Extremely dissatisfied with Admin/Bill staff!!!
I underwent Cataract surgery (on separate occasions, two weeks apart) as "outpatient surgery." While the surgeries were successful, my experience with the "billing" aftermath has not been pleasant and my alleged bill has now been sent to a collection agency, which if not resolved will reflect negatively on my personal credit report.
Under U.S. Federal law, as a TRICARE Prime (Retired Military) insured, I am responsible for a fixed co-payment (patient responsibility) amount on a "per visit" basis. Each surgery was a "one visit" occurrence. On each day -
**-prior to each surgery-** I remitted the amounts as stated by the staff - and received receipts.
Unlike other medical insurance providers, TRICARE Prime insureds cannot be billed additionally for multiple providers who participate in medical procedures. The primary specialist - "Clayton Eye Center" - is solely responsible for assigning and paying any other providers (i.e.; Anesthesiologists, lab technicians, etc.) who participate during surgery.
After hours of research with TRICARE Prime Insurance staff, we have learned the Clayton Eye Center staff applied the remitted co-payment to the wrong account so their third-party billing activity has no record (nor visibility of my full account) that I remitted any co-payment.
Since September 2021 (the month following both surgeries, and when I started receiving bills, later marked as "overdue") I have continually communicated to both the Clayton Eye Center staff, including multiple "Supervisors" in their Escalation Dept, and with multiple staff of their third-party billing entity.
I have submitted multiple emails with receipts and attachments, all of which were acknowledged as being received and filed in my record during calls, as recently as this afternoon.
Twice, including today, I was informed that I am responsible for a co-payment for both the "Facility" and the "physician." Expecting payment of multiple co-payments for the same visit violates U.S. Federal law and the terms of agreement between Clayton Eye Center (the provider) and TRICARE.
During each call, the "escalations 'supervisor'" informed me the matter would be transferred to "upper management" for resolution, and someone from upper management would call me to discuss. I have received no return calls, only subsequent bills, merely stating 'a review of my account was completed' with the same amount due.
For 23 months, communication has occurred only when I initiated it, and only then when I called and remained "on hold" for lengthy periods of time (several times up to 45 mins, often longer when using their "call back feature") for each call - now numbering well over a dozen.
This process has been stressful, and in spite of my continued efforts, remains unresolved. Now I face an adverse entry on my credit report.
One should "think twice" before agreeing to surgery procedures at this medical provider due to their admin/billing staff's clerical errors, and at several levels within their company, their staff's subsequent "non-customer service."
Regrettably, reviewing others' submissions in this resource, I clearly see that my situation is not isolated, but a recurring one, with only the specific details changing as they apply to another patient. read more