ComplaintsforPhysicians Regional Healthcare System

• Initial Complaint

  06/17/2024

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  On 3/29/24 I had an annual physical/wellness exam (claim # ********) and on 4/2/24 l had lab work (account # ******** as a part of my annual wellness exam. Both of these services are fully covered by my insurance and I do not pay out of pocket. However, Physicians Regional has coded both services as being a part of a normal office visit and submitted it to my insurance accordingly. This has resulted in my insurance not fully covering the costs, me having to pay $677.94 out of pocket to avoid this going to collections, and being disqualified from receiving a $500 HSA incentive from my employer for completing the annual wellness exam.My medical records clearly indicate the reason for this visit was a physical exam and that my doctor performed the exam at my appointment. I have made multiple attempts to get this corrected and pointed out the coding mistake, but I have been told this was clearly not a physical despite records clearly showing it was. I even spoke to a patient advocate, but they were told the same thing I was by the practice manager.It should be noted this is the 2nd year in a row Physicians Regional has billed my annual wellness exam as a normal office visit. In 2023 they corrected it after I pointed to the evidence, however in 2024 they are refusing to correct it when being shown the same evidence. There appears to be an inadequacy in their system that leads to appointments being coded as normal office visits either unintentionally or intentionally and individuals are unwilling to correct the mistakes.I am seeking the following from Physicians Regional to rectify the situation:1.Correct the coding of both the exam and the lab work to be consistent with an annual wellness exam, then submit the amended claim to Anthem BCBS.2.Send a refund of $677.94 to my original payment method. I will not accept a credit to my patient account for future bills, as I no longer live in ******* and will not be remaining under the care of Physicians Regional.

  Business response

  06/19/2024

  Dear BBB of West Florida, Inc.
  

  Please be advised that we had previously had this claim sent back for coding review per *****'s request on April 23, 2024. It was determined that the claim was coded correctly as an office visit per medical documentation. Areas of concern were addressed by the physician which makes it an office visit not an annual wellness exam/physical. There is nothing that needs to be corrected or resubmitted. Thank you.

  *****************************, Patient Liaison

   

  Customer response

  06/21/2024

   
  Complaint: 21861251
  
  I am rejecting this response because:

  This was booked as a physical/wellness exam in Physicians Regional's system, the exam was performed as shown in the documents, and this exact situation happened at my previous wellness exam in 2023 and was only corrected after fighting to get it fixed. Physicians Regional made the same assertions in 2023 that it was not a physical exam after a coding review, but later corrected it after I sent screenshots of the documents from the appointment.

  This is a flagrant mis-coding of my appointment, despite the assertions made by Physicians Regional, that is costing my nearly $700 I did not budget for and it is the second time they have done this to me.

  Sincerely,
  
  ***********************

  Business response

  07/09/2024

  Case reviewed by Corporate coding and the coding is correct based on the physician's documentation. Per review with the physician, the patient came in for adjustment of his prescriptions for chronic medical conditions.  The patient was charged for the visit, and part of the charges went to the patient's deductible. The patient owes $214 that is part of his deductible that was not met. The notes are per the physician and his medical judgment. There will be no changes to medical record or the patient's bill.

• Initial Complaint

  04/09/2024

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  The outpatient surgical desk claims they do not have a remote for the *** waiting room ** there fore they cannot add closed captioning to the *** **.SOMEONE had to have the remote to turn on the **...so odds are someone is lying.Why does the ** in the surgical check in section have a ** with closed captioning and the *** ** does not have closed captioning turned on? It would be a simple fix to turn on closed captioning but the check in staff claims ignorance of the process...again probably a lie. They turned cases cationing on on the ** by the check in station...why not in the *** WAITING area where people will be staying for over 8 hours of time Oh and the surgical update board does NOT WORK in the *** WAITING ROOM EITHER.I bet the same person turned on both systems and does not know how to do their job Put on closed captioning in the *** waiting room.

  Business response

  04/09/2024

  Hello ******.

  On behalf of Physicians Regional Medical Center-Pine Ridge, I want to respond to ******************* complaint. The employee at Desk 20 does not have a remote for the ** in the *** waiting room. We apologize that she didn't offer assistance in getting the closed caption turned back on in the *** waiting room. She has been educated that there are universal remotes in our ********************** We keep our televisions on with the closed caption and HG**. The patient board in the *** waiting room was working today. I apologize for ******************* dissatisfaction, as we try to keep patients and their family members comfortable in our facility.

