ComplaintsforEdward-Elmhurst Health

• Initial Complaint

  11/12/2022

  Complaint Type:

  Order Issues

  Status:

  Answered

  More info

  Hi - I went for a *** visit and a blood draw. The *** **** has been sent to the wrong insurance agency, so the blood draw (which was sent to the right insurance) is not being billed as a preventive - and I am being billed $1377 for the blood draw. The insurance company is waiting for the *** claim and it has been over a month now. Mychart ppl are not helpful. Please send proper claim and know I am not paying $1377 for a blood draw!

  Business response

  11/14/2022

  This lab draw was ordered by the patients Physican for a specific health issue. Because of this the order is considered diagnostic, not just routine laboratory work. We have re-sequenced the ordered codes in an effort to help the patient but cannot guarantee this will change.  The balance was not denied by the insurance, they applied it to the patients out-of-pocket. 

  Also, the patient mentioned an incorrect insurance being billed. If the patient has another insurance, we need to know what that is as we have only been provided this one. 

  We will advise the patient of the insurances decision once we hear back on the new claim we are sending. 

• Initial Complaint

  09/27/2022

  Complaint Type:

  Billing Issues

  Status:

  Unresolved

  More info

  On 10/20/2020 I had an outpatient procedure done at the ************************** that was authorized by a doctor (referral is on the system). I thought, it was paid until I got a bill from Edward-Elmhurst Health for $5,484.00 on May 6, 2022, without any explanation why it was denied by my insurance company. I called my Duly Health and Care medical group and was told that they had not received any invoice/bills from *******-******** Health for the date of October 20, 2021. After numerous calls, it turned out that the bill was sent to ******* instead of Duly Health and Care medical group. I have been calling multiply times (06/03/2022, 06/21/2022, 8/16/2022) to the ****************************** and asking to send the bill to Duly Health and Care and was repeatedly told that it will be. Suddenly, I got a Collection letter a week ago. Again, I called to Duly Health and Care, and they had NOT received the bill. After that, I called to ***************************** (09/202022) and it turned out that the bill was still sent to *******. I'm getting nothing but run-around, very frustrating and cannot understand how and where to get help to resolve the issue.***************************** DOB:04/22/1963 Guarantor Number:32237819

  Business response

  09/28/2022

  Good morning. 

   

  The patients insurance is ********** HMO with Duly Health as the network. This was not billed incorrectly, the issue is that the patient's Physician failed to get an authorization prior to performing this procedure. We have been in contact numerous times with **** who informed us on  11/19/21, 12/30/21, and again on 4/5/22 that they would work on the referral. During The last conversation with "*****" at Duly we advised that we are going to have to bill the patient for this if they do not secure this referral. That was never completed and unfortunately we must now make the patient responsible. 

  Once again, this was not billed incorrectly. All bills for this patient are always covered with no problems. The exception is the ***************** failure to obtain the appropriate authorization for this. This was advised to the patient both on the phone and in writing through ******************************************************************** Services. 

  Customer response

  10/08/2022

   
  Complaint: 18135899
  
  I am rejecting this response because: I had a referral from ************************** (referral ID ********* for the procedure at ****** ********************** (the Hospital), on 10/20/21. The procedure was related to a health issue that I had experienced for months prior to 10/20/21. ************* was contacted by ************************************************ (Otolaryngologist) seeking further treatment for it. I am including documentation of that referral in this communication. At the check-in at the hospital before the procedure, I specifically asked if the Hospital had my referral on file. A Hospital employee confirmed for me that the Hospital did have my referral in the Hospitals system on that date. Thus, the Hospitals current excuse seems to be as follows: that one of its own physicians (the referring ******* *************** is a practicing physician at *********************) failed to follow some aspect of the Hospitals and/or Duly Health and Cares internal pre-authorization protocol. The Hospital now contends that due to the failure of one of the Hospitals own physicians, and the failure of the Hospital and Duly Health and Care to proactively communicate to resolve a simple matter of a referral/authorization, the burden must fall on me to pay a $5,484 bill out of pocket. Moreover, the Hospital had encountered a problem with Duly Health and Care in securing referral/authorization for six months and failed to explain this issue to me. I did not receive an explanation to why this bill was denied. I did not receive any letters or messages through MyChartDuly/Dupagemedicalgroup (the only Mychart Im signed up for). I sent email on June 11, 2022 to *********************************************to which I never received a response. I left numerous messages with the ***************** at ************, trying to find out the problem and only once did I receive a call back, from an unidentified person who informed me only that there had been no referral for the procedure performed on 10/20/21,without any further explanation.
  My wife and I despite my health challenges and us both have full-time jobs - took time off from our jobs to make calls and wait on hold; and desperately try to figure out why the claim was denied. Only after filing the complaint with the BBB did,I ever get an explanation from the Hospital regarding this issue. What kind of patients support is this, If the Hospital points the finger at Duly Health and Care and Duly Health and Care cannot say why the claim is denied since no one had submitted a claim for either approval or disapproval? I will not except the responsibility for the $5.484 bill and in the interest of avoiding the expense of future litigation on this subject, please see to it immediately that ********************* Hospital, its employee *************** and Duly Health Group communicate amongst each other to convey whatever information is necessary to ensure that Dr.****** referral for my 10/21/21 procedure is honored.
  
