ComplaintsforScripps Health

• Initial Complaint

  05/16/2024

  Complaint Type:

  Product Issues

  Status:

  Answered

  More info

  This billing complaint is directed at the Rancho Bernardo (RB) allergy clinic. They have demonstrated a pattern of not providing proper documentation to insurers, leading to extreme delays in billing that caused my family to miss the ability to file for FSA reimbursement. My daughter's initial appointment was in December, 2022. We received a bill in April of 2023 - past the deadline to use FSA funds. I called Anthem & Scripps to understand why the payment was so late. It seemed Anthem was at fault, so I filed an appeal with them & a complaint with the Department of Managed Health Care (DHMC) in late 2023. In beginning of 2024, I received another bill from the RB office, for a service that was provided ten months prior. Not long after, we received another bill from Scripps, which included this & a bill from the allergy clinic in Encinitas, that had been processed & paid by insurance within weeks of the appointment. It then became clear: the delays weren't Anthem's fault but the RB Scripps clinic. Anthem denied this claim because, after four months, the Scripps RB clinic did not provide the required medical records. It took another four months to send the paperwork & Anthem processed shortly there after. I appealed to Scripps on April 18. They told me it would take up to 30 days to review, during which time my charges would be paused, & I would receive a letter in the mail or a call with their findings. Shortly after, I got a "final notice", demanding payment, threatening collections. I called their billing team to ask why this was sent when I had an appeal pending. A very nice agent dug around to find that it was "closed" on May 2; a message sent through their portal on April 22 (in response to an earlier question about the bill) was considered their "official response". I am beyond frustrated by the lack of respect and care shown by the Scripps team. Their inability to bill properly has not only cost me money but has wasted countless hours of my time.

  Customer response

  05/21/2024

  see attachment

  

  Business response

  05/21/2024

  Hello Ms. *******.

    I am sorry to hear of the issues you have been having withe our billing process. I am going to be forwarding your concerns to our billing department manager and ask that they reach out to you asap so they can explain the process to you and hopefully clear up any outstanding issues. 

  Respectfully,

  Chris D 

  SMF Patient Relations / Risk Management

   

  Customer response

  06/06/2024

  I have not heard anything from the Scripps billing department (re: case #21719267) and would like to have this reopen until they reach out or provide you more details. At this time, I do not find this matter to be resolved to my satisfaction.

  
  

  Please let me know what's needed for me to move this forward.

  
  

  Thanks,

  ******** *******  ***** ********

  

  Business response

  06/06/2024

  Hello Ms. *******.

    Our Billing department sent me the following correspondence between their office and yourself.  

  From 4/18/24: Spoke to patient's mother. : ******** *******. HIPAA verified. The caller disputed charge. Services were rendered. Balance disputed is $81.68. Patient provided consent to open dispute. Mom stated that the office failed to provide the appropriate paperwork so that the insurance could process claim. She stated that insurance needed the medical records and scripps failed to get the records to them until 8 months later. 

  Our Billing office replied to your concerns via email on 4/22/24 with the following message outlining the timeline between Scripps Billing office and your Blue Cross insurance provider.

  Thank you for contacting Scripps regarding your billing concern, we apologize for the delay in the response. We have reviewed your account.
  
  Blue Cross denied the charges of the 04/10/2023 visit on 08/14/2023 requesting more information. Scripps sent over the requested medical records on 09/05/2023. Blue Cross reprocessed the claim paying for some of the charges on 01/03/2024. The charges which insurance denied after the appeal were adjusted off by Scripps. An electronic statement was generated on 02/09/2024 for the charges of $89.19 which insurance advised was your co-insurance responsibility.
   
  Please let us know if you have any further questions or concerns. Or if you would like to speak to someone, feel free to reach a representative at 1-877-SCRIPPS (727-4777), Option 2*  Monday - Friday 8:15am -4:30pm. 
  

   If the insurer does not except what is initially submitted to them by our billing department and request further documentation it will cause a delay in the processing of that bill.  We would suggest that you follow up with your insurance provider regarding your request for reimbursement of the copay that you were not able to use your FSA for. 

   

  Thank you

  Customer response

  06/12/2024

  I spoke to Anthem again this morning and they did not receive the requested medical records until November 29th (documents attached) - hence why this was not processed until December.
  
  They also said that the initial claim sent in April was flagged and had to be sent to their Special Investigations Unit (SIU). They had to perform thorough research of the charges and were the reason the claim was denied in August.
  
  This is not the first time a similar delay took place from your RB team, as my daughters' appointment from December 16, 2022. That claim wasn't processed until May 24, 2023. However, my daughter's visit to your allergy clinic in Encinitas was submitted on March 14, 2024 - and processed the next day.
  
  I don't think that Anthem would process one clinic within a day but take 8 months to process another if the team had actually filed the claim correctly, with the proper documentation, right away.

• Initial Complaint

  04/30/2024

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  The date of service was April 12,2024 at Scripp's Coastal Eastlake medical offices. The appointment was with Dr. Lee. It was mainly to get a prescription for hypertension medicine . When I made the appointment I asked the person making the appointment if this could be a one-time appointment.Cash Pay. I said I was walking away from a horrible ordeal and wanted to make sure my next doctor would be a good fit. I explained that at the moment I had no health insurance and it was by choice. The ordeal with the previous medical and insurance group was still fresh and I said I will not be choosing to enroll in any new group until I was satisfied that it would be the right fit for me.I had seen Dr. Lee years ago .I didn't want Scripps involved in my health care.Just Dr. Lee.I said to the girl on the phone that I would not be joining any group of theirs on that day and wanted nothing attached or added to me from this visit... I could not have been more clear about my intentions and she very clearly said that it was ok to have a cash visit. I am a perfectly competent adult and I chose to pay the penalties for not having insurance while I decided where I wanted to go next. When I got there they sprung on me a "requirement to sign the document"(see attached). There were two versions of it. I unknowingly signed the very one I originally absolutely refused to sign. They said I could not see Dr. Lee unless I did sign.I foolishly did. I do not consider that document irrevocable. Any contract between health care and patients must have a way to revoke consent or it is invalid. If it is invald, any use of it is a HIPAA violation.I called as soon as I read the visit papers at home. I said I want that document back.Remove it from my chart. Data Intgrity said they could immediately remove it.It would take 30 days for it to be gone from the system and he would call me back. Later that day office person said they would NOT remove it. I feel entrapped ,and outraged. EXPUNGE IT

  Customer response

  04/30/2024

  The amount paid wad $187.00

  I do not see the reason you would want me to release my records.I am not disputing the medical care received and I can show you my bank statement proving I paid.
  

   

   

   

   

   

   

  

  Business response

  05/03/2024

  Hello Ms. *****,
  
    When a Pt wants to come in to see a Scripps provider at a Scripps facility the signing of the Conditions Or Registration (COR) is a legal requirement for services to be rendered.  You were able to make an appointment as a cash pay Pt and when you came to that appointment you had a choice to sign the COR and be seen or not sign and walk away.  You chose to sign the COR so you could be seen by the Scripps doctor you wanted to see and therefore getting that medical group “involved” as that doctor works for Scripps. As was explained prior to your signing of the document it is required for you to be eligible to receive services at Scripps, and since you did see the Dr Lee as requested services were rendered.
   We do apologize for any confusion in regard to your request for removal of this form from your medical record, but it cannot be removed.    
  

  Respectfully,
  Chris D

  Scripps Patient Relations/Risk management department

  Customer response

  05/07/2024

  I was already told by the health information management that it would be removed in 30 days

  I will not be bound to that document!

  It had nothing to do with my visit.

  I DO NOT CONSENT TO THE TERMS OF THE DOCUMENT.

  SCRIPPS DOES NOT HAVE IRREVOCABLE RIGHTS TO CONDUCT RESEARCH WITH MY LABS.

   

  SCRIPPS DOES NOT HAVE IRREVOCABLE POWER OF ATTORNEY RIGHTS TO MAKE ANY DECISIONS IN MY PLACE FOR ANY REASON

  SCRIPPS DOES NOT HAVE IRREVOCABLE RIGHTS TO PHOTOGRAPH ANY AILMENT OF MINE AND KEEP IT IN MY RECORD

  I NEVER RELEASED MY RECORDS FROM MY LAST MEDICAL GROUP. DO YOU CARE TO EXPLAIN HOW YOU MANAGED TO HAVE THEM?

  I WANT NOTHING TO DO WITH YOUR GODDAM OPINION OF ME.YOU HAVE NO AUTHORITY OVER ME AND IF YOU USE THAT DOCIMENT AGAINST MY WISHES I WILL SEE YOU IN COURT

  YOU ARE THE ORIGINAL MEDICAL GROUP WHO ADDED THINGS LIKE A DEFAULT TAPESTRY PROVIDER TO MY HEALTH CARE WITHOUT ANY INFORMED CONSENT.YOU WILL RELEASE ALL CLAIMS FOR ANY CONTROL YOU HAVE PUT ON ME OR i SWEAR YOU WILL ANSWER FOR IT.

  I HAVE NO BEHAVIORAL HEALTH HISTORY IN MY PAST YET WITHOUT A COURT ORDER YOU HAVE ACTUALLY TAINTED MY NAME WITH THE CRAP YOU ADDED.

  I AM PERFECTLY SANE .

  I AM PERFECTLY COMPETENT.

  I WAS GIVEN THE VERY SAME DOCUMENT I REFUSED TO SIGN BUT I DIDN'T SEE IT UNTIL I GOT HOME.

  YOU CANNOT COMMENDERE MY INDEPENDENCE AND MY RIGHT TO KNOW AND DECIDE WHAT I DO AND DO NOT AGREE TO PRIOR TO IT TAKING PLACE.I CANNOT BE MORE SICK TO DEATH OF THIS KIND OF BULLSHIT.I AM NOT INDIGENT DO YOU UNDERSTAND?

  REMOVE THE DOCUMENT

   

   

  

  Business response

  05/09/2024

  We apologize complainant remains unsatisfied with the outcome of our review of her complaint. We have no additional information to offer complainant.  Documents she signed are customary in healthcare and are a condition of being seen at Scripps.  Once executed, such documents may not be removed from the medical record.  

  Customer response

  05/10/2024

  I am 

   

  I terminate the agreement immediately.

  Show me confirmation in writing

   

   

• Initial Complaint

  04/03/2024

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  I went to two different surgeons in the Scripps network, and both set of surgeon stated that the hospital and the surgeon office covered my insurance. In fact the hospital called later and stated they called my insurance and made sure everything was covered. On the day of the surgery, they took charged me $7200 although my deductible was only $5500 - a week later or so they send me a bill for $39,000 - upon calling the billing office of Scripps healthcare, they stated that my insurance is not covered because it’s a health sharing plan. Now prior to the surgery they said everything will be covered and then after the surgery they’re telling me it’s not going to be covered and it’s something that I would need to bill directly to my insurer. I spoke with my healthcare insurer, and they stated that Scripps healthcare is a provider that is in the First Health PPO network - which is in network that is used by my insurer and there is no reason why Scripps is denying. After literally dozens of phone calls, I’m at the spot where I am left with the $39,000 bill, a hospital that does not want to simply provide the information to the insurer as requested so that the insurer can pay the hospital directly, and I’m in the middle not knowing what to do. I’ve called Scripps Billing multiple times, and they are very rude for the most part and do not respect the customer nor give us the time of the day. Not to mention that you have to typically wait at least an hour to get a call back or even to get through if you’re lucky.I’m at the end of my wits. I’m not sure what to do. I called my insurer and they said they will try to bill Scripps directly, but Scripps is refusing to give me the diagnosis codes and the revenue codes. We just want Scripps to be paid and my insurer is happy paying them but Scripps refuses to give the health sharing organization, that uses first health PPO the network, information that they need to process my procedure to process the bill so Scripps can get paid.