  Kind regards,

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

   

   

• Initial Complaint

  01/19/2024

  Complaint Type:

  Service or Repair Issues

  Status:

  Resolved

  More info

  Was 30 minutes early for a 1:30 timed arrival. Took nearly 2 hours Staff at the front desk seemed out of sorts and had a difficult time explaining their billing procedure Techs and nurses are great but administrative oversight is just awful Also, took a metabolic stress test 3 months ago and the facility lost my results.Last week Tuesday, had to have a CAT Scan. I was told that the results would be sent to me within 24 hours, but did not happen Again, the doctors, nurses and techs are wonderful, however, the administrator of this facility does a LOUSY job!

  Business response

  01/23/2024

  The letter below was sent to the patient.

   

  Better Business Bureau complaint ID - ********
  
  
  January 23, ****
  
  
  ******************** (****) *******
  9161 ***********
  ******, **  34108
  
  Dear ******************,
  On behalf of Physicians Regional Healthcare System, I want to thank you for sharing your comments and concerns regarding your experiences with our facility. We take complaints very seriously, and continue to implement improvements based on identified needs. 
  As per our telephone conversation on January 18, ****, you spoke to **************** that day and received the results of the stress test and the ** scans. We sincerely apologize that you did not receive your results as timely as was communicated to you.
  With respect to billing, you did not mention anything to me about a bill. However, I called the ****** Services Center and account #******* has a credit of $679.86. Account #******* is still pending with insurance. I am unsure what $10,000 you were disputing in your complaint with the Better Business Bureau. 
  If there is anything more that I can do for you or if you have any further questions, please feel free to call me at ************,
  Kind regards, 
  
  *****************************
  Patient Liaison
  Physicians Regional Healthcare System
  Cc: Better Business Bureau
  

  
  

  Customer response

  01/27/2024

   
  Better Business Bureau:
  
  I have reviewed the response made by the business in reference to complaint ID ********, and find that this resolution is satisfactory to me.
  
  Sincerely,
  
  *******************************

• Initial Complaint

  12/28/2023

  Complaint Type:

  Billing Issues

  Status:

  Resolved

  More info

  I have called the billing department 15 times and they never answer the phone. I am trying to resolve a billing issue before it goes to collections. On April 24, 2023 I visited my primary care physician. The outpatient visit was a follow up to some medical issues. The bill is $297. My insurance company, Florida Blue denied the claim because it is coded wrong. Florida Blue thinks it is related to a car accident in January, but it is not related. I have sent Florida Blue documentation to support this and I am pushing them to *************. They said they will be reprocessing this claim as of 12/27/2023. I can not get anyone on the phone with Physicians Regional in billing to go over this with them. Even my doctors office at Physicians Regional said that the billing department never responds to them either. My credit is important to me and Physicians Regional owes me a call. This claim will be paid by my insurance. It is not related to my January car accident. Not acceptable communication.

  Business response

  12/28/2023

  Patient was contacted on different times trying to resolve issue along with the insurance company.  It has been sent back to insurance to be reprocessed

  Business response

  01/16/2024

  Please see attached.

  Customer response

  01/16/2024

   
  Better Business Bureau:
  
  I have reviewed the response made by the business in reference to complaint ID ********, and find that this resolution is satisfactory to me.
  
  Sincerely,
  
  *************************

• Initial Complaint

  11/10/2022

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  Hello*I had an unbelievable experience with billing at ****. I went to a adjacent building *on the property and saw a Specialist. At the initial scheduled visit* not emergency * no anthesia I was there for less than two hours and was charged $******* by ****. In addition the doctor charged me for his services which where reasonable *for the service provided* to note.Then for follow up visits to inspect the wound for closure and infection* each time I went to visit the doctor * who billed separately again reasonable charges invoiced. BUT in addition ! **** charged me $ ******* each time I went. Each time I went the total treatment time was .5 hrs. No surgery room * No anthesia * just a standard ************** and room to treat* inspect.Ist visit $4600. One inch wound Debridement.2nd visit wound inspection $4600. Again a One Inch Wound. Treament time .5 hrs 3rd visit $4600.4th visit $4600.5th visit $4600.6th vist $4600.7th visit $4600.I interpret this as a Facilities charge* just to walk on the property* as way to describe it. If this Specialist was not on that Property* I woundn't see the $4600... In addition their billing **** used and incorrect address and I did not receive there mailings*invoices* no phones calls* no emails... and went to collections a year later. The ****************** and Doctor had my correct address in conjunction with this claim/incident and I received their; mailings* email* phone calls. I spoke to Upper Managements Assistant on this matter and can not make sense of way CEO ******************** CFO *************************** and company* are running this business* it is totally wrong* and not acceptable.I have been using Millenium / NCH for a series of years* and in COMPARISON always saw; good services* correct papework and billing. I could make sense of what I was seeing * hearing* reading. I cannot believe this!

