Advanced Pain Management, S.C.

I have had two different providers with APM and am completely dissatisfied. The first provider was running in and out of my initial appointment to handle things unrelated to my case and spent less than a total of 10, very interrupted minutes with me. Immediately, he wanted to put me on a higher schedule narcotic instead of simply increasing the low dosage of the safer one I was already on. The medication was working, just not in the frequency I was currently prescribed. When I didn't want to switch to oxy, he simply told me to stick to talking the prescribed dose of what I was on when I came in, then yanked me off of my muscle relaxer with no explanation or replacement! Several appointments later, he recommended a medial branch block. This requires 2 test procedures to be sure it will help. The first test was a near perfect success. During the second procedure, a different medication was injected at different sites than the 1st and failed completely. Despite the major difference in the 2 tests, the doctor decided this treatment was not going to work for me. He also changed my pain meds to something I couldn't take & I would have known which questions to ask to make sure I could take them had he not rushed the decision on me while I was still coming out of sedation (I have anxiety disorder and also cannot swallow pills, facts I had reminded the doctor of several times. The med was not to be prescribed to those with anxiety & they were large pills that must be swallowed whole quickly). I typically saw his female NP, who was wonderful & spoke to the doctor about trying the medial branch block testing again a few months later when I realized I needed to do more than rely on meds when trigger point injections failed (I did trigger point injections twice with that office. The first time made the pain worse. I reported this & was promised a different injection would be used next time, especially since I had successful injections with a previous doctor. The doctor used the same injection the next time because he forgot, I found out after the fact). I saw the male NP one time only & was warned by the nurse beforehand that this NP was difficult for patients to deal with (really???). When I scheduled my next appointment, the scheduling staff was very understanding when I said I did not want to see him again and they did never offer me another appointment with the male NP. On the advice of my gp at the time, I ended up switching off this doctor's service before attempting the medial branch block tests again.
When I was ready to give APM another try, I began seeing a NP instead of a doctor because of location. From the first appointment, while she seemed very sweet, she was very unprofessional, going on about how I needed to earn her trust and then causing issues with the advocate I decided to bring with me to my second appointment. This is someone I trust to bring with me to most doctor appointments and ER visits, but would not go to this doctor with me again. This provider openly admits to lack of knowledge of the medications she prescribes and the fact that she prescribes based on what he colleagues do! After giving her info on part of my pain acquired from my physiatrist, she referred me to one of the doctors she works for to receive an injection. Upon arriving, the doctor asked some questions about my pain and concluded that the location of my pain was completely wrong for the injection. He recommended I not receive it, but said that it would give me some relief based on the medication in the injection & how it would spread through my system. I opted to have it (I did have to drive over an hour to get there after all) & he was right, some relief, but not what it would have been if I had the problem in the area the NP set me up for. The waste of time, gas, and procedure appointment costs could have easily been saved by a simple question (where exactly is the pain?) or even just feeling the area! I recently tried to switch from seeing the NP to seeing the doctor she sent me to for the injection and was told that (despite her complete lack of knowledge about medications), she's the one who handles the medications for his practice!! (this was not the first time I asked to see someone else, either the doctor or a different NP he works with, but I was completely blown off back then)
Now, I've been forced to switch off of her service with no help from APM's patient advocate except how to file a formal complaint with the state of WI & will be lucky if I can find a doctor willing to truly treat my pain because it looks like I'm a doctor shopper. If it wasn't for that, I would have walked out during my 2nd appointment and never looked back.

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,

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: 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!!

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.

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.