ComplaintsforLander Hope Clinic

• Initial Complaint

  12/07/2023

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  On 12/12/2022, I was a patient at the Lander Hope Clinic. Prior to that date, the co-owner of the Clinic, office manager, John B****, told me specifically on the phone that I could send in a form to my Medicare Insurance Company and be reimbursed for some, maybe all, of the costs I would pay directly to the Clinic (he stated the Clinic does not bill insurance, that a patient must pay all costs up front.) I only agreed to attend the Clinic, with the the understanding he would provide me the form to request reimbursement of my costs, and I had the first appointment. I had follow up appointments, strictly told to by the nurse practitioner, Janeen B**** (co-owner of the Clinic, spouse of John B****). On 01/12/2023 and 03/04/2023 I had follow up appointments. I paid all costs they required, including for lab (blood) draws, with the understanding and based on the word of John B****, that I could submit all these costs to my Medicare Insurance for reimbursement, either in whole or partial. On the last visit, of 03/04/2023, I was overbilled for the hourly rate. John B**** corrected this, refunded $40 after I sent him an email informing him. I am aware he has overbilled other clients and one person had confronted him in person for this. She has never returned to the Clinic either. On my last visit appointment, I was strongly told, by Janeen B****, that I should "volunteer" my time at the Lander Hope Clinic supplemental store (on site) as their employee is taking a vacation and they needed someone to fill in. I knew at that moment I would not be returning to the clinic because my health issues were not discussed, but rather the need of the clinic having me volunteer my time for their business was. Upon leaving the visit, John B**** made the statement that he h**** I was going to volunteer for them (in front of office staff). Janeen B**** is NOT a certified participant of Medicare, therefore NO reimbursement of ANY amount would ever be received. The clinic owners knew this.

  Business response

  01/09/2024

   Ref: ********
  Re: ******* ******
  January 9, 2024
  
  Dear BBB,
  
  Thanks for giving us the chance to respond to ******* ******’s complaint.

  
  Lets start with the matter of insurance. We have signs posted in our office that we do not accept insurance. We have fully disclosed that on our website. We tell callers we do not accept insurance. There are no secrets here.
  We also do not promise any repayment. We are open in telling patients that they may or may not get a reimbursement, but that we will do all we can to help. We make it a habit never to tell the patient that they can expect reimbursement. We are open in explaining that reimbursements are between the insurer and the patient only. Most patients do get some reimbursement, but it is not guaranteed and we do not by any means state that it is.

  
  So, lets look at *******s concerns:

  
  1. “John B**** told me specifically that I could send a form to my Medicare Insurance company and be reimbursed for some, maybe all, of the costs I would pay to the clinic.”

  
  My reply- We tell ALL patients with insurance that they can submit their expenses to their insurance company. In fact, we provide them an instruction form (see attached form “Filing an Insurance Claim”) along with verbally telling the patient what’s printed at the bottom of that same form. “We cannot guarantee that any company will or will not reimburse a part or all of your visit…” I did not tell ******* that she would be reimbursed, only that she should apply for reimbursement.

  
  2. Next, ******* states, “I only agreed to attend the clinic with the understanding that he would provide me the forms to request reimbursement of my costs…”
  
  My reply- ******* submitted those forms to you in her complaint, verifying that we did in fact provide the promised forms to make it possible for her to request reimbursement.
  
  3. “On my last visit, I was overbilled for the hourly rate. John B**** corrected this, refunded $40 after I send him an email informing him. I am aware he has overbilled other clients and one person confronted him in person for this.”

  
  My reply- When we settle a bill at checkout, I go over every charge to verify correctness. We charge $40 per 15min office visit. Many patients do not realize that when we take them in for a full assessment including the initial intake completed with the nurse, that this time is also included in their visit charge as its necessary to the practitioner to complete patient care. Our practitioner prides herself in usually spending more than the allotted time frame of 60min with patients without charging any additional time or fees to the patients.
  ******* was unhappy with her charges when she contacted the clinic, we refunded her $40, not because we felt she was overcharged, but to take care of our patients. We do not want to have any unhappy patients. As far as her belief that we have “overbilled other clients”, I do not know who she is speaking of and cannot attest to such another event happening. Most of our patients are exceptionally pleased with the treatment and rates we provide here.
  
  4. “On my last visit I was strongly told by Janeen B**** that I should “volunteer” my time at the Lander Hope Clinic supplement store….”

  
  My reply- Regarding being “strongly told that she could volunteer”, we have many patients who want to volunteer and we do allow and encourage such volunteers. The key word her is “volunteer”. ******* was invited to do so, not compelled. We would not have done so if we felt the need to be dishonest with ******* in any way. We truly enjoyed her as a patient.
  
  5. “Janeen is NOT a certified participant with Medicare, therefor no reimbursement of ANY amount would ever be received.”

  
  My reply- In 2022, Medicare reviewed reimbursement requests from all medical offices, regardless of affiliation with Medicare. In 2023, Medicare would NOT review reimbursement requests from non-Medicare enrolled providers, BUT that many Medicare Supplemental plans DO cover such costs. We have h**** from many of our patients that they have received some level of reimbursement.
  
  Final thoughts-

  We have been honest and open with ******* as we are with all of our patients.

  We are a “fee for service” clinic and do not accept insurance.

  We have signs posted in the office and It is clearly disclosed on our website, ************************.

  We freely and openly address the topic with anyone making appointments. ******* even alludes to this when she says that I told her she could send a form to Medicare. She indicates that she was fully aware we do not take insurance.

  We do not promise that a person submitting for reimbursement will get a particular payment, if any at all. We address this verbally and on the bottom of the form we hand out to aid in the reimbursement process. We try to avoid any confusion on this matter as It would only add strain to our office and staff.

  In my personal opinion our staff goes above and beyond to send the information needed for these claims especially as its done solely as a courtesy to the patient to help with costs.

  
  We would not still be in business with a growing patient base and a 5 star rating if we made it a habit to “overcharge” patients.

  
  It is interesting that *******’s whole complaints seem to be about who is paying for the care she received. She has no complaints about the quality of care, the professionalism of the medical staff or the treatment she received. We let her know before she came in that she was responsible for costs up front and unfortunately seems to not want to bear responsibility for this. ******* alone is responsible for her health care costs.

  
  I hope this is helpful. If you have any questions, please don’t hesitate to let me know. If you'd like to call as a “mystery shopper” and ask if we take insurance, we would tell you the same thing we told ******* before she came in and every other patient we encounter.

  
  We do no accept insurance.

  
  We DO provide any information the patient needs to file a reimbursement to their insurance company.

  
  We DO NOT promise or guarantee any level of repayment along with stating in writing and I quote “We can't guarantee that any company will or will not reimburse a part or all of your visit” as stated on our forms in office.
  I am unsure of how we could make this any more clear for our patients.
  
  Thank you for your time,
  
  
  John B****
  Business Manager

  Handout...

  Filing an insurance claim
  
  Lander Hope Clinic does not accept insurance but that doesn’t mean your insurance will not pay for some or all your visit. We have had many patients who have filed for payment and been awarded reimbursements up to 100% of their charges.
  
  In filing your claim, you will need to contact your insurance carrier and ask:
  
  How do I file for reimbursement?
  
  Many companies treat us the same as they would any other out of network provider and have processes set up to handle the claim. You’ll want to be ready to submit both of the payment forms we give you – the yellow copy of itemized services and the printed receipt of payment.
  
  The company may want a “code” for the services performed. You can look up codes for whatever procedure or process you had done.  
  
