ComplaintsforPacific Oaks Medical Group

• Initial Complaint

  02/06/2023

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  ********** (CEO emailed yesterday and message today)**************************************** <****************************************> I'm a patient of ***************************** as my initial consultation (December 9th, 2022), the Dr. ordered shoe inserts which at the time - I was told were not covered by my insurance. (Cigna-PPO) Upon leaving the office, ******* stated a $500 deposit is required which was understandable with it not being covered by insurance. Upon my departure from the parking area, I called Cigna to ask why this was not covered based on my insurance since it stated I have a 0% cost. ***** answer my question which prompted a call to your office asking for the office manager which was never returned. Returned on Tuesday, December 20th as the Dr. did not have my insert or *** results. In leaving the office, I mentioned this to ******* and he stated that orthotics are not covered by CIGNA unless Im a Diabetic, which isnt the case and Im NOT diabetic. During the next week, I asked ***** to call your office to resolve which I was told, they talked to ******* and communicated, orthotics are covered by my insurance. In returning to the office on Friday, January 6th, I received my inserts and a discussion with the Dr. about the *** results. Upon leaving, I again asked ******* why I have not been reimbursed for the deposit since my insurance covers orthotics. He stated he called, and they denied my claim. So, for the next 45 minutes, I stood in your office with ***** and ******* requesting clarity on my orthotics. Only to find out that the diagnostic codes were not for my feet which is why they were declined. Again, ******* stated I need to be diabetic to receive coverage under *****. **************** walked up in asking why I was still there and listening to the discussion. I went back to his office to determine the correct diagnosis codes in submitting the claim. Again, ******* stated that h*** have to wait for Cigna to pay the claim before reimbursing me the $500. The claim was filed on January 6th and Paid on January 10th. Left a message asking for a refund of the $500 deposit without a response but received a text on 1-27-2023, Done. Not sure what that meant but waiting for my refund as it was not charged back to my Amex. Received a call from a gentleman from the billing department stating the claim was declined and he cannot return my deposit. I stated the claim had three-line items as both line items 1 and 2 were paid to Pacific Oaks for the orthotics. He stated they declined line item 3 for $1,000 and he cannot. I stated again, I need my deposit returned as the orthotics are covered by my insurance and Pacific Oaks has been reimbursed. If Pacific Oaks is unhappy with the reimbursement, please call ***** to discuss your contract. As CEO of Pacific Oaks with recent filings with the *******************, can you please call me on Monday, February 6th to outline when Pacific Oaks will return my deposit of $500? My number is ************. I understand with recent filings, Pacific Oaks has removed ****************************************************** and included *********************************************. I hope this can be resolved quickly on Monday without further action. *** External Prosthetic Appliances Description A device or prosthetic prescribed by a provider because of injury, sickness or congenital defect. Includes braces, splints, orthotics, basic limb prosthesis. Includes initial fitting. In-Network You Pay $ 0

  Business response

  02/13/2023

  Refund processed on 021023. 

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