Carilion Clinic - Hospital and Professional Billing Services

[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.]
Revdex.com:
I have reviewed the response made by the business in reference to complaint ID [redacted], and find that this resolution would be satisfactory to me.  I will wait until for the business to perform this action and, if it does, will consider this complaint resolved.
Regards,
[redacted]

Mary L[redacted]
General Counsel [redacted]  *  [redacted] January 8, 2016 Experian P.O. Box 4500 Allen, TX 75013 Equifax Credit Information Services, Inc. P.O. Box 740256 Atlanta, GA 30348 TransUnion, LLC Trans Union Consumer...

Relations P.O. Box 2000 Chester, PA 19022re:  Rodeo Ford, Inc. re Joyce [redacted] SSN: 559-80-7596 22199 W Shadow Drive Buckeye, AZ 85326 Request to Remove Credit Inquiry Greetings: I am an assistant to Mary L[redacted], general counsel for the Earnhardt dealerships, including Rodeo Ford, Inc. The legal department has been asked to respond to a concern expressed by [redacted], through the Revdex.com, regarding a claim of an unauthorized credit inquiry by Rodeo Ford on or about September 27, 2015. Ms. [redacted] visited Rodeo Ford with an interest in test driving a Ford F-150. Ms. [redacted] completed a credit application but requested Rodeo Ford not to pull her credit. However, as a result of either a clerical oversight or miscommunication, Rodeo Ford's investigation of Ms. G[redacted] concern as expressed to the Revdex.com on January 2nd, revealed that Rodeo Ford pulled Ms. G[redacted] credit. Rodeo Ford respectfully requests your assistance in removing its September 27lh inquiry from Ms. G[redacted] credit report. Please call if there are any further questions Very truly yours,Mary/Lou C[redacted]Legal Department /mlc   Experian Equifax TransUnion January 8, 2016Page 2 [redacted]
Drive   Revdex.com, Case No. [redacted] 4428 N. 12th Street Phoenix, AZ 85014

[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.]
Revdex.com:
I have reviewed the response made by the business in reference to complaint ID [redacted], and find that this resolution would be satisfactory to me.  I will wait until for the business to perform this action and, if it does, will consider this complaint resolved.
[redacted]

The general manager and service manager of the dealership have resolved this matter with Mr. Lay.   Mary LaRue [redacted]/General Counsel

Review: I went to the emergency room on 5/28/2015. I have two insurances, and I had already done a coordination of benefits stating who was my primary insurance and who was secondary. I received an explanation of benefits in the mail from my primary insurance company on 9/30/2015 stating that they were not covering any portion of the bill, but there was an agreement with the hospital that resulted in a discount. I then received a bill in the mail from the hospital without the discount. I called the company to inform them, and they said they would take care of it in the billing department and that I would get a bill in the mail with a discounted bill. They also instructed me to fill out a coordination of benefits form. I informed them I had already done this, but that I would call my insurances to verify I had done it correctly. I called both insurance companies both of whom said I had done everything correctly. The secondary insurance company informed me they had denied my claim because Carilion had failed to submit the bill to the correct insurance first multiple times. This insurance company then talked to Carilion directly, and they stated they had never received communication from my primary insurance company which was untrue as I had the explanation of benefits from them. The insurance then told me to submit the explanation of benefits I had received from my primary company to them directly and they would take care of it. I then received an explanation of benefits from my secondary insurance on 4/7/16 stating they would cover X amount of my bill and that I was responsible for Y. I then received a bill in the mail from Carilion with the statement dated 4/18/16 for the full bill amount, no discount as stated by the primary company and no coverage as stated by the secondary insurance. I called Carilion again, and they stated both companies had denied my claim or they had not received any notice from the companies. I told them this was untrue as I had both explanation of benefits from both companies. I was instructed to call the insurance companies yet again. I talked with them, and they again got on the phone a second time with Carilion. The insurance company assured me everything was being fixed and that my account was on hold for 30 days. I then called Carilion back again and was told that "the billing department" was making the adjustment but she could not tell me what the adjustment would be. I told them I would be following up several times to ensure this was done correctly as Carilion had made so many mistakes.

