Apogee Outpatient Surgery Center

I am rejecting this response because: My daughter was months old at the time of surgeryDue to the nature of the surgery it is my understanding that any medical billing department who has any clue what they are doing, know that this child is a CCS Medi-cal patient and will be until her 18th birthdayWhen you run the id (BIC) number from the front of the medi-cal id card and look at the message it gives you, it specifically states CCSWhich means any office visit, testing, procedures or surgeries need a SAR (medi-cal authorization for CCS child)Obviously the POS (point of service) was not ranI was a new mom to a child with a disability who needed surgeryI gave all the information I had at the time of service The date of her surgery was 4/10/not 4/10/ 3.Medi-cal does not take months to process claimsThey will send letters and RAF's asking for specific informationIn this case they would have been asking for the SARSo after months of asking for the SAR they denied the claim for untimely billingDue to information they requested not being provided Of course CCS denied the claim on 4/25/it was a year laterThe point about Healthy Families is mootMy daughters BIC card was given at the TOS had eligibility been ran like it should have been the billing department would have seen that she was a CCS child and a SAR was required For the past 4+ years my daughter has had subsequent office visits and testing with her surgeon and has always been paidThey obviously have a billing department that knows what it is doing Although I applaud the surgery centers effort in trying to put the blame on me, their billing department is to blameI have never received any bills regarding this matterIf I had I would have taken care of this immediately by following up with the surgery center and their billing department

We applaud your efforts and are always interested in responding to any inquiry from your organization in an effort to resolve patient complaintsUnfortunately as much as we would like to address the details of a complaint, we are not legally permitted to discuss any details of patients without a direct release from that patient authorizing us to discuss this matter with youT would presume that your agency may have already had the complainant execute a releaseIf so, please immediately forward that to us and we will provide you our already prepared response

I was so impressed with "everyone" staff, nurses ect. They were all so attentive and kind, great sense of humor kept me upbeat. Love Lori, Julie and all the nurses, surgical team (can't remember all their names) just know you were all great. Thank you for the awesome care.
Gaye

I am rejecting this response because:
 
1. My daughter was 6 months old at the time of surgery. Due to the nature of the surgery it is my understanding that any medical billing department who has any clue what they are doing, know that this child is a CCS Medi-cal patient and will be until her 18th birthday. When you run the id (BIC) number from the front of the medi-cal id card and look at the message it gives you, it specifically states CCS. Which means any office visit, testing, procedures or surgeries need a SAR (medi-cal authorization for CCS child). Obviously the POS (point of service) was not ran. I was a new mom to a child with a disability who needed surgery. I gave all the information I had at the time of service.
2. The date of her surgery was 4/10/2010 not 4/10/2013.
3.Medi-cal does not take 5 months to process claims. They will send letters and RAF's asking for specific information. In this case they would have been asking for the SAR. So after 5 months of asking for the SAR they denied the claim for untimely billing. Due to information they requested not being provided.
4. Of course CCS denied the claim on 4/25/11 it was a year later. The point about Healthy Families is moot. My daughters BIC card was given at the TOS had eligibility been ran like it should have been the billing department would have seen that she was a CCS child and a SAR was required.
5. For the past 4+ years my daughter has had subsequent office visits and testing with her surgeon and has always been paid. They obviously have a billing department that knows what it is doing.
6. Although I applaud the surgery centers effort in trying to put the blame on me, their billing department is to blame. I have never received any bills regarding this matter. If I had I would have taken care of this immediately by following up with the surgery center and their billing department.

We applaud your efforts and are always interested in responding to any inquiry from your organization in an effort to resolve patient complaints. Unfortunately as much as we would like to address the details of a complaint, we are not legally permitted to discuss any...

details of patients without a direct release from that patient authorizing us to discuss this matter with you. T would presume that your agency may have already had the complainant execute a release. If so, please immediately forward that to us and we will provide you our already prepared response.

The customer in question's complaint arises from our decision to refer her account to collection after repeated efforts to collect the invoice were unsuccessful. We do not casually refer patients to collection- the decision to refer to collection was over on (1) year after the service was rendered, we were told by the responsible party that four different agencies would pay and no payment was received. Here is the chronology of events according to her billing record: 
 
           1.  The patient (a minor) had surgery at Apogee Outpatient Surgery Center on April 10, 2013. The patient's mother signed a form agreeing to pay our invoices. We bill insurances as a courtesy to patients, but ultimately they are financially responsible if the their party payor does not pay (which they did not).
 
