My insurance states I am allowed to have one routine eye exam per year in exchange for a $20 co-pay. I went to this place for my routine eye exam (99204) and the visit was upcoded to 99204 which is Office/Outpatient New Moderate Mdm 45 Minutes, not the routine eye exam code. "Elevated IOP, bilateral" was put in my diagnosis despite a completely normal exam with an IOP of 18 bilaterally and never having a previous diagnosis of IOP. This means insurance would not cover the visit, and I was charged $268.77. I called customer service almost immediately and was told my bill would be sent to their coding team for review and to not go to the clinic to dispute it. I called 2 weeks later after I had not received an update and was basically told there was no update. I then received a call from their manager, Mary, 2 months later (Almost 3 months since the initial billing). I called back and Mary said she would get it figured out. I call her back about 5-6 weeks later as it still had not been figured out, and I knew the deadline was approaching. I received the following voicemail a few days later. "[The provider] has not reviewed my inquiry yet. I wanted to touch base and let you know that it hasn't fallen through the cracks. We're just waiting. I'm waiting on an update from her. She may have had an overflow clinic today. I know it was pretty busy, so I will touch base back with her in the morning and contact you tomorrow as well." At this point, it had been almost 4 months since I was sent my bill which is the approximate amount of time before PRISMA sells the debt to collectors. She never called me back. I had in fact, "fallen through the cracks." I ended up paying the $268.77 to the debt collectors. I do not trust this clinic and would not recommend it to my friends and family.
