Care rate rather than the Anthem Blueshield rate so it was originally misfiled but again I don't get a straight answer from anyone. I don't believe my son should be responsible for paying for this as it should have been covered by insurance.Desired Settlement: This claim should be filed correctly to Anthem Blue Shield at the agreed upon rate. If this bill affects my sons' credit report the credit report should be ammended by removing it from his record. It is through no fault of his that this issue has not been resolved since it is the inadequacy of the staff at SSM Healthcare and St Clare Hospital to file the claim correctly. Anthem Blue shield should pay the bill once it has been filed correctly.

Business

Response:

I apologize for any inconvenience. I have conferred with our Patient Financial Services Department regarding a status update of the account associated with this complaint. The claim was originally denied by Alliant Blue Cross due to a mis-keyed subscriber number. We have since been in contact with Alliant Blue Cross and they have agreed to reprocess the claim using the correct subscriber number. We anticipate payment as dictated by the patient's benefits.

Consumer

Response: