ComplaintsforLewis Gale Physicians

• Initial Complaint

  01/11/2023

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  My complaint is that Lewis Gale Physicians (LGP) Family and Academic Medicine appears to practice down-coding & up-coding on medical claims.Those are the only terms I can use to explain my billing issues. I am limited to the amount of characters that may be used in a complaint,details will be left out of the viewable complaint, but the full account has been attached to my complaint.1St–This has caused me several hundred extra dollars in medical,since they were for preventive & the monitoring of diabetes,not regular office visits as coded.2nd–****** claim numbers do not match LGP claim numbers.3rd-On 12/15/2022 I spoke to ****** and ****** ********** about services provided by LGP,both agreed it should be coded as preventive.I spoke to LGP office manager ****** about this.She said the code (office visit) was right,and ****** should have recognized that it was every 3 months and known it was preventive.That is when she told me that ************ * ****** **** the NP), had actually coded it down from what he could have,which would have been a higher fee.She said that **** knew the codes and he always did them right and I can ask him about it.That's when I thought to myself,is this medical coding just an arbitrary practice?On 12/20/2022,at the end of the visit,I asked him about the coding, he like,******,used the terms preventive & monitoring to describe the services,which are different codes.He left the room,returned,said I needed to find another provider due to a breakdown in doctor/patient relationship.4th-Then I received a letter on 12/30/2022,which I deem as retaliatory in nature, from nurse ******* * ****** ***, stating that I am “ineligible” to use any Lewis Gale physicians, except the emergency room due to a breakdown in doctor/patient relationship.Without cause,**** decided that I can't use my cardiologist at Lewis Gale.That seems like an awful lot of power to summarily remove 50% of my health care options in Roanoke because I questioned him about coding.

  Business response

  01/19/2023

  On Jan. 18, LewisGale Physicians consulted with the patient and his insurance provider. The insurance provider advised that the patient had an annual preventive care benefit which was utilized on 12.3.2021 with the patient’s next benefit eligibility on 12.4.2022. However, in December, the patient switched insurance providers. The patient was informed that all appropriate medical coding and billing is accurate, including the required patient deductible. The patient should contact his insurance provider for any additional questions related to his billing. Thank you.

  Customer response

  01/22/2023

  I have reviewed the response offer made by the business in reference to complaint ID ********, and have determined that this proposed action would not resolve my complaint.  For your reference, details of the offer I reviewed appear below. The only portion of Lewis Gale Physicians response that is accurate is that LGP did contact me, did set up the 3 way call, (which we went in under provider, not patient thru ******** system). I checked my ****** account on 01/17/2023 and LGP had filed a claim to ****** for a Medicare wellness visit and their usual 40 minute office visit. The real issue here is that they had taken my new ****** ********** card, had me sign a form that the information on the card was correct, and then LGP files a claim to an insurer the I have not had in 2 months. LGP's mantra of being infallible on their billing process has to be questioned at the very least. ******, being a large corporation, records all calls and provides a call reference number. The ****** CSR never once ever acknowledged that I was on the call, which I assumed was because we came in under provider. I believe Lewis Gale Physicians had an agenda going in, to coerce ****** into agreeing with them, but it turned very ugly for LGP, once she (******) had contacted 3 other LGP employees, *****, ******, and finally speaking with ****, she decided on *** ***** and asks "What is the coverage for that"? ******: "Showing here that the benefit is covered , the benefit is automatically covered at 100% during the calendar year, no deductible. no copay for insurance will apply, also, it is showing here there are "no" specific limitations or exclusions". Moment of silence. LGP "So he gets 1 per year"? Me: "Not what she said". ******: "No limitations or exclusions, sorry" LGP:"1 per year, correct"? Me: "she said "no limitations or exclusions" ". The agent, puts us on hold, and this is when a very unhappy LGP rep states that "no insurer will pay for that code, they say they will, but they won't" This is the very essence of my complaint, incorrect coding. It is LGP's obligation to code the service correctly, if there is an issue with an insurer not paying, that's between the provider and insurer, it is unethical to code a service differently for the sole purpose to make sure Lewis Gale Physicians get reimbursed, so they shift the burden of paying to the patient. Every time I have spoken to anyone with Lewis Gale Physicians, they constantly change their answer. They have the habit of giving you an answer at the beginning of the call, but they keep talking until they contradict their own answer and start back tracking when you point out what they previously said. My position, ******s' position is consistent, Lewis Gale Physicians' position is not. My complaint of miscoding stands. Regards, ****** ******

  Business response

  03/15/2023

  Lewis Gale Physicians is committed to the satisfaction of our patients. While we are unable to discuss specific encounters publicly due to privacy laws, we have again thoroughly investigated the patient’s concern as requested and verified that our coding and billing is correct. A conference call was scheduled with both the patient and insurance company to assist providing clarification regarding the difference between preventative and diagnostic coding and billing. While we will be glad to have further discussions with the patient, the insurance company is best suited for follow up questions. Thank you.

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