  Some of the codes that we believe can be used for our more common services include:
  
  Physicals, new baby checkups and children’s visits:
  99381 0-11 mo. (infant)
  88382 1-4 yr. old
  99383 5 – 11 yr. old
  99384 12 – 17 yr. old
  99392 Adult 18 yr over
  
  Office visits                                          Sports/school physical:  99212
  99212 15 min                                      CDL Physical      99080
  99214 30 min
  99215 45 min
  99215 1 hr
  
  To find other CPT codes, you can do a google search:
  
  The procedure you had done cpt code. (example  “urinalysis cpt code”)
  
  We can’t guarantee that any company will or will not reimburse a part or all your visit – or that they’ll accept the codes you provide - but our experience has taught us that you’re better off to try and that our low rates make it easier for insurance companies to pay the claims. We hope this helps.

  Customer response

  01/10/2024

  Better Business Bureau:
  
  I have reviewed the response made by the business in reference to complaint ID ********, and have determined that this does not resolve my complaint.  For your reference, details of the offer I reviewed appear below.

  I disagree with the business, Lander Hope Clinic, on their response to the BBB regarding the complaint filed.
  
  First and foremost, in March 2023, John B****, co-owner of the business, overcharged the last office visit I attended. I confronted him in an email. I had to return to the "clinic" to pick up important medical records I had left with Janeen B**** in December 2022. John B**** told me, in person, that they were refunding me $40 due to the overcharge and it was his error in overcharging me. As stated prior, John B**** told me he had made the "error" with other people, and they caught his error also. How many of his errors were not caught and how many people just chose to not return because of being overcharged? The comment of John B**** to the BBB was "we refunded $40, not because we felt she was overcharged, but to take care of..." Janeen B**** is the only practitioner in the clinic. She is NOT medicare-certified. I handed John B**** the paper presented to me at the time I checked out. He overcharged the visit. He had overcharged others, by his own admission, and was continuing to do so in March 2023.  The time was written on the paper. I was astonished that he said I owed more for the visit than what should have been charged; as I had just spent what was to be a follow up clinic visit with Janeen B**** to listen to her tell me repeatedly that she wanted me to volunteer in their clinic's supplement store. I wanted to leave the clinic, so I paid what he requested I pay, and informed Janeen B**** in an email that I would not volunteer for their business. 
  
  Volunteering was the first thing that was discussed at the appointment, by Janeen B****. She stated their employee was taking a vacation and they needed someone to fill in for the employee's absence. Upon checkout, John B**** immediately stated "I hear you are going to volunteer for us." Anything discussed with Janeen B**** should have been CONFIDENTIAL information. A violation of HIPAA, Health Insurance Portability and Accountability Act, laws is questionable for being violated at this point.
  How is it even possible that Janeen B**** held a brief followup visit with me, which was to discuss medical issues, was shared with John B**** (office manager, and spouse) in that when I went to checkout, he would make such a comment in the office.
  
  It is questionable also on the Lander Hope Clinic who is replying to the BBB complaint. One can question if the response is written by the B****'s attorney.
  
  When I had asked for the three-visit medical records the clinic had on file, for me, John B**** replied in an email that he did not respond promptly to my request because he had to ask their attorney first, if he even had to provide me with the records. It is against certain laws to not provide a patient with their medical records on file. At this time, the Area Agency on Aging was also involved in obtaining the three visit records.
  
  Janeen B****, as stated, is NOT medicare certified. While the clinic's response clearly is advertising their business in the BBB complaint response, the facts should be clearly noted.
  
  Because Janeen B**** is not medicare certified, medicare insurance did not cover ANY costs incurred at the clinic. John B**** presented me with a form, a CMS form, claiming he knew people / patients that were reimbursed by Medicare. Medicare has clearly informed me, in writing and verbally, that because the practitioner is not medicare certified, there is NO reimbursement.
  
  Now, the owners of the Lander Hope Clinic knew this when they started the clinic. Facts are clear, that John B**** claimed Medicare forms could be sent for reimbursement of costs. I was informed by John B**** that even "lab work" could be reimbursed by Medicare. That is false. As long as Janeen B**** remains not certified as a participant in Medicare, even lab work is not reimbursable. At the very least, and for the decency of transparency to a patient / person paying out-of-pocket to the Lander Hope Clinic, the simple truth should have been made known that because the practitioner is not Medicare certified, there is NO reimbursement of the costs paid by certain individuals. 
  
