Central Florida Pathology Associates Reviews (%countItem)
Central Florida Pathology Associates Rating
Address: 7083 Grand National Dr STE 102, Orlando, Florida, United States, 32819-8942
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I was a patient at WINTER PARK hospital in Winter Park, Florida, November 21,2019. I checked in to the emergency room and asked if my health insurance was in-network. I was told that my insurance was and accepted . I asked for everything in regards to my care to be in-network.
I received a bill after my stay from an out-of-network specialist who was called in by my in-network doctor. I am now being billed $455.00 for this out-of-network specialist. (My permission was not given).
After making phone calls and speaking with the hospital billing team, the specialist and my health insurance provider, I learned that my insurance does not cover the specialist due to him being an unnecessary need.
When I called the specialist office they informed me that the specialist billing code evades the insurance company billing protocols. The specialist office said, "All he did was show up and read the charts." "He did nothing else." "And that's why the codes are listed as they are." I stated that was awfully expensive for a person to charge to only look at a chart. They agreed. "Yes that is expensive" and out-of-network."
My in-network doctor made the call and decision to not look at the chart himself but call someone else in to do his job for him. He never asked me if this would be okay. I only saw my doctor for less than two minutes over three days. And it was 30 minutes prior to being discharged.
Upon being discharged and scheduled for a cardiologist follow up I remained persistent that the hospital only schedules me an in-network appointment. The hospital did follow thru.
My hospital bill under my insurance coverage has been paid in full. And I know when somebody is trying to get a little extra payment during an unfortunate health situation. There was absolutely no need for an out-of-network specialist to be present during and in-network hospital stay.
That's on the hospital. Not the patient. Bad faith.
Product_Or_Service: Central Florida Pathology Associates
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Billing Adjustment Since my in-network doctor decided that a momentary chart read would require an out-of-network specialist, then the doctor should be responsible for the charges. Had the specialist and his coding been done with honesty and integrity, his portion and billing would have been added under my insurance policy and paid appropriately. I request that this bill be removed and that this doctor and specialist be be held responsible. This was an unnecessary extra-added bill, bad faith.
The patient insurance is Ambetter and we are not contracted therefore when the claim denied it was patient responsibility. The insurance has now come back and paid leaving no patient responsibility. account has a zero balance.
(The consumer indicated he/she ACCEPTED the response from the business.)
I do accept the stated final results (zero balance), covered by insurance.
I (and I'm sure many patients) are tired of this game between what is patient responsibility and what is covered by insurance. If a patient is at an in-network facility then there never be any disputes such as in this case. Every doctor and specialist used should be either in network or made clear to the specialist that they also fall under a person's insurance carrier.
To come in unknowingly and unannounced and say "Here's our bill" is quite unethical, especially knowing that the patient's insurance is not accepted by the out-of-network specialist. Claiming "patient responsibility" by the specialist is little more than tactics.
The current disconnect between what is in-network and out-of-network remains the biggest hurdle. As a patient who arrives in an emergency to an in-network facility this situation should never arise after discharge.
The specialist knows that this is not-covered under certain insurances and is also deemed unnecessary by the hospital billing staff and insurance company. Therefore they change their coding tactics and then send a bill for services rendered.
An out-of-network specialist at an in-network facility should adhere to "specialist responsibility". The doctor who may have called the out-of-network specialist is also responsible for this decision. Not the patient.
The patient was responsible, in this case, by choosing to be treated at an in-network facility. The knowingly out-of-network specialist who chose to not have their services properly billed, coded, under the patients in-network facility and insurance is the one who then chooses to "not be" properly "responsible".
The specialist and insurance company finally coming to the proper billing procedure at the end of the day says to me, "the responsible patient", all I need to know.
I hope that this specialist's billing tactics are further scrutinized.
Thank you for a fair and just decision, in this matter. How this was handled at the end, is how this should have been handled from the beginning.
Sincerely,
The Responsible Patient