California Emergency Physicians

December 15, [redacted] 11pt;">Re: Account [redacted] Location San Mateo Medical Center - Emergency Department Service Date August 27, Dear Ms [redacted] : As billing agent for California Emergency Physician’s America, I am writing in response to the letter(s) received concerning your bill for services Our office takes your concern seriously and requested the physician group’s Medical Director to review the encounter informationBased on his response to our office, the charges are accurate for the service provided and care was deemed appropriate and within accepted standards of practiceIn addition, we have confirmed that the facility’s Review Board has met and reviewed your caseThey concur with our decision If you wish to review the medical record, please contact the hospital’s medical record department Please remit payment within the next days or contact our office at [redacted] if you have any questions or to see if you qualify for a Hardship ReductionYou may mail in your payment with a copy of this letter or log in to our payment portal at [redacted] to use your credit card to remit payment Sincerely, [redacted] RHIT MBSI- Assistant Compliance Manager

I am rejecting this response because: First I prefer that this response from CEP be sent to my home address in hard copy because I do not have a computer This is my cell phone Second, [redacted] has already stated several times that this bill has been paid in full therefore I disputethe validity of this bill I do not owe this bill, [redacted] ***

[redacted] would have a patient account for the facility fees associated with a visit in their facility However, the professional fees provided by CEP America in the emergency department and any other independent contractors such as the a radiologist, pathologist, anesthesiologist, etcare not included in those fees and must bill independently The billing from CEP America LLC is for the professional services which would include a physician, Advanced Nurse Practitioner, and/or Physician's Assistant The patient/guarantor should refer to the Conditions of Admission Treatment form that she signed at the time of service that provides this information (Item #2) She can obtain a copy of this form, if necessary, through the medical records department at [redacted] ***

The patient has three accounts with the same account balanceWhen payment was submitted without an account number attached, it was applied to one account, leading to a credit balanceThe other accounts still showed outstanding balances, for which the patient was sent statementsWe have since issued refunds to the patient's credit card for the overages on the first accountHowever, outstanding charges remain on the other two accountsWe have reached out to the patient by phone and have left a direct call back number to discuss the account balances/ credit balances with herAs of 1/19/16, she has not returned our call

Visited an emergency room in Mountain View for a skiing accident involving my wrist and wanted to check that it wasn't broken
Waited in the emergency room for about hoursHad a minute conversation with a doctor and x-raysLeft with an arm splint
Was billed the following:
$- Level Emergency
See https://apps.para-hcfs.com/pde/documents/PARA_EmergencyDepartmentChargeProcess_N...⇄ is defined as the following:
"Emergency department visit for the evaluation and management of a
patient, which requires these key components: A detailed history; A detailed
examination; and Medical decision making of moderate complexityCounseling
and/or coordination of care with other providers or agencies are provided
consistent with the nature of the problem(s) and the patient's and/or family's
needsUsually, the presenting problem(s) are of high severity, and require
urgent evaluation by the physician"
Hardly a hour wait, minute conversation, and an arm splint
Short Arm Splint: $
You can buy the same thing on Amazon for $If I had known I'd be charged $132, I would have refused itCompletely unreasonable charge
https://www.amazon.com/Mueller-Fitted-Right-Wrist-medium/dp/B002NLGNW
They also charged $for X-RAY INTERP; WRIST and another $for X-RAY INTERP FOREARM, but my insurance company had the good sense to refuse these charges since I had already been billed separately by Silicon Valley Diagnostic Imaging
Several months later they then send another bill to my insurance company for $255, coded as "Emergency Service", which my insurance company fortunately also had the good sense to deny:
"SERVICE IS DENIED BECAUSE IT IS INCIDENTAL BASED ON THE NATIONAL CORRECT CODING INITIATIVE (NCCI) AS PUBLISHED/MAINTAINED BY CMS (CENTER OF MEDICAID/MEDICARE SERVICES) PARTICIPATING PROVIDERS ARE PROHIBITED BY CONTRACT FROM BALANCE BILLING THE MEMBER
FOR THIS CHARGE."
In other words, CEP attempted to BALANCE BILL - this is an illegal practice by a preferred provider, which this hospital was considered under my insurance plan:
https://www.healthcare.gov/glossary/balance-billing/
I submitted an appeal for the charges above and have yet to hear anything from CEPInstead they simply sent me the same bill againBilling department is difficult to get ahold of and you are on hold for hours, and then just randomly hangs up
If someone from CEP is reading this review, please feel free to reach out to discuss my billing disputeThank you