Throughout this process, not only was I continually harassed and billed incorrectly by Carilion, I was also treated very rudely by the customer service representatives. I was given bad information each time I called and told something would be done, however each time I called back I had to start my tale from the beginning with no resolution. I was also forced to spend hours on the phone not only with Carilion, but also with my two insurance companies. I was informed by Carilion incorrectly that they would not reach out to my insurance company. I was also told incorrectly that it was my fault because I had not filled out a coordination of benefits. It is also important to note that throughout this process I was at different facilities with two insurances and had no trouble from those healthcare facilities as to which insurance was primary and which was secondary.Desired Settlement: I desire my bill to be adjusted to the correct amount, and that this not go to collections or affect my credit in any way for the multitude of mistakes made by the Carilion billing department.

Business

Response:

Thank you for contacting the Revdex.com about your recent Carilion Clinic bill. While we are always discouraged to hear that we have failed to meet patient or family expectations, we are appreciative of the fact that we have been given the opportunity to evaluate and understand the issues to see if there are improvements necessary for the future to avoid such concerns.

At the patient’s request, the account has been reviewed with the insurance several times to see why the claim in question hasn’t been paid. Our research has shown a Coordination of Benefits (COB) update was necessary on several occasions. Our first contact on 9/2/15 indicates that insurance required a COB, and that the insurance company mailed one to the patient 6/24/15 and 7/9/15 with no response. After that conversation with the insurance company on 9/2/15, we mailed the patient a COB letter. We have had several other denials for the same reason on 9/29/15, 3/8/16 and 3/14/16.

Based on a call to our Billing Customer Service office on 5/3/16, we checked with the insurance again. They do show record that the patient updated his COB 6/8/15 but were unable to tell us why that information was not updated in order to have them reprocess the claim prior to 4/7/16. The balance has been corrected by posting the contractual adjustment.

Our records indicate that the patient will receive a statement and a final notice prior to this account being transferred to collections and should contact our Billing Customer Service team at the information below to discuss payment options.

We regret that this has been a frustrating experience for the patient. If we can assist you further, please contact us at [redacted], toll free at [redacted] or by email @ [redacted] We are available M- F 9a-6:00p.

Sincerely,

Manager, Billing Customer Service

Consumer

Response:

I have reviewed the response offer made by the business in reference to complaint ID [redacted], and have determined that this proposed action would not resolve my complaint. For your reference, details of the offer I reviewed appear below.

I completed the coordination of benefits in a timely manner, and I have had no other issues with insurance companies when using any other health care system, only Carilion. Additionally, I was told that Carilion would not contact my insurance company, and I was forced to do so many times to get this corrected. This would have been solved in a timely manner had Carilion simply reached out to my insurance companies. I know for a fact that almost all other hospital systems work with insurance companies, calling them, and I am unsure why Carilion is above this. Additionally, I continually received wrong bills for a full amount with no discount applied for my primary insurance company when I was repeatedly told "the next bill you get will reflect the discount". I am really unsure of why this would happen, and was even told by a Carilion billing department employee that "what I insinuated the company was doing was illegal." Yet I still received bills well after the fact for the uncorrected amount.

Regards,

Business

Response:

Mr. [redacted]:

I am sorry that you continue to experience difficulty with this issue. Our billing department staff have been working with a supervisor at [redacted]. After further review, it appears that [redacted] and [redacted] have both processed as secondary. The supervisor at [redacted] tracked information that was provided by you, indicating that [redacted] is secondary. On 09/02/15 the notes on account stated: “Received call back from pt, ask him to contact [redacted] and give verbal COB information to have claim processed. According to him the [redacted] coverage ended.” You stated that you did not have [redacted] coverage as it had terminated. After eligibility was checked, it was determined that you had active coverage until 06/01/15.

Per the [redacted] supervisor, this is not a Carilion issue. The issue is between you and your insurance company. Our billing department shared that the home plan ([redacted]) states you need to contact them directly along with Revdex.com regarding their response if you feel that is necessary.

I hope that this information is helpful to you in resolving this issue.

Sincerely,

[redacted], RN, BSN, MBA, CPHRM

Director, Patient Advocacy

Tell us why here...

Consumer

Response:

I have reviewed the response offer made by the business in reference to complaint ID [redacted], and have determined that this proposed action would not resolve my complaint. For your reference, details of the offer I reviewed appear below.

