- Report: #1435434
Complaint Review: HealthFIrst - New York New York
Reported By:
Mrs Baile -
Queens, New York, United States
Submitted:
Updated:
-
Author Confirmed
Why?
HealthFIrst
100 Church Street New York, 2128016000 New York, United States
Web:
www.healthfirst.org
Categories:
Business Rating:
(0)
Tell us has your experience with this business or person been good?
HealthFIrst HealthFirst Obamacare Healthfirst Silver Leaf did not pay for claims submitted by medical provider New York New York
On behalf of Physican who provided in network care for HealthFirst patients for the past 15 years. Health First requested all medical charts to be submitted to General Dynamics. General Dynamics is a company that HF contracted for claims review.
Starting July, 2017 we have been submitting records for each and every claim. These claims were supposed to be reviewed by General DYnamics. General DYnamics did not even bother returning our phone calls for three months. Eventually after multiple calls and emails we were able to receive spreadsheets with the reasons for denials for about 70 of our claims. HUndreds and hundreds of medical records were submitted but General DYnamics took five months to give us denials for only 70 claims. Each and every denial was unsubstantiated and bogus. We were told to appeal to General Dynamics and if they deny again then appeal to HF.
we never received any response from General Dynamics or HF. They kept on saying " denied for insufficinet documentation or missing pages." We printed and resubmitted the charts to HF five times and attached spreadsheets with tracking info. When i demanded to be given more specific reason for denying all of our claims i was told by HF that they do not need to explain to me why they are denying. They have right to deny and not pay and terminate without a cause as per provider agreement.
To summarize- Health First request medical records, gave us bogus denial reasons without a chance to appeal or discuss with medical director. They also claimed we did not submit records while we submitted records multiole times with tracking numbers that indicated that they were in fact delivered. HF kept on scheduling and canceling conference calls and not giving us opportunity to appeal or question any of their decisions. Not once we were able to speak with medical director. Multiple appeals, letters, requests were sent to legal offices and corporate offices but no one is interested in addressing this situation. Meanwhile HF owes us about $300,000 which they reported as paid to NYS and got reimbursment from State. However, they do not report the fact that the claims were not paid. In addition they are paying large sums of money to out of network providers whille not paying in network providers because provider agreement does not grant the provider any rights. It is much harder to fight out of netwrok proivders where HF actually has to follow certain rules and regulations. We are filing compaints with DOH and considerering whistleblower lawsuit against Health First under NYS False Claims Act.
