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Complaint Details
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Initial Complaint
10/14/2022
- Complaint Type:
- Billing Issues
- Status:
- Answered
On May 5th, 2022 I had an appointment for a routine consultation at the *********************** (CCC), *************************************************** where I met one of the facilitys nurses. Prior to this meeting, I checked with the facilitys front desk if and how much I have to pay out of my pocket for this visit. The answer was zero dollars. Based on this response I decided to have the consultation. During the visit, I mentioned that to the nurse who saw me and kindly asked her to choose the appropriate service codes in order to reflect the zero cost as I previously mentioned. Unfortunately, that didnt happen and in addition more (routine) blood tests and consequently costs were added. Naturally, when I am buying a good or a service I need to have in advance at least a good idea about the costs but with CCC that didnt work properly. When I later talked with my insurance company I was simply told CCC misled me regarding the medical costs. To summarize, for an occasional, routine visit to this facility, I am asked now to pay $976.90 out of my pocket (acc. #: *********; *********). Two weeks ago, I contacted and talked with the facility manager, ***************************** about this situation. She understood it and promised me to have a closer look but so far no results.Consequently and taking into account all the above, I respectfully ask CCC to reconsider my complaint and remove the charges from my account balance.
Business response
11/11/2022
Complaint ID: ********
*****************************
UnityPoint Health
Accounts ********* and 379756442
To Whom it may concern:
We have reviewed Mr. ********* complaint due to charges for services rendered on May 5, 2022, at UnityPoint Health Allen Hospital Community Cancer Center. ******************** stated that the front desk advised he wouldnt have any costs or out of pocket expense for the consultation. He went on to say he spoke with the nurse and asked her to choose the appropriate codes to reflect a zero cost.
Mr. ********* visit was not routine. In addition, our front desk staff would have no knowledge of the charges that would be associated with the visit or how the patients insurance would cover the charges. The staff member ******************** spoke with is no longer with the organization so commenting on what was said is merely speculation. However,we train our staff to have patients contact their insurance carrier regarding benefits for services rendered. No payment was collected at the time of service. ******************** also mentioned he asked the nurse to code services so there would be zero costs. This behavior would be fraudulent as all charges are coded based on the documentation of services rendered. Office services were billed to Mr. ********* insurance carrier in the amount of $276.00 and after taking our contractual adjustment of $85.09, this left $190.91 balance applied to Mr. ********* deductible. In addition to the office visit ******************** had multiple laboratory tests for chemistry, immunology, and pathology. We sent charges in the amount of $1863.14 to Mr. ********* insurance carrier where they allowed $785.99 for the services, applying this to Mr. ********* deductible.
We reviewed Mr. ********* services with the clinic and a committee of peers to evaluate his concerns. The review resulted in a decision to uphold the charges.
Thank you,
UnityPoint HealthCustomer response
11/23/2022
Date: 11.12.2022
Dear ****,
Since I was not able to formally file an answer, please have below my answers to the Allen Hospital letter:
1. My insurance company didnt pay anything (relative to all charges from May 5, 2022). Please see attached a copy of my Aetna account showing all charges under discussion.
2. This visit was absolutely a routine one:
a. The current ** doctor ******************************* suggested seeing a hematologist just in case to rule out a potential cause of a medical condition I have, which is a slightly enlarged spline.
b. I discovered this condition several years ago and since then I was under the supervision of several ** doctors so far and nobody suggested me to see a hematologist.
c. size of the spline was consistently the same over the years according to the ultrasound test results. That is another indication this visit was not necessary. Test results, old and new are available.
d. a nurse saw me and not a doctor
3. The outpatient clinics front desk told me I dont have to pay anything out of pocket and this is the reason I accepted this consultation. That happened during a phone conversation prior to the scheduled visit. When I am buying a good or a service I have to know the cost of them in advance.
4. It is claimed the front desk is not enabled to provide a cost for a medical service. On the contrary, in all my past experiences they did that. Typically they call my insurance company and ask for costs. Alternatively, they can ask me to do that. However, their answer was zero cost for me after a short on hold suggesting they talked to my insurance company.
5. I asked the nurse to use the appropriate codes to reflect zero payments as per the earlier discussion I had with the front desk. Nothing illegal here and the front desk is responsible for that.
6. The ** doctor **** prescribed me a small number of blood tests (I believe 3 or so). The nurse who saw me multiplied them by a factor of 3 to 5 if I am not mistaken.
To Allen Hospital/**********************************************: With all due respect, please do whatever is necessary and clear all related charges from my account.
Respectfully,
***************************
Business response
12/19/2022
Please see our original response to the patient's complaint. We stand by our initial response.Business response
12/19/2022
Please see our original response to the patient's complaint. We stand by our initial response.
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Get a QuoteCustomer Complaints Summary
1 total complaints in the last 3 years.
0 complaints closed in the last 12 months.