The information you provided was not helpful in resolving my complaint. I will give you three very simple reasons as to why I am unsatisfied.1. You failed to address the fact that I was continually billed for the full amount without the discount applied to my bill from my primary insurance company. 2. You failed to explain why I was incorrectly billed by your department despite me having an explanation of benefits from both insurance companies that contradicted that Carilion stated my claims were denied.3. You failed to address why I was incorrectly told that Carilion "could not" reach out to my insurance companies on my behalf despite the fact that I know billing departments hire employees specifically for this reason.Again, this could have been resolved in mere weeks instead of a year had Carilion reached out to my insurance companies.

Regards,

Review: I have tried numerous times to resolve a billing concern with carilion billing. I have talked to a supervisor 3-4 times who assured me all was resolved. They took money paid to a physicians office and applied it to previous services through carilion. All services prior to visits made to this Doctors office was sent to [redacted]. The amount of service pre paid to Doctors office was 163.00 , which they say I owe . I had 3 visits totalling 163.00 and 2 were paid at time of visit. Insurance paid on 3rd visit, leaving a balance of 24.00 to be paid by me. I requested a statement showing the 24.00 I owe and never received it, but I have had several letters and calls asking for 163.00. I have tried to resolve this but cannot with their billing department nor their supervisors.Desired Settlement: I want a statement showing all services billed to [redacted] along with insurance adjustments, credits and paid by me along with a final statement showing I owe 24.00 leaving me with a 0 balance with carilion.when paid

Business

Response:

Our billing department manager was able to reach Ms. [redacted] to discuss her concerns this morning. The requested detailed bill has been sent to her today. We appreciate Ms. [redacted] bringing her concerns to our attention as they will be used in our continuous improvement efforts.

Consumer

Response:

I have reviewed the response made by the business in reference to complaint ID [redacted] and find that this resolution would be satisfactory to me. I will wait for the business to perform this action and, if it does, will consider this complaint resolved.

Regards,

Review: I have a balance $ 23.00 that I do not intend to pay. This balance results from my 3/15/16 visit to Carilion Travel Medicine department ,occupational medicine. The purpose of the visit was to receive needed vaccination for a vacation trip to Vietnam/Cambodia. When I arrive for my appointment I was inform the I would be required to pay for my visit and treatment at time of service, that I could submit to insurance but they did not bill insurance. They told me the cost of the office visit and said treatment would depend on which vaccines were administered. After consultation the CDC recommendation and my previous vaccinations , HEPA/HEPB, and rabies were recommended. After being informed of the cost of those vaccinations, I decided to only get the HEPA/HEPB single vaccine. I received the vaccine went out front was present with the bill for the office visit and the vaccination and paid the bill with my credit card. On return from vacation I had a bill with a balance of $23.00 .

I called payment services and was told a discount was not applied and that would take care of it.

I then got a bill Statement date 5/22/16 which still showed this 23.00. I called payment services again and was told they would contact the original representative to resolve the matter. I then sent a payment minus the 23.00 to pay this bill. only to receive a bill with a 23.00 balance ..

I hope this can be resolved quickly. On 3/15/16 I paid 100% of the bill I was given for the services I received, with no further bill expected or warranted.Desired Settlement: Apply $23.00 credit to my account.

Business

Response:

Thank you Mr. [redacted] for sharing your billing concerns related to your March visit at Carilion Clinic Occupational Medicine. It is my understanding that you spoke with our billing department representative [redacted] yesterday, 7/21/16 and your issue has since been resolved. I hope you will accept our apology for your experience being anything but exceptional. We take all patient feedback very seriously and use it in our ongoing improvement initiatives.

Sincerely,

Patient Advocacy

Carilion Clinic

Consumer

Response:

I have reviewed the response made by the business in reference to complaint ID [redacted], and find that this resolution would be satisfactory to me. I will wait for the business to perform this action and, if it does, will consider this complaint resolved.

Regards,

Review: Carilion Clinic consitently refuses to provide [redacted] discounts which they are under contract to provide. They repeatedly send invoices and will eventually turn me over to a collection agency (as they have done many times in the past) for refusing to pay what they are obligated to discount. Because this happens EACH AND EVERY TIME I visit my doctor I am convinced it is a deliberate scam to deceive consumers into paying what they do not owe, and in fact should be immediately discounted. The only way I can rectify this, according to my local doctor's office, is to go in person with the invoices for them to take care of it. I call repeatedly to get them to rectify it, but they never do -- even though they promise to take care of it. This is unacceptable and their fraudulent practice must cease -- not just for me but for everyone! Carilion Clinic is a criminal enterprise feeding off of unsuspecting customers.Desired Settlement: Provide me the discount they are under contraction to supply (currently $127.23, publicly apologize to me and all other victims, pay me $250 for damages (time and effort to rectify this, reform their fraudulent practices, and refund all other consumers who have also been fraudulently overcharged by refusing to honor their contract.

Business

Response:

Thank you for contacting the Revdex.com about Carilion's billing practices. While we are always discouraged to hear that we have failed to meet a patient or family expectation, we are appreciative of the fact that we have been given the opportunity to evaluate and understand the issues to see if there are improvements necessary for the future to avoid such concerns.

Carilion’s Professional Billing office has reviewed your account and determined that an insurance adjustment should have been applied in this case. The confusion has been that this is a non-participating insurance except when the treatment occurs in the Shenandoah Valley. The account now reflects a zero balance.

We regret that this has been a frustrating experience for you, but please know we have been able to improve our internal communication processes with the family practice offices in these matters. It does not erase your bad experience, but please know we take these matters seriously and wish to keep you as part of our Carilion Clinic family. Your feedback is appreciated and is used in our continuous improvement efforts.

If we can assist you further, please contact us at [redacted], toll free at ###-###-#### or by [redacted]. We are available M, W, F 9a-4:15p and T, Th 9a-6:00p.

Sincerely,

Carilion Clinic Professional Billing.

Consumer

Response:

I have reviewed the response offer made by the business in reference to complaint ID [redacted], and have determined that this proposed action would not resolve my complaint. For your reference, details of the offer I reviewed appear below.

I am on satisfied that this will resolve the problem in the future. I did indeed have my service in the Shenandoah Valley! They also did not address my other concerns nor reimburse me the full amount that I had requested. A public apology also must be made to all of those individuals who have been overbilled.

Regards,

Review: I have repeatedly, in writing, attempted to resolve a billing error due to a mistake by Carilion after a doctors visit on June 6th 2015. I have written 3 letters which have been almost entirely ignored.I have repeatedly asked them to provide information and they have refused to do so. Now they have turned this over to a collection agency.The ONLY contact ever made by Carilion was a few second telephone call on December 16th 2015 asking me if I was still receiving bills from Carilion and that this was supposed to have been taken care of by the "business manager". This call was made as the result of my third letter attempting to resolve this matter as this date was the deadline that I had made for contact.I then heard absolutely nothing until I received a collection agency notice on February 23rd 2016.I have copies of all the letters and related correspondence.This company has acted in a callous and unresponsive manner in their lack of resolving this issue. Their behavior has been reprehensible.Desired Settlement: Correct the error made by Carilion. Retract the debt collection.

Business

Response:

Dear Mr. [redacted],

Carilion Clinic has received your feedback submitted to the Revdex.com regarding the coding of your bill from June 6, 2015 for your annual physical. You stated that you have tried on three different occasions to resolve a coding issue with the bill you received to no avail. While I was saddened to hear we had failed to meet your expectations, I am always thankful for feedback from our patients, which we use in our continuous improvement efforts.

Based on your feedback a thorough review of your concerns was conducted. It shows that you did dispute your balance for the June 6, 2015 visit siting a coding error that left you owing a balance ($201.11) when your previous visit was covered at 100%. Our billing department did receive your concerns and attempted to change the coding based on the documentation review, but the changes were not accepted after the fact and the bill remained.

Clearly there were some communication misgivings concerning the nature of your visit to your physician and how it was coded. I wish to apologize for the inconvenience this has caused. We strive to exceed our patients expectations at all times and unfortunately we failed on this occasion. The balance you owe ($201.11) has been retrieved from collections and has been adjusted to reflect a $0 balance. Please know we appreciate you Mr. [redacted], and want to keep you as a member of our Carilion Clinic family.

Sincerely,

Patient Advocate, Carilion Clinic

Consumer

Response:

I have reviewed the response made by the business in reference to complaint ID [redacted], and find that this resolution would be satisfactory to me. I will wait for the business to perform this action and, if it does, will consider this complaint resolved.I DO EXPECT THE COLLECTION AGENCY TO SEND ME A LETTER CONFIRMING THE COMPANIES ACTIONS AND CARILION TO VERIFY THAT THIS WILL BE DONE.

Regards,