ComplaintsforAmerican Surgery Center of South Texas

• Initial Complaint

  05/30/2024

  Complaint Type:

  Billing Issues

  Status:

  Unanswered

  More info

  *************************** had eye surgery on Oct 11 2023.We had been told prior to surgery that our part of the insurance co-pay would be $1,015.87. WE paid this amount when we arrived for surgery.our medical provider had our health care insurance information.surgery went well,.. the problem is with the insurance billing process, when UMR processed the billing the following codes arrived with the explanation of benefits.(EOB)...REASON CODE EXPLANATIONS: 905 CHARGES DENIED.CLAIM FILING EXCEEDED TIMELY FILING REQUIREMENTS FOR THE CONTRACT.PROVIDER MAY NOT BILL YOU FOR THIS AMOUNT...CODE 224 UHC NETWORK EDIT REDUCTION APPLIED PER THE PROVIDER'S CONTRACT.YOU ARE NOT RESPONSIBLE FOR THIS AMOUNT.YOUR CLAIM WAS PROCESSED AT THE IN-NETWORK LEVEL OF BENEFITS. ...CODE I4 . TOTAL BILLED OF$5,237,00 GOT A DICOUNT OF $5,237.00.LEAVING A "0" BALANCE TO BE PAID. WE paid $1,015.87., the .money went to pay $500 for LENSAR and $50 for LRI..$1015,87 minus the $500 and the $50,leaves an Overpayment of $465.87.we are requesting a Refund of the Overpayment....the situation got a little worst because the statment from Surgery Partners dated 4/19/2024 had our patient payment amount deleted from the statment. the statments from 2023 did have our payment lusted on the statments.

• Initial Complaint

  02/13/2024

  Complaint Type:

  Billing Issues

  Status:

  Resolved

  More info

  I had cataract surgery on 6/20/23. American Surgery Center submitted a claim for $9805 to my insurance carrier, BlueCross/BlueShield. The covered expense for the procedure was *******. BCBS paid ******* and I paid 2336.26.On 10/18/23 I received a phone call from American Surgery Center informing me I had an outstanding balance. They could not provide me with an explanation for the balance and I requested that they resubmit the claim to ********** and send me an itemized bill. I received a bill one month later on 11/17/23. It shows the total amount for the surgery at $10,405 which is $600 more than they filed with **********. I have called American Surgery Center a total of five times since October asking them to resubmit the claim to ********** with the new amount of $10,405. Two of the calls were three-way calls initiated by me with *********** on the other line. I have gotten nowhere with this .American Surgery Center has yet to respond. This could be easily resolved if they would resubmit the claim. Instead, they are going after me, the patient, for the full cash amount. They have many complaints online regarding their billing practices. I would like for them to resubmit the claim to my insurance so ********** can process it.

  Business response

  03/20/2024

  American Surgery Center received a letter on March 15th, 2024 from the BBB. The complaint is under investigation, and per CMS policy, we have seven days to respond. A response is forthcoming pending a full review of the patients grievance.

  Customer response

  03/22/2024

  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.
  
  Regards,
  
  *************************

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