ComplaintsforProMedica

• Initial Complaint

  10/08/2024

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  I have been going back and forth with *********** financial assistance program for most of this year regarding medical bills for the birth of my son. After giving birth this is the last thing I have wanted to deal with. Initially I was on a payment plan while I was still working to pay on medical bills accumulated from my pregnancy. In November 2023 I was laid off, in January 2024 I was no longer employed. This was communicated to the financial assistance representatives several times and they were advised I no longer would be able to make payments and I applied for financial assistance. I have gotten nothing but the runaround on the remaining balance. First I was never told that more than one application would be needed for inpatient and outpatient services. Both applications were completed. Then I was told that my balances were adjusted at 100% - when I inquired about why only some of the balances were adjusted fully and others weren't the representative wasn't sure. Now they're saying it was a mistake and I should have never been told that. I am not working and cannot pay any more than what I've already given to promedica. I expect ky balance to be resolved/adjusted immediately.

  Business response

  10/08/2024

  Thank you for contacting customer service. In reviewing the notes for your applications, it appears the original submission was not completed correctly. We show that two new applications for yours and your child’s inpatient visits were sent. The application for your son was incomplete. We would need a new completed application and copies of all gross income documents for yourself and his father for April, May and June 2023.

  The applications for your accounts were reviewed and the accounts have received a 40% adjustment. To review for a higher adjustment, additional information would be required. We do have guidelines and policies we must adhere to, in order to review for financial assistance.

  We have forwarded your information to our financial assistance team for further review. They will be in touch directly to discuss. 

  Customer response

  10/09/2024

  
  Complaint: ********
  
  I am rejecting this response because:
  My son's balance was paid in full. Not sure what account you're referring to. Please see attached screenshots for the only open account i am seeing for MYSELF. I was told by your representatives that the accounts were adjusted at 100% and am questioning/demanding this account be adjusted as well. I have sent every paystub for 2022 and 2023 I'm not sure what more you could possibly need at this point but this is ridiculous. I have gotten the absolute run around and at this point I don't think a single representative knows what they are talking about or are even looking at my account or the constant communication i have been having with you all.

  
  Sincerely,
  
  Marissa Mattin

  Business response

  10/10/2024

  Our financial assistance representative has reached out by phone and secure email. The current balance is from your inpatient visit from 2023. You qualified for a 40% adjustment per our policy and guidelines. The previous email received was regarding your outpatient services from 2022. The current balance remains due, per our policy and guidelines. Please feel free to call customer service to setup an interest free payment plan for your remaining balance. 

  Customer response

  10/11/2024

  
  Complaint: ********
  
  I am rejecting this response because: 

  I worked at the same company with the same pay rate. I actually made less in 2023 because of maternity leave, dropping down to part time, and being laid off. If one account was adjusted to 100% they all should be. I have told you all numerous times that I am no longer working and am not able to make payments hence the application for financial assistance. I was making payments during the duration of my employment and notified your financial assistance department when I lost my job. I expect the balance to be adjusted to 100% like the previous accounts have been. I'm not sure why this is so difficult. 

  
  Sincerely,
  
  ******* ******

• Initial Complaint

  10/01/2024

  Complaint Type:

  Billing Issues

  Status:

  Resolved

  More info

  In February, I visited the new Promedica *********** facility on ** ** **** ***. I was incorrectly charged during this visit and was given a $250 bill for an urgent care visit that should be a $20 copay with my insurance. According to my insurance company, this is being billed through ****** ******** despite the service location being the urgent care. Furthermore, ********* is not submittign the correct forms for an urgent care visit. Despite several hours on the phone with Promedica's billing department and my insurance, this matter has still not been resolved and I keep getting the same bill sent to me again and again. Requests for a supervisor to address this matter have been ignored by Promedica. I want to be billed correctly.

  Business response

  10/03/2024

  Thank you for contacting Promedica customer service. I have forwarded this information to the billers for further review. While under review, they have removed the balance from patient liability and have reached out to the insurance. This review/process can take 7-10 days. Please feel free to call customer service at that time for an update, ************.

  Customer response

  10/03/2024

  
  Complaint: ********
  
  I am rejecting this response because this matter has already been submitted multiple times to the billng department and they can not get it done. This absolutely must be escalated to someone at a corporate level or the head of the billing department, so they can oversee this matter. I have spent months with no results by doing the same thing you are suggesting as a solution. This needs to end! Please escalate this to someone who knows what they are doing when billing for urgent care visits! 
  