  Business response

  11/11/2022

  
  To Whom It May ****************** behalf of Physicians Regional Medical Center-Collier Blvd, I want to thank you for sharing Mr. ************* and concerns regarding his July, August, September, and October, 2021 ***** care visits. We take complaints very seriously and continue to implement improvements based on identified needs.
  
   ************** brought his Explanation of Benefits to the wound care clinic August 2022. The ***** Care Clinic Director and the Doctor went over the charges with him and verified that they were correct. ************* asked for the contact information for the Patient Liaison to further address the bill and see if he could get it written off.
  
  ************** called Patient Liaison on August 31, 2022. Patient reported that he did not receive his bills,because they were mailed to the incorrect address. Patient ******* completed an investigation that found the patients bills had been sent to the address that the patient had provided to the billing department. Patient asked at that time to have collection agency work with him on a payment plan. Patient did call and change the address before contacting the Patient Liaison. Patient bills went into bad debt after 12 months of nonpayment. Patient Liaison spoke with the patient on September 2, 2022. ************** was given a number to work with the collections agency to help with a payment plan.
  
  Patient called Patient Liaison on November 2, 2022. ************** said since he did not receive the bills timely, he felt that he should not be held responsible for them. Patient explained that he had received his Explanation of Benefits from his insurance company knowing that he had bills that he would have to pay. It has been determined by his insurance company and our billing group that ************** is responsible for the charges for the care that he received in our wound care clinic.
  
  We continue to strive and work with staff on the importance of providing safe, compassionate high-quality care to all our patients and the community we serve. To know that we did not meet your expectations is disappointing and we will continue to make improvements so these situations do not repeat themselves.
  
  Although we cannot change the experience you had with us, your observations and comments will help us in continuing efforts to improve the care we provide.  If you need further assistance, please feel free to contact me at ************.
  
  Sincerely,
  
  
  
  ***********************, BSW
  Patient Liaison
  Physicians Regional Medical Center 

  Customer response

  11/14/2022

   
  Complaint: 18380912
  
  I am rejecting this response because: 

  Hello ****,

  I wanted to respond to the invoicing issue ,again.  We had talked before that **** Billing vendor/system had an incomplete address which shows on pdf attachment.  You can see there is no number next to PO box, and the zip code is incorrect, no logo, no date.  I got a copy of  this a year later,after it went to Collections ******* **.  That invoice was not like the ones on your website" PORTAL EASY MATCH CODE" FROM INVOICE...  **** Management has to accept responsibility for their in house system; that anything I was mailed was sent back by USPM as incomplete address, and your system or vendor did not correct it, no phone calls, no emails...  ****, I did not receive your invoices,  and it went to Collections as fault of how the *** business as is managed, supervised.   All other Businesses involved in these services/ claim had the correct contact information, and I received all there correspondence  in a timely manner.  Please see pdf comparison.

  I stand my ground on the charges  from ****, for the services provided as stated earlier .  It is an extreme overcharge, and fraudulent to" code it " as Surgey, and submit to insurance.  I have consulted many people in your industry and they stated the charges are insane.  I didn't ask you to "Write it Off"  I am asking to have discussion on a reasonable resolution.  As a goodwill gesture I PAID one Invoice of the three. ( I wonder if your records reflect that?)   I am not willing to pay a Stated Amount to $4600 Surgery Code every time I walked on the property.  As you agreed if that Doctor, was not on the property, I would not be seeing the $4600 X7  "walk on the property visits" costs.  Ask your management what they would do if they where my shoes?  I would be happy to meet on site and review my records.  I can back up everything I am stating here.

  In addition the ****************** you use;  ******* **, ********* **, SSA ******** Billing , personal, protocols , procedures are an embarrassment to ***-all.

  
  
  Sincerely,
  
  *********************

*Some consumers may elect to not publish the details of their complaints, some complaints may not meet BBB's standards for publication, or BBB may display a portion of complaints when a high volume is received for a particular business. ↩