Consumer says Mission Viejo eye doctor didn’t provide correct documents to insurance company

Consumer says Mission Viejo eye doctor didn’t provide correct documents to insurance company

Member Complaint

I went to Tayani Institute of Mission Viejo, California, for eye surgery. Dr. Ramin Tayani performed blepharoptosis surgery on both eyes.

Before the surgery, Dr. Tayani completed examinations of my eyes, including my peripheral vision. The office forwarded the test results to Blue Cross Blue Shield for approval for coverage of the surgery. They informed me that they responded to the insurance company’s request for additional information, including color photographs of my eyes.

Later, the staff told me I was responsible for the surgery cost of $3,600 because Blue Cross Blue Shield declined coverage. However, I had received a letter from Blue Cross Blue Shield stating approval for the surgery.

Dr. Tayani said they would submit appropriate documents to Blue Cross Blue Shield for reimbursement of surgery expenses. Afterward, Dr. Tayani’s office manager informed me that Blue Cross Blue Shield requested additional information, and she would call me with an update. She didn’t call me.

In the meantime, Dr. Tayani hired a new office manager, and there weren’t any records about the request for reimbursement. In addition, the office staff only sent black and white photos to my insurance provider, not the requested color photos.

Dr. Tayani has not responded to my calls and emails. I want a $3,600 refund if Tayani Institute can’t deliver the color photographs of both eyes as Blue Cross Blue Shield requested.

James Watson, Dana Point, California

Status

Penalty Box

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