Hello, Our response is as follows: We attempted to bill the patient’s insurance, both private and worker’s compensation due to misinformation from the patient as to who should be billedWe attempted to reach him by phone and mail numerous times before ultimately placing the account in
outside collections last FebruaryHe has since contacted us and updated his contact informationWe have once again confirmed with the patient that it is a work injury and billed his employerAs of 2/5/16, we have yet to receive payment on the account. Kind regards, *** *** ***
*** *** *** *** ***
*** *** *** ***
*** * ***
*** * ***

Both accounts were billed to the Worker's Comp carrier as instructedHowever, the claims were denied by the carrier on each account
We have since contacted the claims adjuster, who has requested we resubmit the claims as they will now be paying
them
Both claims were resubmitted on 9/10/and the accounts have been removed from collections

Revdex.com:
I have reviewed the response made by the business in reference to my concern, and find that this resolution is satisfactory to me

the patient, *** ***, originally paid this claim with a personal credit card. As such, a refund was processed immediately to that card for the amount paid of $295. Processing completed on 5/3/and he transaction ID number for this refund is ***. MrBenas should contact his credit card company to confirm that the refund is processing to his account.We did submit a claim to the carrier on 4/30/18. We then received and processed a request for a copy of the medical record to support the claim, which was completed on 5/14/18. There has been no further contact with the patient

I am rejecting this response because: CEP America has not reimbursed the injured worker the $he paid despite assuring me that they wouldIn response to our request to CEP America to send their report and billing so we could process for payment, they sent us the attached which is a bill for date of service 01/30/in the amount of $There is a billing code but no report attached to explain what the injured worker was seen for and to justify their billingBilling code *** requires the following: Emergency department visit for the evaluation and management of a patient, which requires these key components: An expanded problem focused history; An expanded problem focused examination; and Medical decision making of moderate complexityCounseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needsUsually, the presenting problem(s) are of moderate severity.We are not able to process a payment without a report and substantiation for the billing. I do not believe CEP America is meeting their minimum burden to act as a billing entity for professional services related to emergency room servicesI will be further filing a complaint with *** *** *** *** and this matter is not resolved.Request: CEP America reimburse the injured worker the $he paid in response to harassing mail and repeated telephone callsCEP America submit a report along with their billing substantiating their billing for professional services for payment considerationCEP America be warned that attempting to pursue payment from an injured worker for an admitted industrial injury is against the law pursuant to Labor Code 3751(b): If an employee has filed a claim form pursuant to Section 5401, a provider of medical services shall not, with actual knowledge that a claim is pending, collect money directly from the employee for services to cure or relieve the effects of the injury for which the claim form was filed, unless the medical provider has received written notice that liability for the injury has been rejected by the employer and the medical provider has provided a copy of this notice to the employeeAny medical provider who violates this subdivision shall be liable for three times the amount unlawfully collected, plus reasonable attorney s fees and costs(We advised CEP America as early as February that this was an accepted work comp injury claim and to send us their report and billing for paymentThe injured worker *** *** repeatedly advised CEP America to contact his claims adjuster for further infoAll to no avail)

The purpose of this letter is to respond to the concern filed by Ms*** ***, the claims adjuster for ***, on behalf of Michael *** on April 25, Ms***' concerns are related to emergency services provided to Mr*** on January 30, MedAmerica Billing Services, Inc
(MedAmerica) is the billing agent fot CEP America, d/b/a VituityWe have investigated the issue and respond as follows.:When patients present to the emergency room, EMTALA requires hospitals to provide an examination and needed stabilizing treatment, without consideration of insurance coverage or ability to payIn this instance, Mr***' worker's compenstaion status was not known at the time of treatmentCEP America made several unsuccessful attempts to confirm with *** as well as Mr*** as to the status of his Worjker's Compensation, and did so to ensure that he would not be improperly billedAttempts were made via letter to *** and Mr*** on 2/9/and 2/14/A statement was sent on 3/13/and on 4/10/Mr*** finally called in on 4/19/t provide his insurance; however, it took a couple of days for our internal system to updateOur process for requesting insurance status is automated and we apologize that our automated call was triggered in this caseThe system called Mr*** on 4/24/after Mr*** and Ms***' phone calls to update his workers' compensation statusUnfortunately, the update was not completed before the file was sent to our automatic dialer for callingWe apologize for inconveience or confusion that the follow up call may have triggered.Accoding toour records, Mr*** paid CEP America $for the services*** has since billed as the work comp carrierMr*** will be refunded his payment amount as we anticipate *** will issue payment for these professional fee services.The facility charge is separate than our professional services feeCEP America is not responsible for the facility fees; therefore, any amounts requiring refund from Sierra View Medical Center should be obtained directly fom them since CEP America is not the billing agent for facility charges.Should you have any questions, please contact me at *** ***.Sincerely,*** ***
Compliance Manager

*** *** *** *** *** would have a patient account for the facility fees associated with a visit in their facility. However, the professional fees provided by CEP America in the emergency department and any other independent contractors such as the a radiologist, pathologist,
anesthesiologist, etcare not included in those fees and must bill independently. The billing from CEP America LLC is for the professional services which would include a physician, Advanced Nurse Practitioner, and/or Physician's Assistant. The patient/guarantor should refer to the Conditions of Admission Treatment form that she signed at the time of service that provides this information (Item #2). She can obtain a copy of this form, if necessary, through the medical records department at *** *** ***

December 15, 2015   [redacted]   Re:           Account          [redacted]            ...

    Location         San Mateo Medical Center - Emergency Department                 Service Date               August 27, 2015   Dear Ms. [redacted]:                 As billing agent for California Emergency Physician’s America, I am writing in response to the letter(s) received concerning your bill for services.   Our office takes your concern seriously and requested the physician group’s Medical Director to review the encounter information. Based on his response to our office, the charges are accurate for the service provided and care was deemed appropriate and within accepted standards of practice. In addition, we have confirmed that the facility’s Review Board has met and reviewed your case. They concur with our decision.   If you wish to review the medical record, please contact the hospital’s medical record department.   Please remit payment within the next 10 days or contact our office at [redacted] if you have any questions or to see if you qualify for a Hardship Reduction. You may mail in your payment with a copy of this letter or log in to our payment portal at [redacted] to use your credit card to remit payment.   Sincerely, [redacted] RHIT MBSI- Assistant Compliance Manager

Per the patient's request, a statement was sent to his confirmed address. He then paid the total remaining account balance and the account was subsequently removed from outside collections. He now has a zero balance and there is no collection activity.

June 19, 2015   [redacted]
[redacted]
11pt;">  Re:       Account           [redacted]             Location          Rideout Memorial Hospital - Emergency Department             Service Date    January 21, 2015        Dear Ms. [redacted]:         As the billing agent for California Emergency Physicians, I am writing in response to your concern regarding your bill for services. We sent statements to the above address on 2/23/15, 3/23/15, and 4/20/15 with no response from you.   EMTALA (Emergency Medical Treatment and Labor Act) requires hospitals/providers to provide an examination and needed stabilizing treatment, without consideration of insurance coverage or ability to pay, when a patient presents to an emergency room for attention to an emergency medical condition. You received a rapid medical evaluation by Sokkunthair Kem, N.P., under the supervision of Mark Agness, M.D. prior to your decision to leave the emergency room.    The criteria used to determine the evaluation and management level for the professional service is not the same as the criteria used to determine the level for the facility charge. Emergency department services are not based on provider face-to-face time but can include provider orders for labs, imaging, medication, etc. Facility charges are billed separately.    If you wish to review the medical record, please contact the hospital’s medical record department.   Please contact the facility to address your concerns regarding their acceptance of your insurance information. However, you may contact us at 877-498-7157  with the information needed to bill your insurance, to make payment on the account, or to discuss a possible discount.   Sincerely,       [redacted], RHIT MBSI – Assistant Compliance Manager

[redacted] would have a patient account for the facility fees associated with a visit in their facility. ...

However, the professional fees provided by CEP America in the emergency department and any other independent contractors such as the a radiologist, pathologist, anesthesiologist, etc. are not included in those fees and must bill independently.  The billing from CEP America LLC is for the professional services which would include a physician, Advanced Nurse Practitioner, and/or Physician's Assistant.  The patient/guarantor should refer to the Conditions of Admission Treatment form that she signed at the time of service that provides this information (Item #2).  She can obtain a copy of this form, if necessary, through the medical records department at [redacted].

Received a bill from these people for ER services by an MD at [redacted]. Called them immediately upon receipt of invoice to let them know I would be paying my portion of the charges in installments (insurance company already paid their portion) -- experience is that it pays to let them collecting group know stat that you won't be paying the entire balance due, unless of course you can.
The guy on the phone was very polite, agreeable, understanding and accepting of my proposal. He also asked a few questions and said I qualified for a reduction in my share. Of course I was thrilled and appreciative -- never has this been offered. In fact, usually these companies are completely unyielding and unsympathetic.
In short -- I wish every time I have to pay my portion of an MD bill that it be handled by these people! A refreshing change from the norm!

December 15, 2015   [redacted]
[redacted]
[redacted]  
11pt;">Re:           Account          [redacted]                 Location         San Mateo Medical Center - Emergency Department                 Service Date               August 27, 2015   Dear Ms. [redacted]:                 As billing agent for California Emergency Physician’s America, I am writing in response to the letter(s) received concerning your bill for services.   Our office takes your concern seriously and requested the physician group’s Medical Director to review the encounter information. Based on his response to our office, the charges are accurate for the service provided and care was deemed appropriate and within accepted standards of practice. In addition, we have confirmed that the facility’s Review Board has met and reviewed your case. They concur with our decision.   If you wish to review the medical record, please contact the hospital’s medical record department.   Please remit payment within the next 10 days or contact our office at [redacted] if you have any questions or to see if you qualify for a Hardship Reduction. You may mail in your payment with a copy of this letter or log in to our payment portal at [redacted] to use your credit card to remit payment.   Sincerely, [redacted] RHIT MBSI- Assistant Compliance Manager

As per our contract with your insurance carrier, statements are not sent to the patient until the final determination of patient responsibility is received by the carrier. Final determination was made in November, 2014 and a statement was sent on December 1. The statement was subsequently...

returned as undeliverable on December 3. A courtesy call was made on December 4th. However, the phone number on file was disconnected.Although the account was billed and referred to an outside collection agency appropriately, as a courtesy, we have removed the account from Stanislaus Credit Control Service. You may contact us at 800-198-7157 to arrange for payment.

The patient has three accounts with the same account balance. When payment was submitted without an account number attached, it was applied to one account, leading to a credit balance. The other accounts still showed outstanding balances, for which the patient was sent statements. We have since...

issued refunds to the patient's credit card for the overages on the first account. However, outstanding charges remain on the other two accounts. We have reached out to the patient by phone and have left a direct call back number to discuss the account balances/ credit balances with her. As of 1/19/16, she has not returned our call.