Advanced Skin Institute, Inc.

We offer medical procedures to our patients depending on their needs. We use the AMA guidelines to bill these procedures to a patients insurance as a courtesy to the patient. We have no control over the guidelines set forth...

or what the procedures are categorized by the AMA or insurance company. The type of procedure referred to in this complaint is an AMA approved procedure where a machine is used to remove and treat certain conditions. The 'water' that was referred to in the complaint is actually not water but treatment solution that is infused into the patients skin for treatment of specific conditions. The names used by the insurance companies are not in our control. Therefore we have already been honest about the whole procedure received. Furthermore, this procedure is a 20 minute not 5 minute procedure. The complaint noted that there was no burning felt and only one cream was applied and compares our treatment to a facial. We did not perform a facial, we performed a medical procedure that a spa is not licensed to perform in order to treat a medical condition. The patient portion that is left over after the insurance pays varies from patient to patient depending on their insurance plan and their benefits. We simply bill a patient for the contracted amount their insurances explanation of benefits instructs us to bill them for. In the case that a patient calls to dispute a bill we scrutinize our chart notes to be sure we bill the procedure properly per guidelines. Like any medical office we go through routine internal and external audits to ensure proper billing procedures are being followed. In most cases, patients don't understand the process or the codes that we have to bill but that doesn't constitute fraud. We have 100% billed the proper codes for this patients visit(s)as required by our insurance contract and the AMA guidelines.

We first saw the patient for his condition on 11-23-12, he then returned for a follow up for the same condition on 5-30-2014. We performed no facial type of treatments of medical grade or otherwise during that interim period. If our goal was to push services onto patients, then surely we would have done so during that 18 month period. When he returned back for treatment in 5-30-14, he inquired about various procedures that can be done to treat his condition(s) and we offered several treatment options. He elected for those treatments and we properly billed his insurance per the medical code guidelines. We also offer cosmetic facials for cosmetic reasons that include multiple products, masks, and massage they are 60 minutes long. Those are for cosmetic reasons and are cash pay. We try to satisfy every patient we take care of and administered appropriate treatments and billed those treatments properly. It is unfortunate that the patient feels that way, as we have done everything according to insurance guidelines.

I am rejecting this response because:
One the first time I went on 11-23-12 was because I had a little chicken pox scar on the LEFT side of my nose and I returned on 5-30-14 but NOT FOR THE SAME CONDITION. I had a little bump in my face, above my nose that was calcium build up, so that's false THAT it was the same procedure, they should check their records better. And now they claim, they never performed no facial types of treatments? When I was there on MAY 30, the dermatologist himself said that they do facials because I had told him that THE SPA in TURLOCK had actually referred me to them but that they would contact my insurance to see if my facials were covered and would get back to me. So I waited for about a week and no one had called me. until I spoke to someone in the office and they told me that yes, my insurance did cover my facials. So for them to bill my insurance as ACNE TREATMENT and CHEMICAL PEEL, two separate procedures, none which I had at all is fraud and they lied to me. They knew right from the beginning that my skin had No noticeable damages and all I was there at their office was for a FACIAL and nothing else and for them to now say now that they have an 1 hour facial on a cash basis, is ridiculous and shows how dishonest these people are and how they change their stories.  Why would anyone chose to pay them $152 with insurance coverage for a 5 to 10 min, so called FACIAL at their office on a cash basis only, when I COULD go to my local spa and pay only 75 dollars for a real facial, hand massage, all included treatment. The FACT is these people lied to me and the Insurance and I AM NOT GOING TO Pay for something I NEVER HAD DONE. THEY have been reported to my insurance for fraudulent activities and for lying to their patients. These are the medical crooks, who lie to their patients and insurance. I am not going to let them get away with them cheating me of my money or that of others...
I  will not be happy until they waive the charges they charged me for something they never performed. I never had ACNE TREATMENT OR CHEMICAL PEEL and that's a fact!!

Review: I been going to a SPA in town and they charge 75 dollars for a FACIAL for an hour treatment and they do an amazing job but since I needed to have something removed by a professional dermatologist, I came here to Advanced Skin Specialties and decided to try out their FACIAL since the dermatologist recommended it and man was I disappointed. I thought them being a skin institute they would be an amazing and professional place but the beautician gave me a 5 minute, sit down facial, where they only applied one type of cream, no burning, just cold cream on the face and skin microdermabrasion with an instrument that uses water. Originally they had told me they would call my insurance to see if they covered it and was happy when they called me my [redacted] did cover the so called facial and that the treatment would be less since my insurance would cover most of it. So I just got my first bill and I notice that I have to pay 152.05 after my insurance paid their share. I call them up and receptionist said sorry that's how it is, it's our National codes we use and we can't do anything about it and I told her they had told me that my insurance would have covered most of it. So I am very disappointed because one they lied to me, two they only do a one, type of treatment that lasts about 5 min and with my insurance share I am paying $152. which is double for what I would pay at a SPA in TURLOCK and they actually do a 1 hour treatment with creams, microdermabrasion, facial massages and only 75 dollars and here at this place, it's 5 min and all for $152, they got to be kidding me. I also called my insurance to report them for fraud because in their bill they have me under two procedures Acne Surgery and Skin Peel Therapy but on the Insurance statement it's under surgical and that's a lie. One I had no surgical procedures, no chemical peel or even had Acne surgery as they billed me for. So apparently they are billing my insurance for surgical procedures I never had and for problems that don't even exist!!Desired Settlement: I want them to be honest and not lie about the code procedures they claim I had. I want to be charged for the actual facial I had and not the skin peel therapy or acne surgery they claim I had. I want to pay only what is fair and not be charged for something I didn't have.

