ComplaintsforGastroenterology Associates of the Piedmont

• Initial Complaint

  09/13/2023

  Complaint Type:

  Billing Issues

  Status:

  Unanswered

  More info

  On April 4 I had a colonoscopy at GAP in ************. I received no indication I had to pay for the procedure since screening for a colonoscopy is supposed to be covered 100% by my health insurance. I have had five prior colonoscopies and never paid a dime out of my pocket. A few months later I receive a bill for $1400. I called my health insurance to see why it wasn’t covered, and they said it’s the way GAP coded the bill. I called GAP the next day. And they told my I was a risk. Yes I was a risk because my father had colon cancer 20 years ago, and since then I have had a colonoscopy every 3 years. But the 5 previously colonoscopies were covered 100%. I said you never provided me an estimate of the procedure. They said they did through MyChart app. I did sign up for the app when I first visited the clinic for a consultation in February. But after I signed up, I couldn’t access the app after I received notifications. I tried numerous times to reset the password, and never received an email to change the password. I should have received a written notification that it was going to cost me $1400, or when I was checking in to have the procedure I should have been told that I would have to pay $1400. If I knew that I had to pay $1400 I wouldn’t have had the procedure, because we are planned to have my wife to have knee replacement surgery, and both procedures weren’t in my budget to do in the same year.

  Customer response

  09/27/2023

  I have not heard from the business in response to my complaint.

  
  

• Initial Complaint

  10/12/2022

  Complaint Type:

  Billing Issues

  Status:

  Resolved

  More info

  Recently, my doctor advised me its time for my first colonoscopy due to my age. I'm 46. Prior to making the appointment, I contacted GAP to verify my heath insurance would cover it 100% and if not, I would not be able to do it at this time because I couldn't afford it. They called me back and told me they contacted my health insurance company and it was covered 100%. I made the appointment and when I first walked in I again made sure it was covered 100%. They again confirmed this verbally in person. While under anesthesia, they found polyps in my intestines and had removed them. Yesterday, I got a bill from them for $759. I called them thinking it was a mistake. The told me the additional cost was for removing the polyps and my insurance refused to pay that amount of the overall bill. I feel this is unacceptable to put me, or any patient in this situation. I have no way to give them the money, and I made that extremely clear multiple times. I feel taken advantage of and feel like this is poor business practice.

  Business response

  10/14/2022

  This email is in response to case ID# ********, ******** ********. 
  
  We have reviewed the details surrounding the above patient’s concerns related to the colonoscopy he had performed at GAP on 9/6/2022.  It is the normal protocol in our office to check insurance benefits for all patients having an endoscopic procedure at GAP. For Mr. ********, we followed our protocol and checked his benefits.  We check benefits by going to the UHC insurance website to obtain this information. The information on the website indicated that he was covered under UHC Choice Plus benefits which pays for a screening colonoscopy at 100%. There was no indication that he had more individualized benefits under the UHC Golden Rule plan. In Mr. ********’ case, his policy is an individual policy that he purchased and determined what specific benefits his policy would have.  The plan he purchased applies all approved services to the deductible until the deductible is met. 
  
  Unfortunately, because UHC does not make this information known on their website when checking benefits and because the patient did not mention when he called that all services apply to his deductible, we did not have accurate information to convey to the patient about the cost of the colonoscopy. We did not learn of the limitations of this patient’s individually purchased plan until after the procedure was filed to insurance and later applied to his deductible. 
  
  We were in no way trying to take advantage of Mr. ******** because there would be nothing for GAP to gain in having the insurance apply all amounts to his deductible. On the contrary, we too would prefer and were led to believe that the procedure would be covered at 100% by the information that UHC displayed on their website. It would have been very helpful for Mr. ******** to tell us that the plan he picked out had very limited coverage.
  
  In a goodwill effort, we are willing to absorb the cost of this patient’s colonoscopy. We will file a corrected claim to insurance to remove all of the charges that we filed with the insurance. We have created a new protocol for obtaining benefits for any patient that has a UHC Golden Rule insurance plan (which is what Mr. ******** has) that will be much more comprehensive than what we do for patients with any other UHC employer group plan.
  
  As a medical provider we do our best to obtain accurate information for all of our patients with all of the many different insurance plans that are presented. Sometimes as hard as we try, there are times when the information we obtain from the insurance company is not accurate or complete. What helps us help our patients is when the patient takes the initiative and understands the benefits/services that are covered under the insurance plan that they purchase. We are glad the patient had his colonoscopy because we believe screening is needed first and foremost to prevent colon cancer.
  
  If there are any additional questions, please contact me for assistance.
  
  Michelle *******
  Practice Administrator

  Customer response

  10/25/2022

  Better Business Bureau:
  
  I have reviewed the response made by the business in reference to complaint ID ********, and I accept it.

   

  In response to your email, my issue has been resolved with your help. I sincerely appreciate your time. 

   

  Thank you

   

  ******** ******** 

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