Costs like deductibles or co-pays can make accessing health care seem out of reach for some. But what if you know your insurance should be covering those costs?
When Let Joe Know viewer Ina showed up for diagnostic testing at Valley provider, SimonMed Imaging, she thought she would pay just a few dollars. Instead, she says she was told to come up with more than $150.
"I was shocked because I knew I'd met my deductible. I knew it shouldn't be that much," she explained.
Ina says she was given a choice: pay out of pocket and upfront at that time or cancel and reschedule the appointment.
For Ina, she explains it wasn't much of a choice, saying, "I didn't want to delay any diagnoses or treatments."
Ina paid what was asked of her at the front desk, but later learned from her insurance explanation of benefits she had indeed paid too much.
"I should have paid $8.96. So, I immediately called SimonMed and asked them for a refund," she said.
We've previously reported on billing complaints plaguing SimonMed. After our initial reports, dozens of SimonMed patients let us know they too were shocked by what they say they had to pay upfront or risk not getting their procedure.
RELATED: Former SimonMed employee speaks out about billing practices
"When I went there, they told me I had to pay cash," one former patient explained.
Another patient who went to SimonMed Imaging states, even after getting prior authorization through her insurance and confirming her co-pay price, she was asked to pay more upfront.
"I even showed her my paperwork and said, 'here's the insurance plan I'm on' and they said 'nope. it's $175 cash and if you don't pay it, I guess you could just reschedule it.'"
These patients shared similar stories about having to pay more than expected and then struggling to get a refund for overpayment.
"I did everything. I called, I went in person, I emailed," one patient said while detailing their experience. Another former patient states she when asking about her refund, she was repeatedly told the "check's in the mail."
When Ina asked about her refund, she says she was told SimonMed would start an investigation. She waited, but when she didn't get answers she filed a complaint with the Better Business Bureau.
On their website, Ina found an alert from the Better Business Bureau regarding SimonMed. It states there's a pattern of consumer complaints about the company not responding to billing and refund inquiries.
One of the big questions from patients is 'why the overcharges when SimonMed already has their insurance information and should know what needs to be collected upfront?'
In a statement, the company writes in part: "SimonMed provides patients with price transparency based on estimates before their appointment. Estimates are based on the information provided by the patient, referring physician, the insurance provider and a national healthcare claim processing agency."
As for Ina, she didn't give up.
"'I will call you every day until I get my refund,' and that's what I did," she said.
Five months later, Ina received her refund of more than $140. She plans to use a different imaging company in the future.
"If you have to go through this kind of hassle, the convenience upfront isn't worth the inconvenience later," she explained when asked about her plans for any future medical needs.
With any medical visit, know your health insurance plan. Understand what is covered and what is not. Be clear about your out-of-pocket obligations and find out if your plan prohibits a billing department from demanding full payment upfront.
Share your complete health insurance information when you make the appointment.
Confirm the financial details of your appointment in advance with your health plan.
Document everything.
Make sure you have proof of what you paid and when and keep your Explanation of Benefits.
Call your health plan's "nurse navigator." That person can assist patients from their initial diagnosis throughout treatment and appointments.
If you have a grievance, file a complaint with your insurer so they can investigate.
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Read SimonMed Imaging's full statement below:
For nearly 25 years, SimonMed Imaging has offered to millions of Arizona residents access to comprehensive, affordable, advanced medical imaging in an outpatient setting. Patients have an opportunity to receive imaging with the most advanced technology, while avoiding hospital visits and hospital pricing for these services. Patients have an option to visit a SimonMed facility or any other outpatient facility or hospital of their choosing. SimonMed provides patients with price transparency based on estimates before their appointment. Estimates are based on the information provided by the patient, referring physician, the insurance provider and a national healthcare claim processing agency. Information relayed and co-payments collected during appointments is based on the accuracy of the information received prior to the appointment. In particular, information from the insurance provider and processing agency can change as other claims are processed. Once a claim has been sent to insurance, it can take weeks to months for the insurance processing to be completed. When adjudicated and if a refund is due, the refund is either credited back promptly to the patient's credit card or a check is issued to the patient. In addition to price transparency, SimonMed provides interest free payment options for those who need assistance. In an effort to further serve the Arizona community, SimonMed donates millions of dollars in free imaging annually to help patients access the care they need but often cannot afford. SimonMed remains the most affordable advanced imaging provider in Arizona and is typically for patients with private insurance about 25% of the price of hospital imaging.
Employees of SimonMed are trained and equipped with resources to ensure they are comfortable with their job responsibilities, while delivering a great patient experience. If a patient has questions about co-pays and insurance coverage upon arrival at the office, SimonMed employees can contact our dedicated Patient Financial Services department to re-verify the insurance coverage and estimate for out of pocket costs. We understand that there can be confusion and frustration around this process as patients are waiting and our staff is working hard to assist them. As with most medical facilities, it is usual and customary for co-pays to be collected upon service and part of the function of the front office employee is to collect the estimated fees due.