Business

Response:

We offer medical procedures to our patients depending on their needs. We use the AMA guidelines to bill these procedures to a patients insurance as a courtesy to the patient. We have no control over the guidelines set forth or what the procedures are categorized by the AMA or insurance company. The type of procedure referred to in this complaint is an AMA approved procedure where a machine is used to remove and treat certain conditions. The 'water' that was referred to in the complaint is actually not water but treatment solution that is infused into the patients skin for treatment of specific conditions. The names used by the insurance companies are not in our control. Therefore we have already been honest about the whole procedure received. Furthermore, this procedure is a 20 minute not 5 minute procedure. The complaint noted that there was no burning felt and only one cream was applied and compares our treatment to a facial. We did not perform a facial, we performed a medical procedure that a spa is not licensed to perform in order to treat a medical condition. The patient portion that is left over after the insurance pays varies from patient to patient depending on their insurance plan and their benefits. We simply bill a patient for the contracted amount their insurances explanation of benefits instructs us to bill them for. In the case that a patient calls to dispute a bill we scrutinize our chart notes to be sure we bill the procedure properly per guidelines. Like any medical office we go through routine internal and external audits to ensure proper billing procedures are being followed. In most cases, patients don't understand the process or the codes that we have to bill but that doesn't constitute fraud. We have 100% billed the proper codes for this patients visit(s)as required by our insurance contract and the AMA guidelines.

Business

Response:

We first saw the patient for his condition on 11-23-12, he then returned for a follow up for the same condition on 5-30-2014. We performed no facial type of treatments of medical grade or otherwise during that interim period. If our goal was to push services onto patients, then surely we would have done so during that 18 month period. When he returned back for treatment in 5-30-14, he inquired about various procedures that can be done to treat his condition(s) and we offered several treatment options. He elected for those treatments and we properly billed his insurance per the medical code guidelines. We also offer cosmetic facials for cosmetic reasons that include multiple products, masks, and massage they are 60 minutes long. Those are for cosmetic reasons and are cash pay. We try to satisfy every patient we take care of and administered appropriate treatments and billed those treatments properly. It is unfortunate that the patient feels that way, as we have done everything according to insurance guidelines.

Consumer

Response:

I am rejecting this response because:

One the first time I went on 11-23-12 was because I had a little chicken pox scar on the LEFT side of my nose and I returned on 5-30-14 but NOT FOR THE SAME CONDITION. I had a little bump in my face, above my nose that was calcium build up, so that's false THAT it was the same procedure, they should check their records better. And now they claim, they never performed no facial types of treatments? When I was there on MAY 30, the dermatologist himself said that they do facials because I had told him that THE SPA in TURLOCK had actually referred me to them but that they would contact my insurance to see if my facials were covered and would get back to me. So I waited for about a week and no one had called me. until I spoke to someone in the office and they told me that yes, my insurance did cover my facials. So for them to bill my insurance as ACNE TREATMENT and CHEMICAL PEEL, two separate procedures, none which I had at all is fraud and they lied to me. They knew right from the beginning that my skin had No noticeable damages and all I was there at their office was for a FACIAL and nothing else and for them to now say now that they have an 1 hour facial on a cash basis, is ridiculous and shows how dishonest these people are and how they change their stories. Why would anyone chose to pay them $152 with insurance coverage for a 5 to 10 min, so called FACIAL at their office on a cash basis only, when I COULD go to my local spa and pay only 75 dollars for a real facial, hand massage, all included treatment. The FACT is these people lied to me and the Insurance and I AM NOT GOING TO Pay for something I NEVER HAD DONE. THEY have been reported to my insurance for fraudulent activities and for lying to their patients. These are the medical crooks, who lie to their patients and insurance. I am not going to let them get away with them cheating me of my money or that of others...

I will not be happy until they waive the charges they charged me for something they never performed. I never had ACNE TREATMENT OR CHEMICAL PEEL and that's a fact!!