  Sincerely,
  
  ******** ******

  Business response

  10/08/2024

  This was reviewed by the billing supervisor The amount of $257.45 that was due was for labs, not the urgent care visit. Your insurance applied the labs to your annual deductible. We did bill the claim correctly.However, as a one-time courtesy, we have adjusted the balance due. Future visits to the same facility may result in a patient liability, which you would need to appeal with your insurance, if you disagree. Again, this is a one-time courtesy.

  Customer response

  10/08/2024

  
  Complaint: ********
  
  I am rejecting this response because there is no listed amount as to what the adjustment will be. Please list what the new bill amount will be and I will accept the resolution. 

  For reference, my wife and I both went to an urgent care to get tested for strep. She went to a community urgent care and I went to the promedica facility. We both got strep and covid tests. We have the same insurance. She was charged a $20 copay from the urgent care she went to. I was charged $257 by promedica. 

  Additionally, my insurance company told me that ProMedica filed the wrong forms and billed through the wrong location (Toledo Hospital). 

  I am satisfied with a billing adjustment as a resolution and appreciate that this matter can be put to rest. However, I wanted to explain why I felt the bill was incorrect because the difference in billing between the two urgent care locations are *****, along with my insurance carriers comments. 

  
  Sincerely,
  
  ******** ******

• Initial Complaint

  09/13/2024

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  My son was seen at Toledo Hospital for an injury to his finger sustained at daycare. The service received was not satisfactory, however that is not the reason for my complaint. We received a bill from ProMedica which itemized Emergency Room or Urgent Care for $1,028, Operating Room Services or Procedure Fee for $1,144 and a few other various charges. After insurance, there was an outstanding balance of $347.71, which we paid as a total of $2,556 seemed reasonable. I recently received a separate bill for $429.68 after insurance ($990 before) from Emergency Physicians of Northwest Ohio. I was confused for a separate physician bill, as I would think $2,556 should have covered the cost for physician care include the 3 sutures and x-ray that was taken in the ER. When I called ProMedica billing, I was told that the $1,028 Emergency Room fee is to provide the necessary equipment needed, and that the $1,144 Operating Room Services or Procedure Fee was for supplies for the sutures. I'm having a hard time understanding how we are being charged $1,144 essentially for the sutures and the light in the emergency room, because we were not taken to a separate room for the sutures to be placed and the $1,144 charge does not cover the resident physicians involved in placing the sutures. When I asked for an itemized breakdown from ProMedica for the $1,144 I was told they were unable to provide a further breakdown of what went into that fee other than it was for the procedure. For context during the "procedure", my wife and I had to hold down our screaming son and two residents attempted to place the sutures. The first one was unsuccessful so the seemingly more experienced resident took over. There was no sedation required, they attempted to numb his finger which seemed unsuccessful and was also never even tested prior to sutures. I don't understand how the total charge for this can be $2,000+.

  Business response

  09/13/2024

  Thank you for contacting Promedica customer service. We have had your son’s account reviewed by our audit department. The charges billed are in compliance with chart documentation. The REV code 450 ER Level 2 charge is based on patient's "presenting" complaint (Finger Laceration), x-rays done, meds administered and the number of nursing assessments and being seen by provider. The REV 361 ER Minor procedure is a billable "separate" charge for the laceration repair of the child's finger.

  
  Again, our charges are billed in accordance with insurance standards. We have set pricing for all services rendered and that it only includes facility charges. This does not include the professional services rendered, which is the billing from Emergency Physicians of Northwest Ohio.

  Customer response

  09/16/2024

  
  Complaint: ********
  
  I am rejecting this response because:
  I understand insurance has agreed to these charges. Ultimately insurance is not the consumer and we as the consumer are the ones who are stuck with the rest of the bill that insurance does not cover. I still do not understand how a laceration repair can cost $1100+ and that does not include physician services. Where is the $1100 going to? Surely it can’t be materials because I doubt a suture kit, and a local anesthetic can cost that much. I would like to see an itemization of what goes into the procedure fee. It seems we are being overbilled somewhere. There were not any nurses in the room to assist during the “procedure” and we did not move rooms to have 3 stitches placed. Please provide further detail as to what goes into each billing code provided as well as documentation from the physicians to justify the charges. 
  
  Sincerely,
  
  ****** ******

  Business response

  09/16/2024

  Again, hospital prices are standard across the board. They only include facility charges. We can mail an itemized statement of charges or you may contact medical records for further information on care received. The charges billed were in accordance with the documentation in the chart. The emergency physicians are not employed by Promedica and their billing is separate. This is also indicated on our hospital pricing sheets that are available online. 