  The CMS form John B**** presented to me, and told me to "fill it out again" was a waste of my time. He should not have even presented me with the form. It would appear I was scammed from the first initial phone contact I made to this clinic, in which John B**** made the false claim of Medicare reimbursement being paid on some costs. 
  
  It is a disgrace that John B**** claims to the BBB that I was not "compelled" to volunteer for the Lander Hope Clinic. He clearly was not in the room with Janeen B**** and I, but he immediately stated upon checkout he knew I agreed to volunteer for their supplement store. I knew immediately, I would not return to the clinic, I certainly did not agree to volunteer my time and jeopardize medical issues I was dealing with. He then overcharged the visit, and through emails I told him of that fact. 
  
  It is with integrity and concern for others, that I will not publically list names of people who informed me they were also overcharged by John B****; and people who were informed their Medicare insurance could be sent "forms" and they too could receive some form of reimbursement of costs they paid to the clinic.
  
  The reply to the BBB from the Lander Hope Clinic appears to claim that my complaint is based on costs not being reimbursed. I was told, as were other people, that most people were receiving reimbursements from insurances, including Medicare. The practitioner must be a Medicare certified participant for this to be true. There is NO medical doctor on the premises. There is no mention on their website who oversees the nurse practitioner, Janeen B****.
  
  I met a wonderful registered nurse on my first visit at the Lander Hope Clinic. On my third visit, she was no longer employed there. I was informed by another employee there were some issues in the clinic, and the nurse resigned. 
  
  It is my professional and personal opinion by the admission of the business's response to the BBB complaint, that I was scammed from the start by trusting the Lander Hope Clinic. The "forms" I was presented with to turn into insurance to hopefully recover some of the costs paid out-of-pocket to this clinic, including lab work that would have been covered 100% at a medicare-approved facility, remain worthless. Mr. B**** and his reply offer no evidence to support his comment that most people are reimbursed; but he does advertise the business through his response. It is hoped the public will be aware of the truth before paying out-of-pocket for expenses of lab work, X-ray, and practitioner services that are NOT covered in any regard by certain insurances. But according to Mr. B****'s response, he lists codes anyways. 
  
  In final response to the business reply to the BBB complaint, the public should be aware that HIPAA violations are serious.
  

   

  ADDITIONAL MESSAGE:

  I am rejecting their reply to the BBB, as if the Lander Hope Clinic's office manager and co-owner, Mr. John B****, had not emphatically claimed multiple times to me on the telephone before I agreed to schedule an appointment in December 2022, that my Medicare insurance could reimburse me some and possibly all of the costs I would pay to the clinic, I would not have even scheduled an appointment.
  
  It is through his dishonesty and lack of integrity in not being transparent that Janeen B****, co-owner and his spouse, the only practitioner on the premises, was and is not a Medicare certified participant, that I would eventually learn through the assistance of the Area Agency on Aging that the forms John B**** told me to fill out for insurance reimbursement should have never been presented to me. As office manager, he would have been fully aware Janeen B**** MUST be a Medicare certified participant in order for a patient / person to request any reimbursement from her services. 
  
  The clinic owners do post signs they do not accept insurance; however, Mr. B**** claimed multiple times, and continues to claim in his response to the BBB complaint, that insurance forms can be submitted. Even with the knowledge, which will be made known public with the complaint, he does not accept any accountability for not being forthcoming and informing the public that Medicare reimbursement is excluded. 
  
  Therefore, I maintain the Lander Hope Clinic, is a for-profit business and transparency is not fully disclosed. Finally, a Pennsylvania  medical doctor MUST oversee a nurse practitioner. It is the law. There is no physician at this clinic. In the length of three months, I am aware of several professional staff employees no longer employed with the clinic.   

  Regards,
  
  ******* ******

*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. ↩