  Customer response

  04/04/2024

  PLEASE FIND ATTACHEDMY AUTHORIZATION. THANK YOU

  

  Business response

  04/05/2024

  Hello Mr. ******,

   My name is Chris and I work in the Patient Relations Risk Management Department at Scripps. I am sorry to hear of the issues you are having with billing for the procedure you had done with us. I will be contacting the manager of our billing department and ask that she reach out to you to discuss these concerns as soon as possible. 

  Respectfully,

  Chris D

  Customer response

  04/22/2024

  Hello,
  
  I have not received any calls from Scripps, although I continue to receive bills and warnings.
  
  Thank you,
  ****** ******

  

  Business response

  05/13/2024

  Hello Mr *******

   According to our Billing Department they have made a couple of attempts to contact you by phone regarding your concerns with billing. The Faith based plan you are asking them to submit billing to is considered a discount plan and is not classified as an "Insurance" and therefore Scripps is unable to bill them directly.  Our Billing office can however provide you with an itemized statement that you in turn can provide directly to the carrier.  If you would like to have this information mailed to you, please respond to the messages left on your voice mail or by calling 858-927-5500 and requesting an itemized statement. 

  Thank you

  Chris D

  SMF Patient Relations / Risk Management Dept. 

  Customer response

  05/16/2024

  I am writing to address an inconsistency in the billing practices of Scripps as applied to my account, following several attempts to contact your office for clarification.
  
  On Friday May 10th, I received a voicemail from a representative of Scripps Health, to which I responded promptly by returning the call and leaving two messages. Unfortunately, I have not yet received a callback.
  
  I wish to clarify Scripps Health’s policy on billing faith-based organizations. Historically, services rendered by Scripps Health, including those b* *** *** ******** and associated pediatric, urgent care, and emergency room services, were billed directly to ********** a faith-based insurance network I had previously engaged. This was contrary to the recent claim that Scripps does not bill faith-based organizations, a statement that seems inconsistent with past practices.
  
  Further, assurances were provided prior to my recent procedure that my faith based plan with ********* including the first health PPO network, was covered. Despite this, I received a direct bill, prompting concerns about a potential shift in your billing policy.
  
  Given these circumstances, I kindly request a prompt response to resolve these inconsistencies and to discuss a satisfactory path forward. I look forward to your urgent attention to this matter and hope to establish a clear and accurate understanding of Scripps Health’s billing policies in order to avoid such situations as they apply to faith-based insurance networks in the future.
  
  Sincerely,
  
  Thomas Philip

• Initial Complaint

  02/08/2023

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  My Husband was denied services at Scripps CLinic on 11/03/22 after he paid his copay and was told to wait in the waiting room. My Husband had severe cold and flu symptoms and he presented himself at **** Mission Valley Road suite 200 ****************************** at Scripps Health Express. My Husband was told by Check in person to wait in his car after he paid his copay, 10 minutes later my husband received a call on his cell from Scripps Health Express stating they will not see him because the Physician Assistant in that day refuses to see my husband. My husband had to drive all the way up to *********************** La Jolla so he could then get a COVID 19 test my husband ended up scheduling a Virtual Visit with Scripps Clinic after being turned away for care from their facility.

  

  Business response

  02/16/2023

  Hello ************************

   

  My name is ********************* and I am Patient Relations coordinator here at Scripps. I am sorry to hear of your husband's experience at one of our clinics. I will be sending your concerns to management that oversees the Mission Valley Scripps Health Express to

  look into what the circumstances could have been that lead to his being directed to another one of our facilities for his care. I will also have billing management review the payment made for the visit and reach out to your husband regarding the refund being

  requested. 

