Boston IVF, Inc.

As requested, attached you will find the consumer's signed "Understanding Your Insurance Benefits" waiver.

Revdex.com:
I have reviewed the response submitted by the business and have determined that the response does not satisfy or resolve my issues and/or concerns in reference to complaint # [redacted].  
On October 27, 2016, I had an appointment for (Saline) Sonohysterogram which was supposed to be performed by Dr. [redacted] in Boston IVF at [redacted] 02180. {Definition of (Saline) Sonohysterogram is a simple outpatient ultrasound procedure designed to help the doctor look at the endometrial cavity (the inside part of the uterus) and the endometrium (the lining of the endometrial cavity). A thin flexible catheter is inserted through the opening of the cervix, so that the catheter lies within the endometrial cavity. {Source: http:/[redacted]} As soon as I arrived in Dr. [redacted]’s office, Boston-IVF wrongfully demanded of me to make a payment of $600.00 prior to the procedure. I paid with my [redacted] Credit Card and the payment stripe showed “Boston IVF, [redacted] 02180”. But, the payment stripe did not show any detail(s) about what this $600.00 was for (Exhibit 1). They did not provide to me any kind of statement or invoice or ICD-10 code for this wrongful payment of $600.00 collected by Boston-IVF from me (while all other healthcare institutions provide). Yes, I was a self-pay patient since they had rejected my insurance and also they had rejected to get this test in another health institution (BWH) other than Boston-IVF. The Boston IVF’s respond to the Revdex.com is incorrect and fraudlent, in their statement viz: “Office notes and images state that the endometrium and uterus were normal and a large ovarian cyst was seen on the right ovary.” This is an incorrect and false statement since it does not fit with the reality of my gynecological organs’ pathology and morphology. Evidently in this Boston IVF’s note, there is no mention of my left ovary while every woman including myself has two ovaries. It does not fit with the reality with the pathology of my uterus and left ovary. This kind of incorrect and wrongful notes even cannot be considered as a simple Transvaginal Ultrasound Test, which usually cost $50-70.00 and which are always done by a licensed sonographer and read by a Radiologist-Doctor with all the details, metric measurements of all the gynecological organs along with the organ morphology and pathology. Dr. [redacted] is neither a sonographer nor a Radiologist-Doctor.      Sonohysterogram test was never performed. Instead, Dr. [redacted] wanted that I first have myself cleared about gynecological malignancy and do this Sonohysterogram test later. He referred me to Dr. [redacted] at [redacted] Cancer Institute. Even after obtaining the necessary consultation and cancer free clarification from Dr. [redacted] on November 16, 2016, the Sonohysterogram has never been done by Dr. [redacted] and/or any other health care provider from Boston IVF. When I asked for a refund for this non-performed Sonohysterogram test, they did create a false and fraudulent document (Exhibit 2) and mailed it to me as if they had done a Sonohysterogram test. They have failed and refused to make the refund of $600.00 collected from me for Sonohysterogram Test which was never done. As it is evident in this fraudulent document that there is no patient’s name as well as no healthcare provider’s name who typed this document. Moreover this fraudulent document said “normal” results which has no connection with my gynecological history and aspects. Furthermore, the pictures wrongfully showed my adnexal complex cysts as it was measured like uterus thickness. Thus, they failed to provide and prove anything about endometrial cavity which was the main purpose of this said test since they had never performed Sonohysterogram test on me. Eight months later, they fraudulently created “Visit Receipt” dated June 01, 2017 showing that $600.00 charges for “Catheter for Hysterography[i]” on October 27, 2016. (Exhibit 3) {Please take a note that Hysterography is not the same thing as Sonohysterogram} {Definition of Hysterography or Hysterosalpingograph is a medical imaging test to visualize the uterus, cervix, and fallopian tubes. A substance opaque to X-Rays is injected into the uterine wall and x-rays are done. {Sources: [redacted]}The catheter injection is the necessary requirement for both Hysterography and Sonohysterogram but no catheter injection was carried out at all by Dr. [redacted] and/or any healthcare provider from Boston IVF. I am herewith to request, require and demand from the Boston IVF to immediatelly refund $600.00 which was incorrectly and fradulantly collected from me.    
Regards,
[redacted]

When we first called to check the benefits we were not informed that the patient had to enroll in the RRS program.  When we called the second time to verify benefits again we were informed that the patient was responsible for registering with RRS to obtain infertility coverage.  This is...

not a Boston IVF regulated agreement. It is an agreement made between the patient, patients employer and their insurance company.  Boston IVF verifies  the patients insurance coverage as a courtesy it is not a guarantee of payment.  It is the patients responsibility to know her infertility coverage before seeking infertility services.

Please contact [redacted] to set up a payment arrangement.

Our Billing Dept notified us that the insurance company will be in contact with the patient with more specific details. We have attempted to work with the insurance company and finally was able to square things away. The patient will receive 50% off her bill.

Hi [redacted] - firstly, we apologize for the confusion and would like to resolve this ASAP! This is certainly not how we would like our patients to feel. We have removed your account from collections, and it is now at a $100 monthly payment level.

Revdex.com:
I have reviewed the response submitted by the...

business and have determined that the response does not satisfy or resolve my issues and/or concerns in reference to complaint # [redacted]. Please add your rejection comments below. 
[ Still waiting for a phone call/message. I can be reached at [redacted] .]
Regards,
[redacted]

The patient states that we must pay $600 to her or a sonohysterogram on 10/27/16.  Since this patient did not have insurance coverage, she was informed of the cost of the procedure and she chose to proceed. Office notes and images state that the endometrium and uterus were normal and a large...

ovarian cyst was seen on the right ovary.  The patient was instructed to see a GYN oncologist to evaluate this large mass and for clearance to proceed with treatment.  She was not told that the procedure would be repeated. All records were provided to the patient upon her request. The standard fee for this procedure is $600 and the patient was provided with a credit card receipt the day of the procedure.  There is no regulation stating that a physician’s office must provide a receipt with the ICD10 codes on it. A billing receipt was generated when the patient requested on 6/1/17. As the patient stated, she did request a refund which was not granted because the procedure was in fact performed

The patient’s complaint has been reviewed and we have determined that the patient still owes the balance for her services that were rendered on 6/5/16.    The patient’s authorization for service was denied by her insurance, as she did not meet the medical criteria for coverage due to a failed test result which was required for authorization to be approved.  The patient signed an “Understanding Your Insurance Benefits” waiver with Boston IVF on 10/22/2015, which indicates that the patient will be financially responsible for any amount not covered by her insurance company. Since the patient’s insurance will not cover this service, she is financially liable.

Below are notes that were also forwarded to the Board of Registration in Medicine.Please let us know if you have any questions. I am addressing the issues as outlined in Ms. [redacted]’s complaint:   (1)    The standard cost at our practice for an initial consultation without an examination is $395.  A credit card receipt was provided on the day of the consult (as attached).  A billing receipt was provided on 6/1/17 per the patient’s request (attached). To my knowledge, there are no rules or regulations that require a physician’s office to produce a receipt with the ICD10 code on it. All receipts were provide to the patient on the dates the payments were made.   (2)    (a & b) Sonohysterogram was performed on 10/27/16. Attached notes and images state that the endometrium and uterus were normal and a large ovarian cyst was seen on the right ovary. Patient was asked to see GYN oncologist ( Dr [redacted]) to evaluate this large mass and for clearance to proceed with IVF and ovarian stimulation. All these records were provided to the patient and are attached herein. (c)  The standard charge for this procedure is $600 and the patient was provided with a credit card receipt at the time of the appointment (attached). A billing receipt was generated on 6/1/17 at the patient’s request (attached).   (3)  The patient was charged $175 by my Practice Manager as a courtesy, as the standard fee for a follow up consultation is $250. Credit card receipt issued on day of consult and billing receipt generated on 6/1/17 at the patient’s request (receipts attached).   The patient was in my office for over 30 minutes while I explained the IVF treatment process. As you can see by my consult note (attached), the patient was made well aware of the very low chances of success (less than 1/300,000) and I tried to discourage her. She was told that the practice had never had a successful IVF pregnancy with a patient in her age group. She wanted to proceed since she had never tried before. (4)  Total payment of $11,050 made with check and credit card.  Receipt (attached) provided that day stating that the payment was for services of IVF/PGS/CRYO all cycle. The services that were not performed were PGS and CRYO as the patient only had one egg which did not fertilize. A refund request of $5050 was submitted to billing on 5/19/17 (attached). The refund was not processed because the patient initiated a credit card dispute for $6050 (attached).   (5)  (a) All ultrasound reports are reviewed by me.  I have significant expertise in ultrasound and have been doing this since 1975. I have also been American Institute of Ultrasound in Medicine (AIUM) certified. (b) On 4/12/17, nursing informed the patient that her cycle would be cancelled due to lack of response and cystic formation (note attached). The patient would not accept this decision and insisted on speaking with me. I spoke to the patient explaining my decision and at the insistence of the patient, I agreed to monitor her for a few more days.        (c) Outside gel can interfere with egg or sperm survival. All hygienic precautions are taken         during this procedure.   (6)  Instructions were given to the patient by the nurse to inject Ovidrel at 11PM on 4/17/17 (note attached). The patient was told to arrive at Boston IVF at 10AM, not 8AM (note attached).  The egg retrieval was scheduled for 11AM on 4/19/17. The process was started at 11:25AM (checklist attached). The egg retrieval began at 12:10 PM and the patient was in recovery at 12:31 PM (notes attached). The optimum timing for egg retrieval is 36 to 39 hours post trigger (in this case, Ovidrel) and the patient’s procedure was well within those parameters.   (7)  I informed the patient that we retrieved one egg and that the embryologist would place the sperm with the egg. That does not indicate that a fertilized embryo exists.  My nurse also spoke to the patient following the egg retrieval and informed her of the same (note attached). Nursing spoke to the patient on 4/20/17 and informed her that her egg did not fertilize (note attached). I am also attaching the gamete sheet from the embryology lab illustrating that one egg was retrieved and did not fertilize.   (8)  Medical records typically take 2 – 4 weeks to be sent out. The request was records was made on 4/26/17 and records were mailed on 5/12/17, which is 2 ½ weeks after receiving request. The patient requested additional information which was emailed on 5/23/17 and mailed on 6/5/17. HIPAA states that we have 30 days to send out records and we complied within that time frame. HIPAA also states that we can charge a nominal fee for services to procure the records. We did not charge the patient for this undertaking.   (9)  We have no control over the costs of medications and donor sperm. The course of treatment was appropriate for the cycle that the patient was undergoing.   (10) Since the patient initiated a credit card dispute, we provided [redacted] with billing receipts for the services rendered.  We did not release any medical information on this patient.