Complaint Review: Summit Medical Group

After being assured that certain testing and visits were "covered" by my insurance plan by the doctors and staff at SMG I learned months after the services were rendered that SMG had billed the testing and visits as out of net work even though past visits at SMG had been billed in network and paid in full for these (much more expensive tests and visits) SMG billed as an out of network provider to my insurance carrier leaving me facing a substantial bill for services which would have been covered in full at another facility as I have good insurance.  SMG has no viable explanation as to why some services are billed "in network" and some are billed "out of network".  SMG is billing procedures to patients' insurance carriers on an out of network basis to make more money.  They get paid at a higher rate when they bill out of network and get to balance bill the unsuspecting patient for the balance.  

SMG violates its own practices and procedures by not discussing with patients their alternatives such as speaking with a financial counsel in the event there might be out of pocket expenditures or advising a patient as to the costs they could incur if billed on an out of network basis.

Furthermore, it is nearly impossible to get a representative at SMG to explain, in a consistent manner, their billing practices and procedures (ie when a service will be billed to your insurance company on an in network basis or an out of network basis), patient responsibility in an out of net work basis 

My recommendation for anyone using SMG is to get in writing a concise description of your financial obligation (the amount) before anything is done.