Complaints

• Initial Complaint

  04/11/2024

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  9/18/23 I went to **************** for an initial visit to check a lesion on my foot. He started the consult, after explaining we went and took some X-rays and after another 10 min of working on my foot, he diagnosed me with plantar wart and told me it needed to be removed. He injected lidocaine and left me in the room for another ***** min. Initial consult was a total of ***** min. He extracted the lesion and sent me home, to come back in a month for a followup (10/9/23). After the first follow-up, he had me return in another two weeks (10/23/23).The first bill I received had a date of 11/1/23, for the charges of 9/18/23:Intial OV ***** minutes $425 adjustment of -$45.21= $379.79 X-rays complete foot $75 adjustment of -$18.15= 56.85 Exc, bening lesion $330 adjustment of -$30= $300 I was told to not pay attention to the first bill as it could be sent out before insurance responded. The second bill had a date of 12/07/23 and it included the same charges as before and the two follow-up appointments.10/09/23 Focused Est. OV $145 -$45= $100 10/23/23 Focused Est. OV $145 -$125.99= 19.01 After this I still waiting to get a bill reflecting insurance, when I received the next one with 01/12/24 date I reached out to my insurance and they stated that because it was out of network it landed on my deductible. I went to the office and showed them the *** asked them to adjust to my insurance allowances and asked for an itemized bill and to remove the interest charge. I got another bill in the mail on 02/15/24 without the interest charge but without an itemized bill and a note saying that they are not required to use my insurance allowances and that they use BCBS allowances. I then again went in and sent a letter (I have a signed copy) requesting an itemized bill to pause the interest charges, and to request a call. 03/12 Next bill, no itemized charges, an interest charge, with a change on adjstm of -$55.99 each. I sent a certified mail a letter with a check, and proof.

  Business response

  04/25/2024

  ******

  Business response

  04/25/2024

  This patient has received answers to all her queries, including the itemized statements she says she never received.Initially, answers to her questions were sent by the ****** through the main office worker.  The patient refused to accept these answers.  Subsequently, the ****** began to send detailed answers via email. The patient greatly underestimated the time spent in her care during the initial office visit.  She has questioned every aspect of her visit and demanded answers. She has received a detailed message indicating how the time was spent on that initial office visit based on the doctors notes.  To this point, she has refused to pay for that visit.  Incidentally, the check she sent bounced.  She came in this week to make a partial payment via credit card to cover the returned check.  Also, regarding the courtesy discount apparently applied to her final office visit, the patient was informed that the discount was given in error as an office visit would not cost a mere $19.

  Customer response

  04/28/2024

   
  Complaint: 21561564
  
  I am rejecting this response because:
  Before I sent a certified mail with the "Final Letter" the only way to communicate with the ****** (*************) was over physical mail, which meant getting a delayed response from them. Previous to that, I had requested her to contact me over by phone or email at least 2 times, with no succes. After receiving the "Final Letter" was that ************* saw fit to email me regarding my inquiries. She sent over a picture of my "patient ledger" along with an explanation. In this email she explained that the visit lasted a total of 72 minutes, therefore, the billing code in question was correct. She also explained that the courtesy discount given in the last visit was an error (mistake she somehow did not realized until after I sent the original letter questioning why I was given that discount for one visit and not the one before), and procedded to charge me $59 more.

  
  After receiving the 1st email, I did not accept that my initial visit lasted 72 min, becuase it made no sense (at this point I was not aware that the visit time included the documentation). I believed that those 72 min included the time spent on the extraction, and after doing some research I found out that the extration code includes the procedure time and it should be included in the visit time. I proceded to respond to the email with my findings and explaination of the time I believed I had spent in the visit, prior to the procedure starting, which made me demand her changing the code ***** to the code *****. I also responded that I had done some research and found out that she is charging from 100% to 156% over the average ***************** prices, which seemed outreageous to me. 

  
  She replied to that email with quotes, stating that the visit time also included documentation time (which I was not aware of), but does not include the time spent on the procedure, which I accept. And she stated that the code ***** was correct and she would not be changing it. She also said that answers to my previous questions/inquiries were replied to by the main office and that sending the ccertified mail was not the only way to get her to respond to me. However, I specifically stated that it was the ONLY reason she finally contacted me, directly over by email, instead of over physical mail. She also stated that most private insurance companies allow medical practices to bill aproximatelly 150% of the ***************** prices. (Keep in mind that some of her billing is 156% over). She said that my bill will not be discounted any further and that I had 2 weeks to pay the rest of my bill, or I will be sent to collections.

  
  To her response, I requested time stamps of how they came up with the 72 minute length visit, as it was still not believable. I requested time stamps of when the appointment started, when the appointent ended, when my procedure started and ended, and the same for the documentation time. I also requested a copy of all my medical records. 

  
  She replied saying that ************ keeps a watch with him and writes down the times on a piece of paper and that is what they base their times off, however, she said they do not have those papers anymore. She stated that based on the time stamps from their computer my visit started at 10:23 am, when ************ looked at my chart and history, and that the visit before the procedure took 49 min. This would mean that from the time he looked at my chart to the time he finished the visit the time would have been 11:12 am. She clearly stated that the time while my toe was numbing and ************ was out of the office does not count towards that time. She states that after my visit was done (and I was gone), he started on documentation and that it took a total of 23 min. She also informed me that my check had bounced. 

  
  After looking at my own records, text messaged sent to my mom after ************ told me it was a plantar wart and he needed to numb my toe to remove it, it clearly shows that the time was 10:52 am. This happened after ************ left the room in search of the materials necessary to numb my toe, he came back not 2 minutes later, and it took another 2 minutes to inject the lidocane in my toe, at which time he left the room again. According to *************, the time spent while my toe was numbing does not count, so this means that the total time of the visit (before documentation) was 33 minutes. If we add the 23 minutes of documentation the total time that should have been billed was of 56 minutes, not 72. Which makes me wonder why she want to claim the remaining 16 minutes as time for the visit, when they were most likely spent on the pricedure. 

  
  After receiving this information and learning that the check had bounced, I went into the office and paid the amount of the check and the $30 bounced check fee, as it was my fault (I had inadvertently used a check from an inactive account). 
  I replied to Mrs. ***** latest email with my response for the visit time. I let her know I had paid what I owed, but I was not going to provide payment for the initial visit as I know that I am being over billed for it. I told her I have my own records showing the time in which the visit should have ended, and that the correct code should be ***** if we follow the correct timeline. I also sent a picture with the credit card receipt and a payment receipt I wrote which the secretary signed. After this email was sent on Thursday, I have not received a response from her, and then on Friday she replies to this complaint (after almost two weeks of being received) and makes it seem like I am being unreasonable and that I filed this complaint even thought she has given me answers. 

  
  I will continue to fight this charge, and I will have proof to discredit it, even if she sends me to collections. I would have paid what it is owed if the charge would have been honest, and I also refuse to accept that after sending out 3 bills, she "realizes" her error on the discounts and charged me more. She says I have questioned every aspect of this bill as anyone would when they receive a bill for over $900, and having almost $600 be from an hour and half of total visit time. Not only that, but she intentionally makes impossible to be reached directly with questions about the bill, causing this whole process to be way longer than it should. 
  
  Sincerely,
  
  *****************************

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