  Sincerely,
  
  *****************************

• Initial Complaint

  09/07/2022

  Complaint Type:

  Service or Repair Issues

  Status:

  Unresolved

  More info

  My son had a telehealth appointment on March 21st, 2022 and he was on hold for an hour and nobody ever picked up. They are charging me $30 copay. I have called and sent message on ******* and they will NOT remove the bill. I don't want this to go to collections. The appointment NEVER happened.

  Business response

  09/27/2022

  Per our Physician group: Thank you for reaching out regarding your sons virtual health appointment that you stated did not occur.  Our records indicate that a visit did happen which is why charges were processed.  I will take one additional level of review but wanted to let you know what our initial review revealed.  Please feel free to call me directly at ************. I will respond back as soon as possible.

  Customer response

  09/27/2022

   
  Complaint: 17929442
  
  I am rejecting this response because:  THE APPOINTMENT NEVER HAPPENED! ALSO WE RECEIVED A LETTER FROM A COLLECTION AGENCY!  THIS IS SO UNETHICAL, NOT ONLY ARE THEY CHARGING FOR AN APPOINTMENT THAT DID NOT HAPPEN, FROM WHAT I HAVE BEEN TOLD IT IS A  HIPAA VIOLATION TO SUBMIT TO COLLECTIONS!
  
  Sincerely,
  
  *****************************

• Initial Complaint

  05/01/2022

  Complaint Type:

  Service or Repair Issues

  Status:

  Unanswered

  More info

  My son, ************************* (DOB 4/18/2013), had strep throat multiple times in 2018, so **************************** Reddy, an Ear Nose and Throat Doctor, removed *****s tonsils on 10/19/2018 to stop the problem, which it did. On 9/17/21, ***** complained of a sore throat, so we took him to Edward-Elmhurst Health ********************* at *****************************************************, where he was diagnosed with strep throat and given antibiotics. He also tested positive for strep throat 10/14/21, 11/01/21, 11/04/21, 12/8/21, 12/14/21, 01/05/22 01/25/22 and was given antibiotics each time . The reason we took ***** to the Edward-Elmhurst Health ********************* was because our regular doctors office The ****************** ********************************************************************************** was either closed or didnt have appointments. The only time that we received a negative strep result was on 9/27. At *****s last visit at ******* ******** clinic on 1/25/22 where he tested positive for strep, the provider noted that, All the tests had been coming back positive today, so lets send the culture to the lab. In the after visit summary notes on 1/25/22, the provider wrote, Patient with positive rapid strep test today. Multiple antibiotic use within the last few months. Discussed with mom that we will send a strep culture to confirm strep before starting on antibiotics due to difficulty taking oral medications. Mother agrees with plan of care.When we did see *****s primary care physician, ***************************, after our visits to ******- ******** Health, she began to question the results of the strep test given by the Edward-Elmhurst Health ********************* **************** requested that we get the strep tests done at her office whenever possible. When ***** got tested for strep throat at ****************** office on 9/29/21, 1/3/22,1/5/22, 1/12/22 2/07/22, all results came back negative.

• Initial Complaint

  04/12/2022

  Complaint Type:

  Product Issues

  Status:

  Resolved

  More info

  I am trying to get reimbursed for overpayment to the hospital for an ultrasound I had on 12-9-21. It is in the amount of $109.15. I have spoken with the billing department on 1-25-22, 3-10-22, 4-6-22, 4-8-22, and 4-12-22 and I'm getting nothing but the run-around. I have been repeatedly told the request will/has been filed. I was told on 1-25-22 that it would take 30 days for processing. It has now been 78 days. My reference number for the case is **********. My birthdate is 12-19-64.

