ComplaintsforScranton Endoscopy Center

• Initial Complaint

  03/25/2022

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  I became very ill in 2020. As a result I had to have numerous tests and see numerous specialists before I was finally diagnosed with a chronic debilitating illness. During this time, I had tests done by the Scranton Endoscopy Center and my health insurance plan at the time had a $5k deductible. The employer reimbursed said deductible for all employees. Almost a year later, as I was trying to submit my EOBs for reimbursement, I learned that one of the claims the facility had charged me for was never processed by my health insurance company. The insurance had requested additional information from the facility which the facility never provided. The insurance company reached out to the facility with myself on the line to try to resolve this matter. The individual from the facility was not only unwilling to help or even look into the issue but was so rude and disrespectful to the agent, that she asked to speak to a supervisor to which she was told there was none. The insurance company resent the documentation to the facility and advised me to do the same, which I did. I then received a fax back from the facility attaching a copy of a Remittance Advice from **** ****** showing the amount paid by the insurance company and the amount I owed. I reached back out to the insurance company regarding this and also, because there is no EOB on my account showing that I owe this money. The insurance company again confirmed that they have not processed this claim and that the facility has no right to charge me an amount which the insurance company never processed. Most alarming to me is this two page Remittance Advice contained other patient names on it along with who their doctors are, their claim numbers, the cost of their procedures, what they owed, etc. This is a clear HIPPA violation and based upon the unprofessionalism of this facility I am highly concerned that my privacy may have been breached as well. I intend to make others aware of their HIPPA violation.

  Business response

  05/02/2022

  ******************,

   

  The research which has been completed confirms that the claim was processed by the payer and there was patient liability for the amount of 170.90 which was applied to the annual deductible.  Insurance remittance advice reference information check date 10/21/20, check # *********.

   

  The complaint regarding HIPAA violation has been submitted to the Privacy Officer, this will be fully investigated and the correct action will be taken.

  Business response

  05/17/2022

  Hi ******************,

   

  The facility received notification today regarding the patient rejecting the previous response.

   

  We have the insurance remittance advice for check date 10/21/20 which shows that the charge in question was processed and 170.90 was applied to the annual deductible.  The insurance payment and contractual adjustments were posted appropriately.

  Customer response

  05/25/2022

  [To assist us in bringing this matter to a close, you must give us a reason why you are rejecting the response. If no reason is received your complaint will be closed as Answered]
  
   Complaint: ********
  
  I am rejecting this response because: I cannot agree with their response because my health insurance company is confirming with me that they HAVE NOT processed that claim and when I log on to my online account, the EOB for that claim confirms what the health insurance company is saying. I have had a few ********* and ********** health insurance plans and in fact, I had ********* and ********** coverage from a different plan that started in December of 2021. The only thing I can think of is that this claim was submitted under a different plan than the one that was active during that time but the insurance I had in October of 2020 ended the last day of November 2020 and the plan did not process this claim. That's a fact because if they did, it would show on my EOB and it does not.  However, since the business has been uncooperative from the beginning, including to the health insurance company when they reached out to them to try to rectify this issue, I do not wish to waste anymore time dealing with them.

  I do however want the HIPPA violations addressed. Enough time has passed at this point that there should be responses with regard to the multiple breaches of privacy. I intend to notify the insurance company who sent the business the check that the business violated the health insurance company's customers as well as I believe these other patients should know their privacy was breached by this business. 

  Regards,
  
  ***************************

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