  Customer response

  09/17/2024

  
  Better Business Bureau:
  
  I have reviewed the response made by the business in reference to complaint ID ********, and although the result is unsatisfactory, it is clear that Promedica is unwilling to be transparent with their billing practices. To be charged an additional $1100 for sutures on top of a $1000 ER charge seems like double billing for services rendered if one or both of those does not include physician services rendered. The response from Promedica seems like a case of “because I said so” without offering any real answer as to what goes into the charges beyond these being standard “facility fees”. To avoid going around in circles I will close this case out, but will be pursuing other avenues. At this point it isn’t about the cost of additional charge from the physicians but rather a lack of transparency, which consumers should have a right to. Thankfully we have the means to make the payment, but there are so many others out there who do not and get stuck with medical systems taking advantage of consumers because they have no other choice. Unfortunately Promedica is the major hospital system in the Toledo area so I have no other choice but to continue using them for any emergency needs.
  
  Sincerely,
  
  ****** ******

• Initial Complaint

  09/06/2024

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  7-11-2023 Yearly Health Check covered 100% by *************** as preventative care. The ProMedica provider (MD) was unethical in the two visits. I filed a complaint. No one ever got back to me with multiple follow up calls. I eventually spoke to someone in the complaint ***** who was able to wipe the bill to $0.00 (me, patient owns ProMedica nothing). Due to the extreme unethical visit with the MD. Six months after the bill was zeroed out, I receive the bill again! I called billing, there was nothing noted on the bill. I was told two different stories by ProMedica billing. Neither true because this was already resolved. I continue to work my insurance Aetna but they just reiterate the billing process. No one can speak to the fact that this bill was resolved by an ProMedica employee. It's over a year now and ProMedica can't seem to do the right thing even after the fact. Under no circumstance would I even return to ProMedica and will share my experience with anyone as people NEED to know the ***** about ProMedica. Healthcare is broken. They do not care about the patient (customer) and will go to the ends of the earth to ensure they collect there $$$ under all circumstances. ProMedica prove me wrong and show me you have some tiny shred of integrity by once again doing the right thing.

  Business response

  09/06/2024

  We are in need of further information to review the claims. We will need the patient's full name and DOB. We are not able to locate a patient in our system with this name and address. 

  Customer response

  09/19/2024

   
  Complaint: 22250641
  
  I am rejecting this response because: nothing has been resolved. ******* ******* 04/02/1982
  
  Sincerely,
  
  ******* ******

  Business response

  09/19/2024

  We show that the wellness visit was paid in full by the insurance. We show there was a balance due for some of the labs for the same day. Some of those labs are not covered at 100% as preventative, which had specific diagnosis assigned to them. The insurance applied this to your deductible. This was applied to the *********, Vitamin B12 and Insulin tests. Per notes on file, when the insurance company called, they indicated that $109.65 was the balance. We are showing that was the balance on the account and was paid in full 8/29/24. If there is anything further needed, please call customer service at ************.

• Initial Complaint

  08/20/2024

  Complaint Type:

  Customer Service Issues

  Status:

  Answered

  More info

  I took my 2 year old son into the office on 8-14-24 because he was limping. After doing basic test and X-rays on his leg, the doctor couldnt find anything wrong and told me to schedule a visit with his primary care physician if the limp or pain flared back up. Well a few days later we found out the issue which was a toenail infection. I called the office to tell them the issue and was told that they dont write scripts over the phone and that I would have to pay again if I wanted my son to been seen again. Im upset because not only were we at the office less than a week ago, they actually want to charge me again to check out my son for the problem they never solved. And oh yeah, Im sure that Ill be getting charged for the X-rays.

  Business response

  08/20/2024

  We have forwarded your care concern to the appropriate department for further review. We have requested they contact you via phone when their review has been completed. Please allow time for their review to be completed. 

• Initial Complaint

  08/12/2024

  Complaint Type:

  Billing Issues

  Status:

  Resolved

  More info

  My daughter had 2 exact surgeries (bilateral) 2 months apart at promedica Toledo hospital. We were told an estimate of $500 at the hospital the day of surgery. Her november surgery was billed to us at $4,500. I called billing and explained and was told it would be reviewed. One week later I received a call that my balance had been adjusted. Upon checking my chart I could see it was adjusted to $500. Same surgery in January, same estimate- sent a $4,300 bill. Again I called and it was reviewed. Billing supervisor called me back stating that I can make an offer for a price but my insurance will not allow another $500 surgery. Back and forth of questioning why I should pay 10x more for one surgery than I did the previous and why we are given an estimate no where near the actual cost as I can not afford this surgery - no helpful response. Called my insurance and they stated the adjusted balance from novembers surgery was made through premedical and they don’t even see that it was changed so they don’t understand why they are saying it has to do with insurance. Still have not received an adjustment or a call back from promedica.