  Business response

  04/25/2022

  Patients refund was processed on 4/20/22.

  Customer response

  04/26/2022

   
  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.  The refund check was finally issued and I have received it.
  
  Sincerely,
  
  *********************

• Initial Complaint

  04/08/2022

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  A claim for a procedure performed at ********************* on 11/5/2021 was denied by ******** due to incorrect diagnosis/procedure code. ******* billing department has refused to contact ******** and provide them with the correct coding information.

  Business response

  04/20/2022

  The diagnosis code is exactly as ordered by the patients Physician and matches the procedure the patient had. If there is any changes that need to be made to a diagnosis code, the patients Physician would need to write and sign a new order and fax it in. In addition, as required by ********* the patient was given an Advanced Beneficiary Notice prior to services advising that ******** will not cover the procedure. The patient checked box 1 electing to have the procedure done anyway and signed the form. Our registration team did contact the patients ****************** on the day of the procedure and were informed that the order was as intended and could not be changed. 

  Customer response

  04/20/2022

   
  Complaint: 17007097
   
  I am rejecting this response because:

  I contacted ******** and was told the provider (******) needs to call the ******** provider number (which only ******** providers have) to get the proper diagnosis/procedure code.
  
  Sincerely,
  
  *********************

  Business response

  04/21/2022

  As previously stated, it is illegal for a healthcare provider to change diagnosis codes unless the ordering Physician makes a change and signs the appropriate updated order. Any insurance, including ******** does not have the ability to say something is coded wrong as they were not present when the provider entered the order. They can only speak to what would be covered IF the Diagnosis code was something else. Once again, as a courtesy we contacted the ****************** prior to advising the patient this would not be covered and were informed there would not be a change.  Unfortunately, we cannot make any changes and any questions regarding the order should be directed by the patient to her Physician that ordered the cost. 

  Customer response

  04/22/2022

   
  Complaint: 17007097
  
  I am rejecting this response because: As the attached documents indicate, Medi
  care states that the maximum we can be billed is $780.  Yet ****** billed us for the entire amount of $1,749.
  Sincerely,
  
  *********************

• Initial Complaint

  10/28/2021

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  Since 02/2021 my medical bills for my car accident have been sent to a wrong insurance, Geico was supposed to be the one.Hundred not just dozen times, I contacted ****** ******************* to adjust to a liability insurance and not to be sent to United health care. Every time I would get a billing person on the phone I was informed, it will be adjusted and sent to Geico, or they will pull from United healthcare insurance and would submit to Geico, and story would continue constantly like this. I have been calling to the billing department since March every other week, can you imagine?Multiple times talked to billing personnel, some of them are **** *****, supervisor *****, ******* B, Irelian,I contacted billing to make sure to send my invoices to a correct party, so in conclusion it was never done.The liability insurance was entered at every appointment correctly, I was able to confirm with the facilities that I visited.The billing department have been entering wrongly on their side, and both billing department including Physician and Hospital, have been doing a poor job.I am losing patience; I just cannot imagine how elderly patient must be patient and deal with the billing issues for an almost a year.Couple of my bills were sent to a collection, were the billing department associate confirmed will **** Geico, and at the end I get a collection letter, it is not big amount, but it is so wrong to send me to a collection when vividly see in the notes that I have been days and after day inquiring about my account to be fixed.I even have stopped going to a physical therapy just being afraid they again will send a **** to a wrong insurance and will end up owning copays or deductible. How is this ok, this is Hospital Billing, do they even care about the patient, I have stressing over this for month this defiantly not good for my health.... Plus, in September, exact day 09/21/2021 I requested that Billing Director call me, his name is ***********************, never did.

  Business response

  11/01/2021

  Good morning. We made efforts to reach out to Geico however after numerous attempts we received no contact back from the adjuster. We just recently learned from Geico that the adjuster changed and the original adjuster was not assigned to this any longer. Because Geico did not reach back out to us we were left to **** the patients Health insurance which paid on each of the accounts minus the Out-Of-Pocket responsibility. Per Geico, the patient has $5000 in med pay benefits which have already been paid out. The patient has no more benefits available for this claim. As a courtesy we are waiving the patient Out of pocket responsibilities which total $1163.01. 

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