ComplaintsforSouth Florida ENT Associates, P.A.

• Initial Complaint

  04/04/2023

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  South Florida ENT Associates called three days before my surgery to tell me my insurance coverage was not met and that they needed me to pay $1414.39 before the procedure. I received a call from a surgical coordinator for South FL ENT named ****** who misunderstood my insurance coverage and insisted that I had a $15,000 out of pocket premium which is false. I explained that my maximum out of pocket is $3,000 after the deductible, 20% of 15k. I explained I met both the deductible and out of pocket maximum with the fees for the surgical center and that all other charges need to be directed to my insurance company. She agreed as she knew I was already paying $6,200 to the surgical center but insisted that I was wrong about my out of pocket dues and that I still had to pay them because hadn't met the $15,000 out of pocket. The surgical coordinator then casually threatened to cancel my surgery if I did not pay 2 days before the procedure and hung up on me when I told her I needed to double check with my insurance first.I called my insurance rep. and confirmed my benefits, and indeed my annual out of pocket is met after the fees paid to the surgical center and all other fees should be directed in full to the insurance company. The insurance rep then called South Florida ENT directly with me on the line to explain my benefits to them again and clear the misunderstanding. A South Florida *********** Department Manager named ****** took our call and the insurance rep explained to her that I am 100% covered and to bill the insurance directly. The South Florida ENT manager called the insurance rep incompetent, said she was incorrect then asks for $642.36 a radically different amount than what was given by ******. When we asked for a breakdown of the cost and to clarify the numbers she hung up on us.

  Business response

  05/01/2023

  Response:

  Attached please find copy of the UnitedHealth One on-line benefit verification reflecting the $3,500.00 deductible and 20% co-insurance due from patient until the $15,000.00 Max Out of Pocket expenses are met.

  Information was provided to patient based on the above.

  Information was also provided to UnitecHealth One representative who was on the line at the time.

  The patient had already discussed the ************** monies due them and we were collecting the amount due **************** based on all of the information obtained from verifying her insurance benefits.

  The Surgeon's fees (****************) and the Surgical Facility fees are two separate areas, and both have their own co-insurance/deductible amount due from the patient.  Neither Norkis or ****** have any recollection of having  hung up on any party to this matter.  

  Thank you,

   

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