  Business response

  08/15/2024

  Estimates are created according to orders, and orders can be subject to change resulting in updates to patient responsibility. Our estimates have language that indicates the estimate is based on information known at the time the estimate is created and the final amount due will be based on the actual services received and the processing of the medical claim by the insurance company. We are billing the patient/responsible party according to the insurance explanation of benefits provided to us by the insurance company. This amount is based on the benefit design of the policy chosen by the responsible party. The discount on the previous claim was provided as a courtesy to the patient and is not required to be applied to any other claims.

  Customer response

  08/15/2024

  
  Complaint: ********
  
  I am rejecting this response because:
  My original adjustment was not ever explained to me as a courtesy it was simply just stated as being reviewed and adjusted and was given the same estimate for the second surgery. Therefore, I was to understand that it was a corrected mistake, knowing this I would not have proceeded with the second preventative surgery because we are unable to afford this. I’ve also been told that there is not manager or person above the supervisor the last 4 times that I have called and now suddenly there is someone responding above said supervisor, why was I not allowed to discuss this matter with the higher up? I understand you say estimates are for what you know at the time but how is it fair to a patient to receive a bill 10x the estimated amount, that is a ridiculously low estimate and therefore not allowing patients to prepare for such financial burden.
  Sincerely,
  
  *** *******

  Business response

  08/21/2024

  Our estimates have language which indicates the patient responsibility may be different than what is estimated based on actual insurance processing for services ordered and rendered. A procedure can start out ordered as inpatient but based on criteria may be converted to an outpatient order. The patient’s insurance policy has different benefits for inpatient and outpatient services. The responsible party can follow up with their insurance company directly for more information on their benefits.  A 50% discount on this claim was previously offered to the responsible party, though not required. This offer was rejected; however, we are still willing to honor the discount. We also offer financial assistance for those that qualify and payment plan options for those that cannot pay in full right away.

  Customer response

  08/21/2024

  
  Better Business Bureau:
  
  I have reviewed the response made by the business in reference to complaint ID ********, and find that this resolution is satisfactory as its going to get for me per our phone conversation.
  
  Sincerely,
  
  *** *******

• Initial Complaint

  08/06/2024

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  [BBB Transcription via Ohio AG]

  My pulmonary function exam which was conducted in a clinic was grossly overpriced by a couple 
  thousands of dollars. Which on average before insurance would run normally between $200 and $500 I 
  was charged $2850. This heavily inflated quote would lead me to suspect price gouging and in turn 
  some form of fraud as they refused to provide billing codes and labels. The balance of $2850 conflicted 
  with a figure of $847.57 reported by their billing customer service charges before insurance. And an 
  initial payment of $432 was mane June 15th which was a more reasonable cost as expected for the 
  services. Only for me to be re-billed again as I saw on a physical statement. The itemized bill I believe 
  was made to show and justify price gouging of the services. The location of services rendered was infact 
  a clinic. I can send additional documents if they did not all upload. These tests and scans were 
  necessary due to approx 10 months of bronchitis, coughing blood, and issues with the condition and my 
  history of asthma.

  Business response

  08/06/2024

  The estimate for services shows a total patient balance due of $847.57: facility $798.36 and physician $49.21. Once the claim processed with your insurance, the total due was $874.20: facility $831.56 and physician $42.64.This is just an estimate and subject to final processing by your insurance. If you disagree with how the claim was processed, please follow up with your insurance.

  Our pricing for services are set prices for all patients. The services in question were performed at a hospital outpatient department, which generally results in a higher priced service fee compared to the fee for services performed in a general physicians office. The reason for the higher-priced service fee is that hospitals have much higher infrastructure costs (for example, they need to keep emergency rooms open 24/7) and they typically have more specialized equipment and resources.

