ComplaintsforOhio ENT & Allergy Physicians

• Initial Complaint

  05/01/2024

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  ****************
  
  I appreciate your help regarding my questioning of the billing and office documentation.  While it may appear that the ov notes cover the ***** code most of the note is false.  Most of the procedures were not performed during my brief ov with Dr. *** ****.  The ov was a pleasant experience and I scheduled the surgical procedures.  I have since cancelled via VM for *******; ###-###-####
  
  I trust I signed a financial agreement but that was not included in your fax/ email via barracuda. The up coding is an issue but not as big an issue as the fraudulent documentation.  I have no desire to escalate these concerns.  I would appreciate a reduction of my balance as a patient who indicated he was self pay and was refused.
  
  I am a licensed chiropractic physician who has to document and bill the same way your offices do.  I am all too familiar and confirmed with Dr. **** ****** and his office manager that the Medical Doctors have the same requirements.
  
  I cancelled my procedures due to the billing dispute provoking a 2nd opinion with Dr. ***** **********.  His fees are $200 less for the same procedures as 9/21/23 and he decided to provide a scope as a professional courtesy.  I am grateful the 2nd opinion cost me less than $150. An opinion I did not think I needed but was serendipitous He and his PA spent much more time with me and he informed me there are only 3 ENT’s in Central Ohio qualified to perform the procedure I need.  He had nothing but positive praises for Dr. *** **** and he informed me another doc in your group is qualified and actually performed the same procedure on him in the past.  I believe it is the facial plastics specialty.
  
  I believe a fair fee for the services provided should not exceed $311. Please send a revised/ corrected bill and I will pay it promptly. 
  
  Sincerely,
  
  ****** ******** **** *****
  
  For a *****, all three major criteria (history, physical exam and medical decision making) must be met.
  For a *****, the review of systems must include at least 10 systems or body areas.
  For a *****, the past, family and social history must cover all three areas
  For a ****** the physical exam must cover at least 18 bullets from at least nine systems or body areas.

  

  Business response

  05/01/2024

  ****************
  I am writing to respond to the complaint forwarded from the Better Business Bureau on April 26,
  2024. Your complaint is regarding a billing dispute and office documentation with Dr. ****** ****
  for date of service September 21, 2023. You would like for the doctor’s office to send a correct bill
  for the services.

  Medical Mutual cannot change the coding submitted on a claim. If the doctor submitted the claim
  with medical codes that do not reflect the services rendered, you should ask for the claim to be
  resubmitted with the appropriate coding. The claim was processed in accordance with your innetwork
  benefits and applied to your in-network deductible. Any reduction in the payment owed
  to the doctor would need to be discussed between the doctor and the patient.

  Sincerely,

  ******* ********
  Customer Resolution Specialist
  Appeal and Complaint Department
  ************

  

  Business response

  06/03/2024

  The Clinical Director and the Billing Manager have previously addressed this complaint with the patient. Per review of the documentation from the physician and the 2021 AMA E&M coding guidelines the charges billed were correctly billed. However, we will make a one time exception to write off his charges. The patient can complete a medical request release form that can be found on our website if they would like their records forwarded to another provider.    

  Customer response

  06/04/2024

  *************************
  
  Thank you for your help.  If they previously addressed the complaint the BBB would not have been contacted.
  If the services and billing were done correctly the BBB would not have been contacted.
  
  If they previously addressed the complaint and corrected the billing they would have been paid appropriately.
  
  While I appreciate the write off I would prefer their billing practices be corrected and other patients could benefit.  Maybe this will prompt change and they will not need an in house collections department?
  
  
  

*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. ↩