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SimonMed patients covered by insurance but told to pay

Money generic
Posted at 5:00 AM, Sep 08, 2021
and last updated 2021-09-13 14:01:25-04

PHOENIX — When getting access to health care, costs like deductibles or co-pays can make needed procedures seem out of reach for some, but what if you know your insurance should be covering those costs?

We told you about Samantha and her issues with the Valley provider SimonMed Imaging.

"They know they have a broken system. But they're not doing anything about it," said Samantha. "Everybody is paying them because they are bullies."

As an amputee, Samantha had needed several x-rays and scans at SimonMed and each time she was told she had to pay hundreds of dollars despite her insurance covering the bill.

Soon after we shared her story, many others shared theirs.

Jennifer wrote they told her to pay upfront five minutes before her MRI appointment because her insurance was not covering $1,200. She paid and is now waiting for a refund because her actual out-of-pocket cost was only $33.

Stephanie shares she made 15 phone calls ahead of her SimonMed visit. She says they told her she had to pay $800 when her cost was nothing.

L Huber says she felt cornered already worried about her scan results.

"She said, well if your insurance will pay for it, you'll get the money back," said L. "I was a little apprehensive about it going in anyway. So, I write the check."

She says it took almost 8 months to get her money back.

We tried calling SimonMed, emailing them, being referred to different people who never replied. We even direct messaged them on social media and Better Business Bureau links, calling individual locations across the Valley, and got the same response patients say they received. Nothing.

We wanted to know - how they verify benefits and Is there a process for people to dispute what they are told they owe.

SimonMed finally responded saying:

"Because of privacy regulations, we cannot discuss any specific patient experience. At SimonMed, we are committed to providing patients with quality care at affordable pricing. SimonMed has been a leader in imaging for over 25 years with comprehensive service, affordable out-of-pocket costs, advanced technology, convenient locations across 11 states and personalized care for patients. We appreciate the opportunity to hear feedback from physicians and patients and we have taken many steps and continue to focus on billing practices and scheduling as well as ensure adequate staffing is available at each site to create a positive experience for each patient that is seen at SimonMed."

If something like this has happened to you, you can file a complaint with the Better Business Bureau here.

After our story aired, SimonMed provided The Let Joe Know Team with the following updated statement.

SimonMed is a leader in the community with comprehensive, affordable advanced medical imaging. We provide patients with price transparency as well as estimates before their appointment. Estimates are based on information provided by the patients insurance provider. Once a claim has been made, it can take months for the insurance company to complete the process. When adjudicated and a refund is due, the refund is either credited back immediately to the patient’s credit card or a check is issued to the patient. SimonMed provides interest free payment options for those who need assistance. SimonMed has been recognized for partnering with many philanthropy programs and donates millions of dollars in free imaging annually to help patients access the care they need. SimonMed remains the most affordable imaging center in Arizona.