This office is either incompetent, negligent, fraudulent , or all three. The problems started almost a month ago. I called the office based on a referral from my primary care provider to stay 'in network' to ensure I was covered by insurance. I asked if I was covered, provided my insurance plan name and number, was put on hold, and then told I would just owe a co-pay for the visit. I was very explicit too because I told them I was out of work at the moment and can't afford to pay for extra expenses. Since they said I just had a co-pay, I agreed and scheduled the visit about 3 weeks later.
The week prior, I called to confirm they received the referral and confirm I was covered. They indicated they had not received the referral even though two weeks had passed. I called my primary care provider and confirmed they had sent it originally, but also asked them to fax it in again and specifically to ensure it referred to the specific issue I was being seen for to ensure I was covered.
I show up the day of the appointment and confirmed before doing anything else that they did in fact receive the referral. However, as I filled out the paperwork I noticed they listed me as uninsured. I immediately asked one of the customer service reps at the front desk that in fact I had insurance and you had previously confirmed I was covered for the visit. They said 'yes no problem we have your insurance information, you are good to go'. I then met with the doctor and as I left I asked front desk that I needed to pay my co-pay for the visit and they said 'oh there is nothing at this point we will bill your insurance and whatever they don't cover you will owe'. I then got very concerned and said I was told it was just a co-pay for the basic office visit. They refused to tell me how much they were going to bill. I told them right there that wasn't right because I could have shopped around if I had known I wasn't covered and said to them I hope there isn't a huge bill because I am out of a job right now.
While the overall exam and procedure the by Dr. provided was smooth, I noticed after the fact that what was done on one eye was also not done on the other eye and that other eye was not doing as well as the eye that was taken care of. In reality both eyes should have been done since I'm pretty sure for that procedure, both will be billed. I then called in the next day to request another appointment to address the other eye, but said I needed to confirm what the cost would be since there is no way I'm going to come in again with the possibility of not being covered by insurance. They refused to indicate the cost and the rep on the phone unwittingly spilled the beans and said 'oh it doesn't look like your insurance is covered because you have a deductible'. I said, I know that, but I do have co-pay coverage for 'specialist' office visits and since this was a referral for a specific eye issue and your office originally said I was covered with just a co-pay, BEFORE I SCHEDULED, that this was completely wrong. They argued with me about this for a bit, and but then reluctantly agreed to confirm what the cost of the next visit would be and would call me back the next day.
Well, it's been over a week and I never got a call back. I'm pretty sure they will never call me back. I'm now waiting for what could be a bill I can't afford and am in limbo about what to do next with my other eye.
This office needs to get its act together. I now get the impression that front office staff are just following standard operating scripts to just tell people they are covered and do whatever it takes to get them scheduled to bring in new business. Federal law requires 'no surprise billing' as of a few years ago and since I had on several occasions asked and confirmed I was covered, they likely broke the law. Crazy that before this law, medical providers could in fact intentionally not disclose all costs up front for elective services, but not anymore. What ultimately this robbed me of was being able to shop around since this was a 'referral' and I could have asked other out of network providers what their real cost was for this basic exam and procedure was and then either choose the best provider based on cost, or choose not to do it all if could not afford it. read more
