Carecentrix

I'm reasonably sure No Surprises Act violations are a daily occurrence. This company fails to take any accountability with consumers.

I am filing a formal complaint to investigate willful negligence in the state of Florida.

These fools lied about pricing. In fact they refuse to give you a real firm quote for your cost, which is ridiculous. They worry that a vendor bills without them, but don't care that they wrongly bill members. We returned overpriced equipment with approval from Carecentrix and from the vendor yet we still recieve bills.

I called, Carecentrix doesn't care says I have to contact their vendor that they contact with and have their vendor contact Carecentrix. If we go into collections I will bring about litigation on our behalf as well as for any other impacted members with similar mishandling. This company deserves to be fully shut down. Total incompetence.

We bought the equipment from Amazon, took 2 days to get to us and our was cheaper, better quality and most importantly NO HEADACHE OF USING CARECENTRIX!! A total waste of a member benefit. I would rather receive a credit on my insurance for NEVER using Carecentrix. State and Federal investigation should take place for the massive fraud.

Example my friend's mother was dying with cancer, Carecentrix was so terrible that the family went out of pocket to buy supplies than to deal with these billionaire fools.

This is a juicy lawsuit just waiting to happen; actually they, Carecentrix, are begging someone to sue them. I hope one day to read about it.

I have done some research on the company CareCentrix. I found out that CareCentrix is a third-party billing company, hired by insurances, BlueCross BlueShield primarily, to review referrals, approve or disapprove referrals and claims, and to bill BC/BS clients (the patients) for services and supplies.

Additionally, BC/BS and CareCentrix billing to patients is not based on actual cost, but on whatever CareCentrix deems Reasonable and Customary billing for the service or supply. What this means for the customer is that your Medical Insurance company (BC/BS) is paying another company to send you bills (you already pay for your insurance) at a greatly inflated rate, for medical services or supplies you are prescribed by your medical provider.

Their accounting practices are poorly managed, and their accounts representatives are not held accountable for incorrect information they provide to their customers (the patients). They create multiple accounts for the same patients, for the same type of service, from the same provider. Here is my story.

I received notification from a Collections agency that I had an outstanding balance in January 2021. I immediately called CareCentrix (thinking they were affiliated with the provider of these services/supplies) to clear this account. The representative offered me a 20% discount if I paid the entire balance at that time. I paid the entire balance and asked the representative if she was absolutely certain I did not have any additional outstanding owed, to which she assured me I did not.

Fast forward to April 2021 I received a Collections letter for the same amount as the invoice I paid in January 2021. I immediately called CareCentrix for explanation the representative was not able to find this amount due at first, then was able to find it she said oh, I see where you paid this amount in January, I will refer this to my supervisor to get it corrected, my apologies, you do not owe this balance. I was assured this was not my responsibility. July 2021, I receive another collections letter I call CareCentrix again to now be told that I had two accounts and did indeed owe this amount.

I questioned the customer service rep about how I had two accounts, and she replied that she didnt know. I attempted to explain what had happened during the previous calls, and she talked over me and said she had read the notes on the account. At this point, I had been on the phone for over an hour. I told her that I wanted to pay what ever amount I owed to get this cleared up, and that I had been previously told I did not owe this amount.

She eventually transferred me to an Accounts Representative to take my payment over the phone.

I was shocked when I was told that if I did not have a valid form of payment on record, CareCentrix would not approve or authorize any future supply or services for me. They plainly stated they will deny medical care based on what they deem is my ability to pay not what was medically necessary as prescribed by my Medical providers. I was told this by their Accounts Representative, who I assume is not a medical professional. I felt threatened by this statement.

I need medical care and medical supply as prescribed by my BC/BS participating providers. I pay a monthly premium for BC/BS insurance to cover these costs. To be threatened that my medical care will be withheld because CareCentrix provided incorrect information to me regarding my account is not within what I would consider best business practices, very disappointing and very concerning.

I followed up with the provider of these services who relayed additional horror stories, both personal and professional, related to their dealings with CareCentrix. I asked what the cost would be for me to self pay for the medical services/supplies I will need going forward.

I was quoted a price that was less than half of what CareCentrix charged me for the same.

CareCentrix needs official review of their billing practices, by their clients, and potentially Medicare and Insurance commission.

Their inability to provide correct information to their patients, as well as the excessive mark up on the services and supplies is questionable. Denying medical care based upon what they deem is a patients ability to pay may not be illegal, but it is certainly not ethical.

To Diana Sybal , supervisor

I would like to explain what a dedicated , professional and conscientious worker Diana Sybal is with resolving customer's issues and working with other companies (Apria) in getting everyone on board and working together to resolve the issue.

At the beginning of the year I was supplied with breathing apparatus by Apria Healthcare. I was told by Florida Blue that it was fully covered under my insurance, but I received a bill for over $579.00 from Aprea 's demand payment .

They told me it had been turned down by Care Centrix and I had to pay it. After trying to sort this out on my own and failing ,Diana Sybal got involved and eventually I got my money back.

Diana Sybal was the only person who would help me.

I would like to sincerely thank her and tell her supervisor what a wonderful worked Diana has done.

Regards Gary Olyarchik

Ret. Pratt & Whitney program manger.

Phone 352-689-****

Sent from my iPad

I work in a physicians office who is trying to start home infusion services in an oncology patient. There is no response from CareCentrix for greater than 2 weeks. Unable to get a representative on the phone to help resolve the issue.