   

  Thank you,

  *********************

  SMF Patient Relations Coordinator 

• Initial Complaint

  01/03/2023

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  Scripps Health performed a endoscopy procedure on in April of 2021. The bill was submitted to my insurance company Aetna. They paid 80%, I paid 20%. Payment in full was made to Scripps for the procedure. In May and June, 2022 I received new new bills for $1158.13. I called and the person at Scripps *************** She said my bill was paid in full and is no longer shown on the myscripts on line portal. I received additional invoices for the same amount $1,158.13. After asking my insurance provider to get on the phone with me, a supervisor told us this was a new invoice was for new charges that they forgot to add to my original bill and that it had been sent to collections for non payment. She said it was never submitted to ***** and would not as it was an older billing. Instead of a procedure costing $2,834 paid in full, it now looks like the procedure cost $4,389.85 and was told the invoice will not be submitted to Aetna for payment and that I owe the additional amount or they are taking me to collections. I do not understand how new charges can be added to a previous procedure after a year has passed. I can not verify these new charges are legitimate. I demanded the itemized list to present to Aetna for their review. There's a charge for 2 biopsies for $3,883. I've never received a report for a biopsy and never saw the Dr. again. No follow up by the Dr was requested. I'm waiting on *****'s review while Scripps still shows I owe the full amount.

  

  Business response

  01/05/2023

  Dear ************************,

  Scripps apologizes for your experience. I'm going to have the Business Service Manager contact you by Friday 1/6/2023. If you do not receive a call from them, please contact me at ************.

  Sincerely,

  *********************, Director Patient Relations for Scripps Foundation 

• Initial Complaint

  11/21/2022

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  On 5-31-22 I had a routine Cardiology follow-up visit that lasted 5-7 minutes, or around **** minutes including the ********** before the doctor arrived. It was coded with CPT code *****: Established patient office visit, ***** minutes.I understand that the billed time can include time to review the chart before the visit, and time spent documenting the chart after the visit, but ***** minutes for a 5-7 routine follow-up visit with no symptoms and no issues seems excessive. This department seems to always use codes with excessive durations, longer than the actual services rendered. Also, the visit notes seem to document deep discussions when only passing comments really took place or could even have taken place in the short visit. I do not see this happening in any other department.The coding department supposedly reviewed the code (after 5 months!) but deemed it appropriate, which shows that the coding review department is not really doing its job of fairly reviewing overcharges. Instead, it is simply helping the overcharges stand. I have paid the overcharge to avoid issues, but the services should be resubmitted with the correct code for the actual services provided.Scripps doesn't offer any venue to fairly address these issues, so I am doing it via BBB. I trust my health to Scripps, and I believe that it is an ethical organization that should support truthful coding by providers as well as unbiased review of coding when overcharges happen. I was overcharged some dollars, but Scripps has more at stake here if this is a widespread problem affecting many patients and it comes to light. So, I am really trying to help Scripps, even at the personal risk of retaliation.

  

  Business response

  01/05/2023

  Dear ****************, 

  Scripps apologizes for your experience. I'll have the **************** manager contact you to review your concerns, no later than Friday 1/6/2023. If you do not receive a call, please call me at ************.

  Sincerely,

  *********************, Director of Patient Relations for Scripps Foundation

• Initial Complaint

  10/18/2022

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  I have been trying to get my cat scan images thru Nucleus. It is not working. Scripps refuses to contact nucleus and nucleus refuses to help me because I'm the patient. They only support providers.

  

  Business response

  10/18/2022

  Dear ****************,

  Scripps apologizes for your experience. I have forwarded you complaint to the radiology department director. I'll have radiology reach out to you and assist with getting you a copy of your CT scan.

  Please feel free to reach out to me if no one has contacted you by Thursday, 10/20/2022.

  My cell number is ***********.

   

  Sincerely,

  *********************, Director SMF Patient Relations

• Initial Complaint

  09/26/2022

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  During an oncology treatment at the Scripps Mercy facility, my nurse asked what I did for a living. I told her I was a teacher. She said "you don't teach that critical race theory, do you?" I was speechless. I wanted to tell her that it was a right-wing conspiracy theory, but I come once a month for care and I don't want to start a fight with a provider. The nurse was unprofessional. Politics should NEVER come up during a health care appointment.

  

  Business response

  09/27/2022

  Dear ******************,

  Scripps apologizes for your experience and will have management at Scripps Mercy review your concerns and reach out to you to confirm that they have addressed your complaint.

  Sincerely,

  *********************, Director of Risk and Patient Relations for Scripps Foundation 

• Initial Complaint

  09/21/2022

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  Hi I just filed a complaint about scripps blood lab at *************************************************. It was pertaining a issue with me requesting a butterfly needle to do my blood draw. I did not sign or date the prior form and was concerned it would not count. On 9/20/2022 between 8:30-9:00 am yesterday I went to get blood work ordered by my doctor. I specifically ask for a butterfly needle and was told a ludicrous story that the blood flow through the butterfly needle would not be an effective blood test. Her name is **** and she saw how upset I was asking her and telling her that I have **** a caregiver to my parents and took them for they're blood work every month for four years at another place. , I begged her for a fourth time to have the butterfly needle she was persistant and had the other needle in my arm very fast. , i felt that there would be confrontation with her if I did not let her use the needle she wanted to use on myself. years ago when I had blood work there, I had a painful and uncomfortable experience with the needle that she used yesterday. Something is not not normal about what happened yesterday. my phone number is being blocked from submitting this form and my working phone is ************. Please get back to me, thank you *************************

  

  Business response

  09/23/2022

  Dear ******************, 

  Scripps apologizes for your experience. We have forwarded your complaint to the lab manager who will review your incident with *********

  We take these complaints seriously and will follow up with you.

  Sincerely,

  *********************, Director of Patient Relations for Scripps Foundation 

   

• Initial Complaint

  09/15/2022

  Complaint Type:

  Billing Issues

  Status:

  Resolved

  More info

  I am being charged $356 for an appointment I did not make or have, and neither ******** or my supplemental insurer will pay for because my Well Woman exam (covered by ********) has been billed as a Preventative exam by Scripps Health which is not covered. There was no type of preventative actions or new problem(s) discussed during my exam.On 3.8.2022 I was told by the doctor's ****** I had to come in for my WW annual exam in order to have an Rx renewed. There was absolutely no indication that this annual exam would be anything else than what is covered by ********. (See Appointment log attached)Most importantly, I was told by the doctor during my exam on May 19, 2022 it was covered by ********. Noting this was my first Well Woman visit as a ******** patient, my doctor explained during the exam ******** allows a WW exam every 2 years, so I was okay for this exam but if I have an exam next year, it will not be covered. It is clear the doctor was giving me the appropriate ********-covered exam, otherwise there would have been NO reason for her to bring the only every 2 year allowance to my attention.The normal procedures for a WW visit were done - breast exam, pelvic exam, a reminder to make an appointment for a mammogram, and Rx renewal. The doctor sent a referral to a specialist for a urological problem which is NOT a new problem, discussed during my March 2021 exam, attached. After receiving my first bill in June, I spoke with a ******** representative who agreed the exam met the criteria for a WW covered exam. I called the Scripps billing ****** June 15th (hung up after 20 min. on hold) and then again June 21st. The representative told me the bill would be sent back for review and to allow for ****** days for a reply.On August 15th, I received a letter from Scripps Health ***************** Services which states in part, The documentation for this date of service supports a preventative exam was performed. I continue to be billed $356.00.

  

  Business response

  09/16/2022

  Dear ****************,

  Scripps apologizes for your experience. Someone from ******** Services will contact you within the next (2) business days and review your billing concerns.

  Sincerely,

  *********************, Director of Risk and Patient Relations for Scripps Foundation

  Customer response

  09/19/2022

  
  Better Business Bureau:
  
  I received a prompt response (phone call) from a Scripps Health billing supervisor in reference to complaint ID ********.  I sincerely appreciate this representative had already reviewed the complaint, spoken with her manager, and had a solution for the issue before we spoke.  She spent a considerable amount of time explaining the confusing rules of ******** and was very friendly, professional and considerate. 

  Scripps Health has addressed my complaint and I consider this complaint resolved.
  
  Regards,
  
  ***************************
  
   

  
  

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