The complaint has been investigated and
resolved to the customer's satisfactionResolved Santa Monica Eye Group — Overcharges and bilking the insurance company
resolved to the customer's satisfaction
We've gone to the SM Eye Group for about 15 years and enjoyed great service. The last few years, with the economy being tough we have elected to go for annual visits to get our prescription for contacts filled but then use that prescription to purchase the lenses through online companies. This saves a bunch of money. So, we are aware that the eye doctor charges a fee for the visit and issuing the prescription. We've done this for last several years. Costco offers a similar check up service as well as most vision centers. So, when my wife booked her appointment his year to go to the doctor she asked on the phone how much it cost for this type of appointment. She was very specific because if the cost was too high she was prepared to go to Costco instead. They told her $75.00. She went to the appointment and they asked for her insurance card. She gave them but also told them that she was paying for this visit and this wasn't going through insurance. They told her this was a formality. She had her appointment which included a dilation of her eyes. We've had this dilation each time. My wife hates doing this because she can't see very well to drive home after so last year she asked if she could skip it but the year before she did it and I did it last year as well. Anyway. The visit was fine. She got the prescription. However, at the visit she saw a new doctor. She was informed that the old doctor retired and this new doctor came into the practice two years ago and now has taken over full time. That doctor also recommended another test for my wife which would cost more money and told her that someone in the office would call back to quote her the price. We never heard from anyone. But about 3 weeks later we going an invoice notice from our insurance company, Anthem Blue Cross. It seems that Santa Monica Eye Group had submitted a bill to them for over $200 of services for this appointment. The insurance company was informing us that our obligation was only $98.15 and that they wouldn't pay the rest. I was shocked. How could they submit a bill to insurance? When I called SM Eye Group i was told that the service my wife received was more than just the check up and prescription and that the dilation process cost more money. I explained how we had been coming there for years, had the same service each year, never been charged like this before, and that my wife even was specific when booking about the fees. The person told me that the doctor would have to make a decision on these charges. A couple of days later another office person told me that the doctor agreed to reduce her charges by 20% but we still owe about $78. I explained that we already paid $75 at the initial check up and she said that this fee was additional to that cost. I knew that a scam was on.
I then called my insurance provider. They told me that the total cost for my appointment was $98.15 and that if I already paid $75 I should only pay the difference. I mentioned that I was quoted only $75 for the appointment and that I did not incur over $200 over services. They said that it's common for the doctors to submit as much as they can and the insurance company then reviews what is fair cost for that appointment and provides the amount that can be charged. So then I called the doctor back and left a message. Finally about a week later the doctor called and spoke to my wife. She did not try to apologize for any overcharging. She said she did agree to give 20% off and that if the difference is only $3 or $4 they would just waive it. Again, i heard nothing from the office so I called them once again and they informed me that they $98.15 was still a separate charge from the original $75 and that the insurance company wasn't correct in telling me that I only have to pay one fee. Finally, another month later I got a new bill from them for $23.15 which is the difference between the $98.15 and the $75.00 I originally paid. No discount of 20% but at least not a separate charge.
Regardless, this doctor is trying to overcharge clients. I had asked them for a copy of any paperwork that was signed for the initial appointment and what they sent me was a list of legal paragraphs. There was one paragraph that indicates the fee is $75 for the appointment and another paragraph that indicates that during the appointment your eyes might be dilated but nothing that suggests there is any additional fee for this. This was a pure rip off.