I've used Karma twice and neither time did they actually submit my application to the state, nor did they take the requisite materials to do so. I am an out-of-state student and was informed I would apparently require a Nevada ID. However, I was never told I needed to provide it by a finite date.
I called today and was informed they would need to bill me "another $250.00 at least" (verbatim from the representative) to submit my application because it had been over 90 days. This policy was never communicated to me as a customer either in-person or otherwise.
Bottomline, I find such actions to be indicative of poor business practices- especially if a business has failed to inform the customer (knowingly or otherwise) and then exploits that fact for financial gain.
Doctor was very nice though.