Boyce & Bynum Pathology Professional Services Reviews (%countItem)
Boyce & Bynum Pathology Professional Services Rating
Address: 200 Portland St, Columbia, Missouri, United States, 65201-2499
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6/5/19 "Encounter ***" with *** (whom I have never met before in my life) up-coding for tissue exam by Pathologist. Showing no applied insurance payment (it gets applied towards your deductible) yet no discounted rate and up-charging at someone's most vulnerable time.
The purpose of this communication is respond to consumer complaint referenced above.
We are in receipt of your letter regarding complaint ID received August 5, 2019.
It is our position that there were no deceptive or incorrect billing practices performed. It is our goal to be transparent in our billing practices and provide the best patient experience. *** physician removed three complex (LEEP) tissue specimens that were submitted to Boyce and Bynum for examination and diagnosis. Boyce and Bynum coding staff followed the coding guidelines to determine if the specimens submitted should be coded as an ***. Using these coding guidelines and the complexity of the case, *** w accurately billed.
Boyce and Bynum billed *** the contractural allowed amount. BCBS claims process approved the billed charges and assigned the approved amount to the patient's deductible.
As a result of our investigation of this complaint we found that *** had previous biopsies earlier in 2019 that were paid and not applied to her deductutible. On behalf of *** we have asked that BCBS re-evaluate this claim and determine if the dedutctable had been met. *** has indicated that this process could take up to 30 days to complete their review.
What may be confusing to *** is the fact that the previous biopsies submitted for examination and diagnosis were removed by her physician using a different method and therefore did not meet complexity criteria and were billed with the less complex cpts ***.
We hope this helps clarify the confusion and resolved this issue for the patient. Should you require any supporting documentation, please contact our office.
Complaint: ***
I am rejecting this response because:
As you say prior biopsies had already been done, in office, by my physician in which case does not make this "complex" but excessive and not ran by me ,the patient before hand, helps prove extra biopsies had been made and not taken into consideration when "complex biopsies" were ordered (Without discussing outrageous charges were going to exist.) Also admitting not giving everything done towards said deductible. Unnecessary charging and upcoding. I DID call regarding this matter in which I was told the coding wasn't up to B&B. I pay my monthly premiums, office copays And for what just to get more outrageous charges and the run around? Patients shouldn't have to pay for miscommunication and mishaps between doctors offices and pathology. Unnecessary tests/lab work was done at what you're trying to justify the patients expense. This is corrupt and unacceptable.
Sincerely
Had blood work done at the lab in Lenexa, Kansas. It was the persons first day at the lab and she was the receptionist as well as the lab draw person. I remember filling out paperwork in regards to insurance and if I was willing to pay if not in network. I also filled out a pink slip of paper right before I had blood draw. I was not informed of being out of network at the time. Most businesses will check and see if you are out of network but not this one. Blood draw was 7/23/2018. Four months later I receive a bill for close to $800.00 dollars. I was out of network and I had to pay for the whole amount. Called my insurance, BC/BS and they tried to help. Ended up getting a 30% discount if I paid the whole bill off. I did, not to my approval. My issue now is that I have tried to get hold of the paperwork I filled out on a clipboard. Called several times and got sent to at least 8 people at the headquarters at Columbia, Mo... I finally asked for the lab in Lenexa, Ks. and talked with a person there. He said I would have to come down to the lab and get paperwork, I went down January 21st and asked to get a copy of my paperwork I had filled out. The person looked very surprised and really didn't know what to say. She said that she wasn't at the lab during July and really couldn't do anything. This is incorrect because she was the person that was there and took my blood. She acted like she was hiding something. I then asked for a blank copy of what a new patient would fill out. She said she couldn't give me anything since it was all computer generated depending on the insurance. She also said any paperwork filled out that day went over to Columbia with the blood in and envelope. I thought legally, I had a right to my paperwork of anything I filled out. I t seems like my paperwork has been lost. My concern is that I could not get a look at my paperwork and see exactly what I did check off. If I did check that I would pay out of network than I totally agree but if I checked that I would not pay if out of network than my rights have been violated. It seems like somewhere in the paperwork trail that mine has been lost. I understand that they have been bought up by Quest and will no longer be in business as of February 8th. The issue of being lied to and given the run-a-round really puts a bad taste in my mouth. From now on I will take a picture of all paperwork I fill out. Hard lesson learned.
Dear Representative of Revdex.com,
We are in receipt of your letter regarding complaint ID. It is our position that there were no deceptive or incorrect billing practices performed. It is our goal to be transparent in our billing practices and provide the best patient experience. While the Bill of Health states it is the patient’s responsibility to know who is in or out of network with their insurance, we do our best to inform patients of network status whenever we can. Unfortunately, we do not always know this information prior to claim submission.
Although we are contracted with *** as an in network provider, the insurer informed us after claims adjudication that this patient’s plan is excluded from our network.
We provided services to the patient on July 23, 2018 and performed multiple tests as requested by the patient’s physician. We filed the claim to the patient’s insurance per the written order by the physician. The patient’s insurance processed the claim as out of network and left 100% of the bill to patient responsibility. Our office contacted the insurance to confirm that the claim had been processed correctly and were told it had been. We worked with the patient and her insurance and provided a 30% discount as is our policy for cash pay or out of network patients. The patient paid her remaining portion and her account has a zero dollar balance.
We believe there was some confusion regarding what the patient believes she signed or filled out. Boyce and Bynum does not have pink forms and during our investigation of this complaint, we contacted the physician's office and they do not have pink forms either, so we are unclear what document the patient is referencing.
Patients arrive at the laboratory with their orders and if fully completed by the physician’s office, no additional information is needed from the patient by Boyce and Bynum. We are enclosing the information provided to us by her physician’s office. Her physician’s office was located in the same building as the lab, and it is possible that the paperwork she filled out was completed at the physician’s office, not at the lab, which is a separate entity.
Complaint: ***
I am rejecting this response because:
Sincerely
Boyce & Bynum is falsely billing for charges that *** indicated were already included in a previous code. After I paid $191.09, per the Boyce & Bynum bill, I compared my bill to the EOB from my insurance. My EOB indicated a $100 charge was already included in a previous code and therefore denied. I contacted Boyce & Bynum to get my $100 back. They said they would send a refund. At no time did they indicate they were resubmitting the charges. In the end, Boyce & Bynum resubmitted the $100 charge and changed the code so I now owed $40 and they refunded $60. I tried contacting their Customer Service department & spoke to a supervisor, but she couldn't give me a direct answer as to why they are billing for charges that are not owed, per insurance, in the first place. I have since received 2 other bills for the same services, as the same blood work was performed on 2 other dates, and they were billed incorrectly with Boyce & Bynum trying to collect for charges that had been denied by ***.
Re Complaint ID
Dear Representative of Revdex.com,
We are in receipt of your letter regarding complaint ID. It is our position that there were no deceptive or incorrect billing practices performed, nor are there any additional monies owed to the patient. It is also our position that is our right to appeal denied claims with the insurance company for payment of services rendered.
On February 15, 2018, we filed a claim to *** for services rendered to the patient. These services were performed at the request of the patient's physician. On March 1, 2018 we received a partial payment from ***. One line item of the claim had been paid leaving $91.09 to the patient's deductible, the other line item had been denied leaving a $100.00 balance.
On May 7, 2018 we received a call from the patient's wife questioning the balance on the account. Our customer service department, seeing the denied item, asked the patient's wife to disregard the statement and sent the claim to our accounts receivable department to be appealed with ***. The patient's wife stated that she had already sent in payment for the full balance of the account. Our customer service representative then flagged this account for a possible refund once the insurance had reprocessed the denied line item.
We appealed the denied claim line item with ***, adding a modifier to indicate the service was separate and distinct from the previously paid line item. *** overturned their decision to deny the $100.00 line item applying $40.00 to the patient's deductible on June 12,2018. This put the total patient responsibility for this claim at $131.09.
We had received payment of $191.09 from the patient. The patients account was forwarded for review for a refund. On June 13, 2018 a refund of $60.00 was mailed to the patient with refund check number 87053. Figure 1 represents the final processing by ***.
On June 19, 2018 we received an email form the patient's wife asking for a status on the refund for the account. We emailed her back letting her know that it was mailed June 14,2018 and should be arriving any day.
On June 21,2018 we received an additional email from the patient's wife stating that she only received $60 and wants the full $100.00 returned to her. We explained that we appealed the $100.00 denied line item with *** and they reversed their denial and approved the line item applying $40 to the patient's deductible, therefore, they were only due $60.00 refund. The patient's wife then wrote back stating that she disagreed with our decision to appeal the denial and wants the additional $40.00 sent to her.
On July 18, 2018 the patient's wife called and spoke with the coordinator of our customer service department. Our Customer Service Coordinator explained the account to the patient's wife and walked through the two separate explanation of benefits the patient should have received from ***. The patient's wife indicated she understood the charges, adjustments, and payments and what was the patient's responsibility. The patient's wife was told that if she ever had any additional questions to not hesitate to call us back.
We hope this helps clarify the confusion and resolves the issue for the patient. Should you require supporting documentation, please contact our office.
***
Revenue Cycle Manager
Complaint: ***
I am rejecting this response because:
1. When the original charges were processed, the $100 line item was denied with code I4. As per the ***, code *** means: 'Payment for this service or supply is denied based on our reimbursement policy. This service was INCLUDED in a service already reported or it is not paid separately. If you used a Network Provider, you don't owe anything.' I have attached a copy of the EOB for reference. *. At no time during this process was I told that the denied charges were being re-submitted. I did not find this out until I received the $60 check and contacted customer service for an explanation.
3. Having the denied charges re-processed only benefits Boyce & Bynum. Where I didn't owe anything before, as referenced on the *** code of the EOB, I now owe an additional $40.
I would like Boyce & Bynum to stand by the original EOB for these & similar charges and refund $40 to me.
Sincerely
We do not dispute the statements in point number one of the complaint response. However, we maintain that it is our right to appeal denied claims with the insurance company for payment of services rendered.
The highlighted portion of the enclosed EOB from ***, originally provided by the patient, clearly indicates our right to appeal *** decision to deny our claims for services rendered. *** agreed with our appeal and reversed the decision to deny payment. Boyce and Bynum Pathology Laboratories is contractually obligated to bill the patient for their portion as assigned by ***.
If the member disagrees with the way the claim was processed, they have the ability to appeal *** decision. Details for appealing claims are listed on the EOB provided to the member.
We performed this testing in good faith, at the request of the patient’s physician, with the understanding that we would be paid for our services and that the testing was medically necessary for the patient’s condition.
We hope this helps clarify the confusion and resolved this issue for the patient. Should you require any supporting documentation, please contact our office.
I respectfully disagree with Boyce & Bynum's response, as per the *** original EOB, the $100 charge was included in a service already reported or not paid separately, therefore when Boyce & Bynum re-submitted the claim it was detrimental to me. I request that Boyce & Bynum honor ***'s original processing of claims for all services to date, in calendar year 2018 and I will pay Boyce & Bynum per the original *** EOBs amounts, if still owed.
This is the worst company I have ever dealt with in the medical industry. I wish that they were not connected to my hospital because they for sure make a bad name. I called because the bill I received looked like my insurance wasn't charged. The guy I spoke to said " I don't know about insurance but this is what your EOB says" 1st never received the EOB he said he was sending then I called them back because I had called the office my labs were sent to and gave me information. I was so lucky to talk to him again when I called the main billing office back (not) he said "those people you spoke with don't know about the billing or insurance" my response " I called this number to speak with the insurance and billing people and you said you didn't know so who do I speak with" he continually said I am misunderstanding and was constantly talked down to. I just cannot believe how terrible these people are and how they have an A+ is beyond me. again it is very unfortunate to have people like that work to help people talk about bills. I wasn't even calling to argue I would have paid that with him if he wasn't so rude and unhelpful. I was just making sure insurance was billed before.
Had a test done in Jun 2016 for a cancer tissue exam, same test was ordered by my Dr in Feb 2018. They've took it upon themselves to change what the test were originally for. My Dr's office shows the same test ordered both times. The first test was $67 the second was $271.25 over a 400% increase. Now I have argued with this office who will no longer take my calls. Telling them that my Dr has on file the correct information. They told me I am a liar and have not dealt with this situation correctly. They have the duty to prove the bill they are sending is valid. At this point they cannot prove that it is valid, as they're ordering test that my Dr did not order.
Good Afternoon,
Please find attached our response to complaint ID. Please feel free to contact me with any questions concerning this issue.
Thank you