           2.  On May 13, 2010 the claim was billed to Medi-Cal per the patient registration form and insurance information provided by the responsible party (this proved incorrect and was the first of four conflicting payors provided by responsible party). On October 13, 2010 Medi-Cal denied the claim stating " patient not eligible at time of service".
 
           3.  On October 14, 2010 we received a call from the responsible party now advising us of a different story-- the patient was covered by Healthy Families Blue Cross (this also proved incorrect). On October 14, 2010 we billed Healthy Families Blue Cross.  On November 1, 2010 Healthy Families Blue Cross. On November 1, 2010 Healthy Families Blue Cross denied the claim stating "policy terminated on January 1, 2010."
 
           4. On March 12, 2011 the responsible party now informed us that the patient is covered by CCS (Crippled Children's Society) and she would be faxing over the information. On March 17, 2011 we received the CCS information and sent out a claim. (This also was proved incorrect).
 
           5.  On March 29, 2011 CCS called us to inform us the patient is not covered with CCS but has Healthy Families Blue Shield. This has never been reported to us by the responsible party.
 
            6.  We called Healthy Families Blue Shield and confirmed eligibility and subsequently billed them. On April 25, 2011 we received a denial form Healthy Families Blue Shield stating the charges should be covered through CCS.
 
7.  On April 25, 2011 we billed CCS again which was subsequently denied again by CCS.
 
           8.  After four conflicting reports of a payor, we directly billed the patient and received no payment.
 
           9.  Over one year later, after exhausting all efforts to seek payment from the patients  mother and billing multiple insurance companies we transferred the account to our collection agency.
 
           10.  On September 6, 2013  we were asked by telephone from CCS to re-bill as CCS advised there was a SAR (Service Authorization Request) on file with CCS and the valid dates of treatment where 12/18/09 to 9/30/10. We rebilled CCS with the SAR and valid dates of treatment and again it was denied for timely filing and stated we could not appeal due to the 90 day deadline.
 
           11.  On May 22, 2014 a person identifying themselves as DHCS-CMS called and stated she was going to put the claim in process even with the date being so old. We resubmitted the claim to [redacted] at DHCS-CMS.
 
To date we are still waiting to receive payment. It has been over four years since the service was rendered. The decision to refer to collection an unpaid account is never casually made, but we believe under the circumstances it was indicated. This response has been prepared only after receiving a patient release form authorizing us to address this matter.

Review: To whom it may concern, My daughter [redacted] had a procedure done with the Apogee Surgery Center on 4-16-2010. My daughter's insurance is thru California Children Services (CCS) due to her being born Hard Of Hearing. She had to have bilateral tubes placed in each ear. I had an approved authorization called a SAR thru CCS to proceed with the surgery. The surgery center failed to bill correctly and I was unaware of the billing problem. They called me over a year later asking me to fax the SAR again to them and I did. I never heard about the issue again until March of 2013 when I received a court order for a wag garnishment and at that point in time I contacted the Apogee Surgery Center and proceeded to find out that they failed to bill correctly. I asked them please resolve this matter promptly. It has taken them over a year to finally submit the correct information to the insurance company. I have made MANY MANY phone calls to the surgery center in the course of the year. This whole time thru their neglect to resolve this matter this wage garnishment has put me and my family thru extreme stress. I still currently have the wage garnishment going on now. I appreciate your help. Thank You, stephanie alexander.Desired Settlement: I expect to receive a full refund from the surgery center plus interest that I have paid. I would hope that the surgery center will take this matter seriously, to give me a proper apology for putting my family thru this stress and to take priority in resolving this and that they would have better billing practices so another person doesn't go thru the same stress that I have had.

Business

Response:

We applaud your efforts and are always interested in responding to any inquiry from your organization in an effort to resolve patient complaints. Unfortunately as much as we would like to address the details of a complaint, we are not legally permitted to discuss any details of patients without a direct release from that patient authorizing us to discuss this matter with you. T would presume that your agency may have already had the complainant execute a release. If so, please immediately forward that to us and we will provide you our already prepared response.

Business

Response:

The customer in question's complaint arises from our decision to refer her account to collection after repeated efforts to collect the invoice were unsuccessful. We do not casually refer patients to collection- the decision to refer to collection was over on (1) year after the service was rendered, we were told by the responsible party that four different agencies would pay and no payment was received. Here is the chronology of events according to her billing record: