Complaints

• Initial Complaint

  08/06/2022

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  July 27, 2022 11am. Scammed my daughter out of $1,000 for anesthesia that was supposed to be covered by her PPO insurance. Kept us waiting for two full hours after appointment time for wisdom teeth removal surgery. My daughter was in pain, wanted to get this over with. Billing clerk came in with a bill for $174 copay that needed to be paid before doctor would see her. My daughter gave her her credit card. Clerk took her card and then came back and said it would now cost $1,174 because insurance wouldn't pay full amount for the anesthesia at $250 for every 15 minutes, one hour minimum. "Insurance company's rules," she said. If my daughter didn't prepay they wouldn't do the surgery, even though they were in network for a PPO insurance plan. She paid, in tears over the exhorbinant cost, and they took her to surgery. She was in for 27 minutes. When she called her insurance company a few days later they said her copay was just $90 for the anesthesia and agreed to call the doctor's office with her to clear this up and secure a refund. The billing clerk told them that's "just what we charge" and there would be no refund. This, despite her surgery lasting less than half an hour from the time she left the waiting room (1:02pm) until the doctor came out to tell me she was finished (1:29pm). Which would put the charge at $500 not $1,000. And again the insurance company they are contracted with said the patient should only have a $90 copay. Completely unethical, they wear you down until you just want to get it over with, not caring that you're in pain, and then refuse to accept the terms of the insurance company they have contracted with.

  Business response

  09/26/2022

  Business Response /* (1000, 5, 2022/09/07) */ ********* is not a patient, customer or affiliate of our surgical practice; this complaint was filed on behalf of her daughter who received surgical services at our surgical facility on 07/27/2022. I will not be disclosing her daughter's information because of HIPPA privacy laws. Her daughter, who is a 27 year old adult female, presented for emergency consultation for evaluation of dental complaint, she was evaluated and appropriate surgical treatment plan was discussed with the patient, insurance verification of coverage of surgical treatment was done by our staff; the patient was advised that anesthesia services will not be covered by her insurance plan, she was given a cost estimate of the cost of surgery and anesthesia based on contracted fees by insurance company, since anesthesia service is not a covered benefit, out of pocket cost was provided to the patient before proceeding with surgery; Non covered services under insurance plan are billed at the usual and customary fees dictated by the business; this is dictated by the law- Cal. Ins. Code § 10120.3 Patient signed treatment plan as explained and agreed to proceed with surgery. Surgery was done under anesthesia as planned, patient was discharged in a stable condition, she was reevaluated twice post operatively to ensure complete healing as dictated by standard of care for surgical practices. In regard to her claim of "scamming", this can not be further from the truth, her daughter was evaluated and was given treatment estimate prior to proceeding with surgery and anesthesia, insurance verification was completed during her office visit(audio recording of insurance verification and all communications are available to verify), a treatment plan was provided to the patient prior to any treatment rendered as dictated by CMS SURPRISE BILLING ACT 2022. In regard to her claim that the surgery took 30 minutes and she was charged for an our of anesthesia services; anesthesia services billing time starts when the patient is under the anesthesia care of the provider, that means that anesthesia time starts when the anesthesia provider evaluate the patient for fitness for anesthesia, placing the patient on vital signs monitors, obtain intravenous access and ensure safety of the patient undergoing anesthesia, surgery starts when the patent is fully anesthetized and anesthesia care does not end with the end of surgery, it ends when the anesthesia provider transfer post procedure patient care to a qualified allied health professional for monitoring during recovery from anesthesia; definition of anesthesia time is explained by CMS and ADA as "Anesthesia time begins when the anesthesiologist begins to prepare the patient for the induction of anesthesia in the operating room or in an equivalent area and ends when the anesthesiologist is no longer in personal attendance, that is, when the patient may be safely placed under postoperative supervision" Actual anesthesia time and discharge time is documented in anesthesia record in our facility. Furthermore a copy of the anesthesia record was provided to the patient to assist her with appealing insurance decision of lack of coverage, a three way phone call was made to the insurance company with our insurance coordinator and patient in attendance to verify lack of insurance coverage for the anesthesia services. Audio recordings of the phone call is available for review as well.

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