Advanced Pain Management, S.C.

Review: I started visits at Advanced Pain Management in Appleton on 2-5-15. On my second visit it was suggested that I have epidural spine injection performed. Before leaving the office on that day, I scheduled my appointment. I received a full size sheet of paper with the words Advanced Pain Management at the top. On this piece of paper it states my name, the date and time of procedure along with other information that didn't pertain to me or my procedure. On or about April 11, 2015 I logged into my health insurance website to see if the claim came through for the 4-2-15 procedure. Upon logging in there were 2 claims for that date of service. One was from Pain Centers of Wisconsin and the other for the Doctor himself. Once I clicked on the explanation of benefits I could see what was covered and what was not and also what my portion of the bill was. At this point I discovered that Pain Centers of Wisconsin was considered "out-of-network" for my insurance. When something is billed out-of-network, that has a whole separate deductible. So over the next few weeks, I made some phone calls to my insurance company as well as Advanced Pain Management. My insurance company verified that in deed Pain Centers of Wisconsin was out-of-network and that there was nothing they could do because that is the way it was billed. So again I called Advanced Pain Management to see if they could help me. Not sure who I spoke with, but they told me to ask my insurance company, "Where was the doctor suppose to do the procedure, in my back yard?" At this point, the person said they would look into it for me. I then proceeded to call my insurance company back and ask them the question state above. The women on the other end didn't know what to say. She apologized and said they have to go by the claim that came in. I explained to her that I had no idea that it was going to be billed differently. As when you walk in, you registrar at the same desk and talk to the same people. Again she apologized and said I should call Advanced Pain Management. Over the next several months I tried getting this issue take care of. I was working with [redacted] , who worked in Risk Management of Advanced Pain Management. He told me that I was not the only one this was happening to and that they would be suspending all my billing until further notice. I don't remember the exact dates that I spoke with him over a several month period doing follow up calls with him. On August 18, 2015 was the last call I had with him. I stated to him that I wanted to get this taken care of before it got sent to collections or something. His response was, "Your billing should have been suspended and you shouldn't be receiving any bills." I told him I hadn't received any bills. He then proceeded to tell me, "Don't worry about it." So I left it at that. Then on 3-18-16 I received a phone call from someone at Advanced Pain Management stating that the decisions was not going to be reversed....as I believe those were the words she said. She then went on to say that my billing was being reinstated and she was wanting to set up a payment plan with me. I told her, " I was not setting up a payment plan and I wanted to file a grievance." I then went on to ask her, "How and who do I file with?" She said she would send out a statement and all the information would be on it. Upon receiving this statement, it was mailed to me in an Advanced Pain Management envelope. So I sent this exact information as I am stating here, in a letter, along with a copy of the piece of paper that was given to me with procedure date and time. I also indicated in my letter of grievance and now, that I was given NO indication verbally or on paper that the procedure was going to be performed and/or billed by Pain Centers of Wisconsin. Had I been given this information, I surely would have made sure that it was going to be IN NETWORK. Because of this, I have had to now seek treatment elsewhere, because I couldn't have anymore procedures done, even though it was made clear that I needed further procedures done. I was also told that he was working on getting credentials to practice at a hospital in Appleton. I also indicated in my letter, that I am not sure what the time frame is for filing claims with insurance companies, as I did bring that up with Steve as well. I have high deductibles and high out of pocket expenses and simply can't afford to pay separate ones of "in network" and "out of network". In closing of my grievance letter I stated all I was asking is that they bill it so that is is covered as "IN NETWORK" I also stated I look forward to their response. I mailed my letter dated 3-26-16 on 3-28-16, to the address listed on my Pain Centers of Wisconsin-Appleton billing. On the envelope I put att: Grievance Department. On 4-11-16 I had not heard anything from them. I called the phone number listed on my Pain Centers of Wisconsin-Appleton. I spoke with [redacted] in patient accounts. She said it didn't look like they received my letter but would check into it and give me a call back. On 4-21-16 I called again and spoke with [redacted]. She indicated that she sent an email to [redacted] in compliance on 4-15-16 to see if my grievance was received. [redacted] indicated that [redacted] had not responded to her email and that she was re sending the email as we spoke. I also at this point asked for a phone number for [redacted]. On 4-28-16 I called and left a message with [redacted]. I waited most of the day and did not hear back. I proceeded to call again and spoke with [redacted]. I told her that I left a voice message for [redacted] and she had not returned my phone call. [redacted] stated I should wait for [redacted] to return my phone call. [redacted] also indicated she believed that [redacted] had not received my letter and that [redacted] sent an email on 4-27-16 to [redacted]. I called again today 5-4-16 and left another message on [redacted] voice mail. As of now, she has not returned my phone call. On my message I indicated that I was calling about my grievance letter, that I left a message last week, was doing another follow up. I also indicated that I did not want to resend my letter through the mail and asked if there was an email address I could send it to? I also left my name and phone number if she could please return my call.Desired Settlement: I am asking that this be billed so that it is covered as IN NETWORK.

Business

Response:

After a thorough review and complete audit of the account we agree that there was confusion regarding the place of service for the procedure presented to the patient. Due to the confusion regarding this encounter a onetime full refund will be granted to this account and all applicable payers will be contacted. We sincerely apologize for the misunderstanding caused during this encounter and the time spent by this patient in attempting resolution.

Consumer

Response:

[A default letter is provided here which indicates your acceptance of the business's response. If you wish, you may update it before sending it.]

I did call the the phone number listed on my statement today 5-12-16, to make sure that there was no balance. Upon using the automated system, as they were not open at the time of my call. I had to enter my account number, and date of birth. The automated system stated that there was no outstanding balance at this time. I just hope in the future down the road, that I don't receive a bill or something from a collection agency stating I owe this money. I have reviewed the response made by the business in reference to complaint ID [redacted], and find that this resolution is satisfactory to me.

Regards,

I am a patient of APM in [redacted], WI for less than six months. I felt comfortable with my first doctor last fall. He was willing to think outside of the box. He has since left APM. So I was given a new doctor who I first met yesterday. He spent less than fifteen minutes with me. He kept interrupting me, contradicting himself and was down right rude. He gave me a rx to see physical therapy and said he was going to make a referral to my neurologist. Been there done that. He never asked if I did yoga and other stretching exercises given to me by my physical therapist & chiropractor, which I do almost daily. He Kept pushing Cymbalta, which caused my seizure in the first place. He then proceeded to inform me that he was taking away one half of my current pain management, fentanyl patches. I have been treated for pain since 1997. Since he wouldn't listen to me or the reason why, I am only allowed 4 pills a day which was my original dose in 1997. He should ask more questions. Then the RNs...just rude. I was herded, unceremoniously, out the door by a receptionist on all visits. So no chance to tell the RN or doctor about anything because they were no where to be found. We played phone tag for three weeks before I received a call. I'm afraid of to call them today as I'm afraid of retaliation or be labeled a drug head. I'm afraid to switch pain clinics as this might appear as drug seeking. My two hour ride home was spent crying. Now, apparently, I've been marked as a drug head. Ashamed, humiliated and hopeless is how I feel today as I did in 1997 before a doctor took the time to listen and searched until he found out what was wrong with me. I was finally told "It's not just in your head" as I was told by a other doctors. Now eighteen years later to be, basically told, "It's in your head" is truly disheartening. Avoid [redacted], better yet the whole office.

Review: On January 16, 2015 I was scheduled for an outpatient surgical procedure through Advanced Pain Management at [redacted]. Because my health insurance had changed from employer based to COBRA coverage (same insurance company, same plan, same policy) my coverage wasn't up to date in the system. I was told that in order to have the procedure I would need to pay up front in full. I paid $5602.90 by credit card, under the mistaken belief that within a few weeks my insurance coverage would show as retroactively being in effect (which did happen) and I would be reimbursed my payment (this has not happened). Within a month my insurance company had my coverage information corrected and confirmed that coverage had been in effect without any lapses through the time period when both procedures were done.

During this time I was in contact with the billing office at Advanced Pain Management and was told that the claims were being submitted to my insurance company. Once the claims were processed I was assured that I would be reimbursed for my out of pocket payment. In March some of the claims were denied because the procedures were not considered appropriate and the EOB stated that as the patient my responsibility was $0 (Advanced Pain Management is an in-network provider). After repeated calls to Advanced Pain Management (I was told that they would 'look into it' or that 'the claims were being resubmitted') I was informed that my payment to APM was for a similar procedure on December 19, 2014 that had also been denied for lack of coverage. I asked that the claims be resubmitted since my coverage was in effect. Not once did I receive a return phone call from APM's billing department although I was repeatedly told that my case was being expedited and that I would hear back from someone shortly.

Over the next 6 months I continued to call APM about once a month while tracking the claims online. Several were denied for filing past the time limit or for the provider not submitting necessary information. I repeatedly asked APM to refund my payment since, as an in network provider APM couldn't bill or collect money from me for charges that were denied by the insurance company. Again, no resolution, no response. By August 17th all charges had been processed (and paid) by United Healthcare, yet I was still not able to get an answer from APM on when I would be reimbursed for my out of pocket payment.

