Sunrise Detox

To Whom it May Concern:
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Regarding Complaint ID # *** I have researched the complaint in detail and apologize for any inconvenience that this matter has caused the customerIn an effort to resolve the matter, I have asked our internal Insurance Processing group to contact the Customer and verify that we have accurate insurance information on fileOnce this is confirmed the Processing Group is instructed to file the requested claims on behalf of the customer and respond to any and all requests from the insurance company regarding the claimOnce the insurance company completes processing the claim and remits a check to us we will review the accompanying Explanation of Benefits for any potential customer responsibility (i.edeductible, co-insurance and copay) and forward any money that should be returned to the patient
Should you have any questions or require additional information regarding this matter I can be reached at ***
Sincerely,
*** ***
A/R Manage

Patient was admitted on Sunday 5/1/and check was received for $1,as a deposit for the eveningA medical transfer was done on 5/2/due to no substance abuse coverage per the patient insurance policyPatient was billed $1,for the one-day admission at
Cherry HillThe patient was assessed, medication administered, and received counseling and case management services

Complaint: ***
I am rejecting this response because:re: ***This issue has not been resolved and I was not aware I had to respond assuchPlease reopen this complaint because this issue has most certainly notbeen resolved.*** ***
Regards,
*** ***

Review: I was put on [redacted] and I needed assistance with detoxing. I decided to seek some additional support in the last week or so because I was concerned about my blood pressure etc. I eventually contacted Sunrise Detox on September 6th, 2014. I explained my situation and they advised that I needed a 3-5 day stay to support my ending detox and they agreed to help. I was told that they would need to pre-authorize this with my insurance company ([redacted]) and a few hours later they told me to report to their facility on Monday, September 8th, 2014. They also told me I was 100 percent covered. On Tuesday, my second day in their detox program I was told that someone dropped the ball, that an additional 30 days were required because my insurance might not cover this expense. This was supposed to have been pre-authorized. I replied that this was not what was agreed too and I was not prepared for such a stay. I was basically threatened with expulsion if I did not agree. I said that I could not do this and I would not pay because this was not my mistake. I further asked for copies of any paperwork I signed and was refused. The following day (Wednesday, September 10th, 2014) I was asked to leave their facility. When I returned home I called my insurance company to ask about their pre-authorization and was told that there was no record of any pre-authorization by any Sunrise Detox. The insurance rep told me that they could still submit a retro review after the billing cycle. Apparently this never happening because my insurance company received two bills for over four thousand dollars (month or so later) which they did not pay (no prior authorization). Later I finally received a bill for a flat $1650.00 How can I be liable? I was told my insurance would pay. I was told by Sunrise Detox that my insurance was 100 percent covered and that I should report to their facility. I trusted them to be faithful to their word. This action was allowed and sustained by their staff. How I can be liable is untenable. Clearly, just by being admitted into their facility is indicative of their culpability. Sunrise Detox should be responsible and accountable for their error, not me.Desired Settlement: I received a bill for $1650.00 and my insurance was billed about $4,000.00 which they did not pay because a "pre-authorization" was never called in - no record of this (according to [redacted]). I stayed two days and was asked to leave and I should not be held responsibly. The error/deception was by Sunrise Detox. Had I been told that I would be personally responsibly if my insurance didn't pay I never would have gone in the first place.

Business

Response:

When Mr. [redacted] called us the first time, we did an assessment with him over the phone. Over the phone, Mr. [redacted] gave us the information of using [redacted] x 1-2 months daily, but when we did the nursing assessment inside the facility, Mr. [redacted] gave us different information of using [redacted] only 2 mg x one month, which is not a qualification for our detox program. We have written documentation of the nursing assessment to verify this information. We gave Mr. [redacted] Information about his coverage based on the information he had given us over the phone, the reason we had never made an insurance authorization for the client is because the information was inaccurate, and the bill was sent directly to Mr. [redacted].

Consumer

Response:

Review: [redacted]

I am rejecting this response because: This a complete lie. I am completely unaware of this reaction. I was told "someone dropped the ball and we need you to go to another facility for a month (they suggested their facility in [redacted] - which I rejected) for this to be payable thru [redacted]." No mention was ever made to any other option - for any other reason. I have never been told anything like this - my memory is fine. Made up - a complete fabrication. I stand by my original statement.

Regards,

Business

Response:

It is our practice to verify insurance benefits prior toadmission, and gather appropriate information to qualify the client for ourprogram. The verification of benefits isnot a guarantee that the insurance will cover the stay,that is based on medicalnecessity and criteria. During Mr. [redacted]’s prescreen over the phone, hereported taking [redacted] daily for 1-2 months. A daily use of [redacted] would require our services and meet medicalnecessity, which is why we scheduled him for admission. Upon admission into the facility, Mr. [redacted] wasassessed by the medical staff. This is standard procedure and necessary inorder to properly treat our population. During his nursing assessment Mr.[redacted] revealed that he was taking 2mg of [redacted] once a month, not daily for1-2 months as he stated previously during prescreen. We did not attempt to pre-cert Mr. [redacted]due to his reported use and the fact he did not meet medical necessity for thedetox level of care. Once he was evaluated and placed on an observationprotocol, the staff approached him to discuss his options. It was explained toMr. [redacted] that he did not meet criteria for a detox protocol, and that wecould work with him to set up aftercare. We typically recommend that clients follow up with aftercare once theyare cleared for discharge from our facility, the average length of stay in mostresidential/inpatient aftercare programs is typically 30 days. Mr. [redacted] refused the aftercarerecommendation and signed off that he refused. Additionally, it was explained that we wouldnot be attempting to pre-cert his case with his insurance company, and weattempted to collect payment. When Mr. [redacted] explained that he was unable topay at this time, we let him know he would receive a bill in the mail. Additionally, when Mr. [redacted] voluntarilysigned himself into our facility, he signed the financial agreements whichstate that ultimately he is financially responsible for his stay. [redacted] Executive Director Sunrise Detox Centers

Review: I was a patient at Sunrise Detox Center from July 12, 2014 until July 22, 2014. I paid $10,000.00 by credit card at the time of admission. This facility failed to bill either of my two health insurance plans and have disregarded numerous requests from both myself and both of my health insurance carries to provide required documentation so I may receive reimbursement.My patient identification number ([redacted]) is [redacted]Desired Settlement: I would like Sunrise Detox to properly send a correct and completed claim to both of my insurance companies so I may receive reimbursement. They have been requested numerous times to do so and have failed. Since I paid $10,000.00 when my health insurance companies should have been billed, I am alternatively requesting reimbursement from this facility somewhere close to the $10,000.00 I paid. Their negligence and disregard has caused me a severe financial burden.

Business

Response:

To Whom it May Concern: