T J Samson Community Hospital

Review of the account indicated that the claim was billed twice and the insurance denied twiceThe insurance company denied stating that the expenses were incurred after coverage terminatedDuring the calls with the client at no time was there additional insurance information given until 03/29/2016, at which time it was past the timely filing limit for the insurance companySince the date of service was 9/7/2014, the insurance Company would not have considered the claim, regardless of the insurance changing and the original having no funds.Would appreciate an opportunity to speak with this clientThe phone number listed below is a direct lineI am hopeful we can find a resolution to this issue.Thank you very much, [redacted] ***

Revdex.com:The claims made by the business are most certainly not trueThe original insurance billed was an old insurance that I had before I was marriedWhich was billed to begin with because the registration clerk working at the Urgent Clinic did not make a copy of my current card even though I had both the current insurance information and social security cards out ready to give it to herYour error number oneShe told me that she did not need itWhen I received my first bill I called the billing department and gave them the correct insurance informationI called many times throughout and everytime was asked for more informationEvery time I talked to someone I gave them my current insurance informationOn 3/29/I was finally told that the insurance was rejecting because my husband's social security number was needed to fileI immediately gave them that information, but was never asked for that information before that dateThe error is on TJ Samson not on our partEvery time I called the recording said that our conversation would be recordedSo they have on file where I gave them the correct information many times within a time frame that would have resulted in the claim being paidI can easily give them proof that our insurance was in fact valid and active at the time of service on 9/7/ 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 Regards, [redacted] ***

See attachment for original company responseLetter received: 09/26/ID #: [redacted] After a review of the account, I can acknowledge that better information should have been obtained from you on the date of service of 9/7/14, Review of the recordings show that there were nine contactsOn 12/18/14, no insurance information was given with that call - we were just asked to re-bill the accountOn 1/2/15, we again spoke with Ms***; but, no insurance information was givenOn 1/6/15, we spoke with the patient and Ms [redacted] gave insurance information of the secondary insurance, [redacted] (under her maiden name)There were five contacts with no insurance information given; but only Ms [redacted] expressing concern that the account was not being resolved.On 3/29/16, we received the [redacted] Health informationSince the original insurance had been billed to the old Coverage, the insurance company denied stating that the expenses were incurred after the coverage terminatedFor the [redacted] Health - it was past timely filingWhen I received the first letter, I went ahead and gave the discount [redacted] would have received on the account had they been billed timelyWe also issued a contractual adjustment as though [redacted] had paidThe patient responsibility on this account is $50.00.I would appreciate an opportunity to speak with this clientThe phone number listed below is a direct line.Thank you very much, [redacted] ***

TJ Samson, being a hospital in Kentucky, does not participate in California Entitlement/Welfare/Medicaid State programsThe program referenced by the complaint and known as "***" per the GuarantorHad the debtor reviewed their benefit package via the high tech California web site,
or called to inquire as to benefit providers in the Kentucky area, they would have discovered that coverage was not available via the California Entitlement Programs at this State of Kentucky licensed facility
Of course TJ Samson Medical Center regrets the misunderstandingAnd understands that it might create a hardshipSince there is a dispute concerning information, and no indication of which TJ Samson Employee supposedly indicated to the guarantor that their California Entitlement Plan would, or would not, cover the medical visit, TJ Samson has agreed to discount this claim in whole through our Charity Assistance Program.
Thank you,
Director of Patient Financial Services

Revdex.com: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.
In response to the accusation that we did not first verify with [redacted] that our son's emergency services would be covered, I'll tell you this: I DID call [redacted] and they confirmed that any emergency services rendered outside of California would be covered. The failure is entirely on TJ Sampson Hospital's end. Why? Because they have explicitly refused to even bill my insurance. [redacted] has not received a claim. [redacted] has confirmed multiple times that if they did in fact receive a bill from TJ Sampson that it would be covered. Secondly, in regards to my failure to get a name from your financial team that told me the incorrect information I'll say that EVERY person I spoke to from the front desk (during our visit) to the billing dept (over the phone several times) all told me the same thing: that they were working on billing my insurance, not to worry, and that they would take care of it... Etc. The only person who told me that we were responsible for all bills out-of-pocket was a manager in the financial dept. This was after I had been told the opposite for months. I will not accept your resolution of getting a discount on the bill until the bill has been processed through our insurance.Additionally, just in case this was not communicated by your Billing dept., the reason TJ Samson will not bill [redacted] is due to the current lack of a "state-to-state" compatibility that the hospital has. They also explained to us that they had no legal obligation to file the claim correctly in order for our insurance to be billed. While I understand that there is no legal obligation, I would venture to say that if the only thing stopping you from billing our insurance is an extra document, then it comes down to MORAL obligation. ESPECIALLY since we were misled and lied to from the time we walked in the door, and throughout the months following while we tried to resolve all of these issues. It's also worth noting that, after talking to [redacted]'s representatives, I understand that the document would apply to anyone using [redacted] at your hospital in the future. I think your Billing dept and your future California patients will appreciate that.Regards,[redacted]

Revdex.com:The claims made by the business are most certainly not true. The original insurance billed was an old insurance that I had before I was married. Which was billed to begin with because the registration clerk working at the Urgent Clinic did not make a copy of my current card even though I had both the current insurance information and social security cards out ready to give it to her. Your error number one. She told me that she did not need it. When I received my first bill I called the billing department and gave them the correct insurance information. I called many times throughout 2015 and everytime was asked for more information. Every time I talked to someone I gave them my current insurance information. On 3/29/16 I was finally told that the insurance was rejecting because my husband's social security number was needed to file. I immediately gave them that information, but was never asked for that information before that date. The error is on TJ Samson not on our part. Every time I called the recording said that our conversation would be recorded. So they have on file where I gave them the correct information many times within a time frame that would have resulted in the claim being paid. I can easily give them proof that our insurance was in fact valid and active at the time of service on 9/7/2014.
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.
Regards,
[redacted]

See attachment for original company response. Letter received: 09/26/16 ID #: [redacted]After a review of the account, I can acknowledge that better information should have been obtained from you on the date of service of 9/7/14, Review of the recordings show that there were nine contacts. On 12/18/14, no insurance information was given with that call - we were just asked to re-bill the account. On 1/2/15, we again spoke with Ms. [redacted]; but, no insurance information was given. On 1/6/15, we spoke with the patient and Ms. [redacted] gave insurance information of the secondary insurance, [redacted] (under her maiden name). There were five contacts with no insurance information given; but only Ms. [redacted] expressing concern that the account was not being resolved.On 3/29/16, we received the [redacted] Health information. Since the original insurance had been billed to the old Coverage, the insurance company denied stating that the expenses were incurred after the coverage terminated. For the [redacted] Health - it was past timely filing. When I received the first letter, I went ahead and gave the discount [redacted] would have received on the account had they been billed timely. We also issued a contractual adjustment as though [redacted] had paid. The patient responsibility on this account is $50.00.I would appreciate an opportunity to speak with this client. The phone number listed below is a direct line.Thank you very much,[redacted]

Review of the account indicated that the claim was billed twice and the insurance denied twice. The insurance company denied stating that the expenses were incurred after coverage terminated. During the calls with the client at no time was there additional insurance information given until...

03/29/2016, at which time it was past the timely filing limit for the insurance company. Since the date of service was 9/7/2014, the insurance Company would not have considered the claim, regardless of the insurance changing and the original having no funds.Would appreciate an opportunity to speak with this client. The phone number listed below is a direct line. I am hopeful we can find a resolution to this issue.Thank you very much,[redacted]