Finally, on September 3rd I again called the billing department and was told that one claim was being appealed, a facility charge for Wisconsin Health Center, not Advanced Pain Management (physician's services) although both are handled through Advanced Pain Management's billing service. I asked why I couldn't be reimbursed since it was clear that I had insurance coverage. I was told that this was 'policy'. I asked to speak to a supervisor and was connected with [redacted]. I explained that if APM had known that my insurance was in effect at the time of the procedure I would never have had to pay in full, out of pocket. Mr. [redacted] responded that their policy is that until a claim is fully processed they do not issue refunds. He stated that this is because if they issue a refund and later determine that an amount is owed by the patient they would then have to collect on the money they had reimbursed. I pointed out that standard practice for patients with insurance is that services are rendered, the claim is processed and only then, if there is a balance due, the patient is billed. Mr. [redacted] was sympathetic but stated that this was their policy. I asked if there was someone higher up who might have the authority to waive 'policy', or if it would be necessary for me to take action through other channels such as the insurance commissioner or the Revdex.com. Mr. [redacted] put me on a lengthy hold and then informed me that my case was going to be reviewed the next day. He gave me his email address so that I could send him my email address as he would be away from his desk most of the day but would be in contact by email and would either call or email me by the end of the day on Friday.

Late Friday afternoon Mr. [redacted] left me a message stating that the issue had not been resolved but that he would get back to me by 10 am on Tuesday, September 8th. I did not hear back from Mr. [redacted] on Tuesday so left him a message on Wednesday morning asking for a response by noon. Mr. [redacted] called me at 3:40 pm to inform me that the person he had asked to review my case had determined that policy was to be upheld. However Mr. [redacted] was going to talk to another person to see if they could authorize a refund. I have heard nothing from Mr. [redacted] or anyone from [redacted] or from Advance Pain Management.

At this point I feel I have given APM/[redacted] more than ample time and leeway. My case has dragged on because of their failure to a) file the claim within United Healthcare's time limits; and b) to provide necessary documentation as requested by United Healthcare. APM has had an interest free loan from me for almost 8 months and I am experiencing fi[redacted]al struggles as a result. I do not have an extra $5600 to spare, nor do I believe that APM has the authority to hold onto my payment after they confirmed that my health insurance was in effect at the time of service.

The policy of holding off on issuing refunds until all appeals have been exhausted seems unfair and biased. Patients with insurance in effect are not required to make a full payment before receiving services. I have been a patient of APM for over 8 years and have an excellent credit record with them.Desired Settlement: Please help me to get reimbursed promptly for the overpayment (less any copayments that may be due (with interest would be great but I'm doubtful that I'd have any luck with that request). Any action that can be taken to ensure that Advanced Pain Management and their affiliates to not repeat this process of withholding patient refunds would also be greatly appreciated.

Business

Response:

Revdex.com Case # [redacted]

replyAdvanced Pain Management has done a thorough review of all

the issues Ms. [redacted] raises. First I would like to apologize for all the

calls and communication problems Ms. [redacted] encountered; that is not how APM

wishes our patients to be treated. APM has reprocessed all claims and have adjusted all the

accounts mentioned in the complaint. After receiving confirmation from the

numerous carriers and their representatives, which took an inordinate amount of

time, APM has processed the refund of $5,247.10. This was the refund amount

left after all the co-pays and co-insurance obligations, according to the

insurance carrier’s contracts, were met.This check was sent to Ms. [redacted] the week of October 12,

2015. Please accept APM’s deepest apologies for this problem.

Consumer

Response:

I have reviewed the response made by the business in reference to complaint ID [redacted], and have received a refund check from APM. I appreciate their apology and acknowledgment of the communication problems. I hope that management at APM will review their policies regarding refund of patient overpayments so that in the future other patients do not have the same negative experience of a 9+ month delay in processing and issuing refunds. In situations such as mine, where there was no question of insurance coverage and where APM was solely responsible for delays in timely claims filing, the patient should not be penalized for APM's error. Refunds should be issued promptly when it is determined that payment was collected for covered services and insurance coverage was fully in force.Thank you for your assistance in resolving my complaint.

Regards,

Review: I am writing this for the due to the run around I have encountered from this facility to obtain an itemized bill for a procedure that was completed. I was charged close to $10,000 for a test injection, which is divided out as 3,907.00 as dr. fees, and 6,087.00 in facility fees. These fees are outrageous I did not receive an IV for medications or anesthesia for this injection. I had also requested an MRI before treatment but was informed that it was not warranted. I have insurance which does protect me from this high billing, but I feel that they are taking advantage of insurance companies with their billing and if I was not covered by insurance there is no way I could afford this bill. I would still like an itemized bill from this facility, but I don't know where else to contact they only provided be with CPC codes which mean nothing to me. I was treated by another facility after an MRI, for a fraction of what Advanced Pain Management charged for a test injection. I will not refer or recommend Advanced pain management to anyone. My Cortisone injection into the same area that from the other facility totaled 1,062.00 and it was also completed in a surgical suite and I can't understand the monetary difference.Desired Settlement: My insurance company refunded some of the money billed if able.