• Initial Complaint

  08/02/2024

  Complaint Type:

  Billing Issues

  Status:

  Resolved

  More info

  Promedica started charging me for the Dr room rent and never notified me of this prior to COVERED RADIATION RECHECK APPOINTMENT! This recheck is covered for 5 yrs after completed treatment and has been covered up until now. I am being billed $144.00 for this rented room? I paid my copayment at time of appointment as always. Surely if I had been notified of suddenly having to pay the Drs rent, I would have cancelled that and all remainder appts with this facility. No one will resolve this issue and I DONT FEEL THEY HAVE A RIGHT TO CHARGE ME AND I AM NOT PAYING! How is this legal to do to a patient? Who can I go to that will help me? Why would ANY PATIENT go to a Dr for a non covered appointment. How is a patient to know that SUDDENLY they’re going to be charged for a rented room in Flower Hospital fir appts that were PREVIOUSLY covered? Why wasn’t the patient NOTIFIED that there was gonna be a new UNCOVERED charge?My insurance is MMO AND they claim its Flower Hospital’s issue and Flower Hospital (PROMEDICA) is saying its MMO!! I am the one at risk for collection and credit score issues and now out of an oncology radiation Dr due to this? I am caught in the middle. Id like some help please!! I need this charge to disappear!

  Business response

  08/02/2024

  The services in question were performed at a hospital outpatient department, which generally results in a higher priced service fee compared to the fee for services performed in a general physician’s office. The reason for the higher-priced service fee is that hospitals have much higher infrastructure costs (for example, they need to keep emergency rooms open 24/7) and they typically have more specialized equipment and resources. This fee was billed during your previous visits as well.

  
  Your insurance company has paid the charge in the past. The most recent visit was denied by your insurance as non-covered charges. I have had the biller review the claim again and the balance has been adjusted, as a one-time courtesy. However, going forward, ProMedica provides a hotline for patients who would like to understand their estimated out-of-pocket responsibility before a service is rendered. Patients are encouraged to use this free service so that they can be as informed as possible when making their health care decisions.

  Customer response

  08/07/2024

  
  Complaint: ********
  
  I am rejecting this response because:   I need to know if FULL amount was taken away from account or portion  response is too vague sorry just wanna be clear that I DO NOT owe the $144.00.  If I am in the clear of this charge then we are all good.  I emailed BBB to see if they knew and was told to reject response then I could verify if the $144.00 was removed.  

  thank you for understanding:
  
  Sincerely,
  
  ***** *****

  Business response

  08/08/2024

  Yes, there is no balance due. This was a one-time courtesy. Please review with your insurance prior to any future services as this fee will be billed for these appointments.

  Customer response

  08/08/2024

  
  Better Business Bureau:
  
  I have reviewed the response made by the business in reference to complaint ID ********, and find that this resolution is satisfactory to me.
  
  Sincerely,
  
  ***** *****

• Initial Complaint

  08/01/2024

  Complaint Type:

  Customer Service Issues

  Status:

  Answered

  More info

  Dealing with promedica financial assistance they don’t take care of account as they should. They don’t return calls…..they say they will help you but never hear from them ….than they send you to collections. I’ve set up two payment plans…first one I was told was “not valid”…..set up second one….that was canceled z two days before payments were due to start…REASON…..because I missed a payment on the first one that they told me was voided!!!! I personally have worked in medical billing for the last 30yrs…….never ever dealt with such people ?? someone didn’t do the job correctly and now I the patient has to suffer! ..

  Business response

  08/01/2024

  The payment we received in June was for the missing payments. Mgmt agreed to have accts removed from collections to re-establish payment plan. However, the June payment was also needed. Calls were placed indicating that we still needed June’s payment to continue with the plan. We held the accounts for 30 days to allow for the payment to be received. When it was not received, the plan was terminated again for collections.

  
  We do show an online financial assistance application was started on 4/30/24, but then immediately deleted by the patient. We have not received any completed financial assistance applications. If you have questions regarding financial assistance, please call our customer service number at ************

  Customer response

  08/08/2024

  
  Complaint: ********
  
  I am rejecting this response because:
  This is the only company that calls from RANDOM 1-800 phone ##’s and NEVER leaves messages!  I was even told by a Supervisor that it’s true and she apologized.  I’m posting this complaint so other patients can be aware as to how they work….bad practice management does contribute to mental health/stress of patients.
  Sincerely,
  
  ****** *********

• Initial Complaint

  06/11/2024

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  I get a scam sales person when I call billing and promedica hasnt taken care of my account in over 3 years.

  Business response

  06/11/2024

  We do not show an outstanding balance for $58.00. Our customer service phone number is ************. We do show a recent visit with a slightly higher balance. We are showing there was an issue with the insurance. I was able to verify the information online. We have updated your claim and resubmitted the balance. If you have any further questions, please call our customer service phone number. 

*Some consumers may elect to not publish the details of their complaints, some complaints may not meet BBB's standards for publication, or BBB may display a portion of complaints when a high volume is received for a particular business. ↩