Business

Response:

APM’s billing system processes procedures in a bundled form in

agreement with contracted health insurance payors. We have provided Ms. [redacted]

a statement showing the bundled charges which offers more detail regarding her

dates of service. Ms. [redacted] is welcome to contact our billing department for

any additional issues. This contact information is provided on the statement

sent to Ms. [redacted].

Services were fine. Scheduling difficult-had to provide ALL insurance info before they would even schedule appt. Their policy is to obtain urine sample BEFORE you even get put into exam room (insulting for those of us who are NOT, and never even been, suspected of abuse). Cash co-pay was not applied to statement until I contacted billing with receipt info. Total charged for visit was astronomical!!

It was one of the most negative experiences I have had. First he had an opinion and pre conceived notion of me before he even met me. I had been to 6 doctors and was hoping that being at a pain management I would be able to get on the correct pain meds and reduce some of the meds I was on. I have been struggling with these issues for years now tried, chiropractor, physical therapy, braces, and many different anti inflammatories. I also do yoga that helps sometimes. However as I was telling [redacted] this he didn't want to hear it I know what I've tried. He kept trying change my muscle relaxer and I told him that actually doesn't help any of my pain unless mu upper back hurts from lifting to much. I have fibromyalgia which I feel like he had no clue how painful that can be and he called me an addict because 10 years ago I had an issue with a completely different issue. And what I'm going through now is pain and suffering nothing like before how do you compare 2 different pieces of my life especially when you don't even know me at all. I also have a moderate to moderately severe annular disc bulging at all 5 lumbar disc spaces and facet arthropathy at l5-s1 and l3-4 small facet effusions and much more. He made me feel like I was fine. He had me walk back and forth bend Bach and forth which hurt but he didn't ask that. I am in constant pain and he didn't bother to listen or show understanding. I started crying because I'm so tired of being treated like all I want is meds when all I want is pain relief and less meds. He put the kleenexs on the desk and left the room and our appointment was technically not even over nothing was figured out. He send his nurse back in with a pamphlet for the brace and I was like I have tried that before and it didn't do crap. And a referral for a pain psychologist that's nice but are they going to give me pain relief ugh. He just left before our appointment should have been worked through. I showed him the list of all the medications on the paper and said I haven't tried 95percent of these. We could have reduced and changed up meds to try something new to see if it worked. Talk about neglect and not understanding.

Review: we have been attempting to collect $300.00 from MAPS for incorrect billing for the last 24+ months! We have received one (1) reply (11 months ago) to let us know that they are "working on it". I have left at least 5 phone messages for "Alicia" with no return calls. (I just called her number and it states that she will be back Nov 14th, go figure that out). I have emailed "Jen K." 3 times with no response. It seems impossible to to get any kind of resolution to this problem. We have been very patient throughout this ordeal but now am frustrated. This all transpired around the time that APM purchased MAPS. The procedures were billed as "Ambulatory services" when all the previous billings were all processed as "Physicians Services".Desired Settlement: We would like our $300.00 returned to us.

Business

Response:

We apologize for the extreme length of time this whole audit took. MAPS billing did an in-depth review of all 6 claims, the result of that investigative audit revealed that UCare claims were not processed accurately according to the terms of the UCare contact with MAPS. MAPS billing contacted UCare explained the errors that were found and requested that all 6 claims be reprocessed as they were not done consistently. U Care verified that the patient benefits had changed in 2014 but refused to reprocess the claims. If they would have reprocessed the claims the patient would have been responsible for those other three $100.00 co-pay amounts, per the contract with UCare, because they refused the patient has a zero balance, as the co-pays were never collected no refund is due. UCare also said it was contacting the patient to explain their error. In regard to the employees mentioned in the complaint, neither employee is now employed by MAPS and we apologize for the confusion and dropped calls.

Consumer

Response:

[A default letter is provided here which indicates your acceptance of the business's response. If you wish, you may update it before sending it.]

I have reviewed the response made by the business in reference to complaint ID [redacted], and find that this resolution is satisfactory to me.

Regards,

[redacted] I have no other choice other than to accept. MAPS put the blame on U-Care and U-Care puts the blame on MAPS! (Just can't win sometimes) Thank you to Wisconsin Revdex.com for their help in this matter.