Crystal Clinic Orthopedic Center, LLC

Initial Business Response / [redacted] (1000, 5, 2016/06/09) */ Contact Name and Title: Ronald S [redacted] , Pres/CEO Contact Phone: [redacted] Contact Email: [redacted] 06/07/ Re: Revdex.com Case #: [redacted] Please know that this patient's concerns were very carefully reviewed The consumer is disputing the pricing associated with medical services rendered on March 21, and March 28, at one of the Crystal Clinic Orthopaedic Center's outpatient clinic locations According to the consumer: "Service provide was much more than previous experienceI had a Ganglion cyst Aspirated on 3/28/There were a total of bills; Clinic bills and doctor bill, totaling $Approximately years I had the exact same procedure, with the insurance company, including consultation and surgery from a different clinic for less than $The doctor at that time no longer works at that clinic therefore I choose Crystal Clinic insteadThat turns out more than twice the price! I call the billing department and Anna couldn't provide me with the details of the billingI request to speak the office manager, Diana, and as of today, she has not call me backI wanted to know why the consultation alone was $PLUS $office copay so $281! The aspirated procedure itself cost less then the consultationOn top of that, the day I came in for the surgery, you wanted another $in copay! Upon review of the consumers account, it was confirmed that the charges billed were a true and accurate representation of the services providedWe do have record of the patient contacting our billing department with a request that an itemized breakdown of resources be provided that substantiated the billing associated with the clinic room charges (such as employee costs, utilities, miscoverhead expenses, etc.)Our billing office explained that exact cost amounts in each expense category could not be provided but did provide an overview of what category of expenses are considered Patients who are seen in any of the CCOC hospital outpatient clinics receive two (2) bills; one from the CCOC for the facility services, and one from CCI for the physician's professional servicesThese two bills are in no way duplicativeThe CCOC charges cover the costs for the building, equipment, support personnel, supplies, insurance, etcThe CCI charges cover the costs for the professional services of the physician and/or mid-level providerThis billing model is both legal and common throughout the country, and many examples exist throughout Northeast Ohio Consumer's Itemization of Account Facility Services Account # [redacted] (DOP) Date Description Amounts 3/21/Clinic Room Charge $ Total Charged $ United Health Care Allowed $ United Health Care Contractual Discount ($96.80) United Health Care Payment $ Patient Balance Deductible $ Patient Paid $ Balance remaining to patient $ Account # [redacted] (DOP) Date Description Amounts 3/28/Betamethasone Vial Medication $ Treatment Room Charge $ Total Charged $ United Health Care Allowed $ United Health Care Contractual Discount ($188.67) United Health Care Payment $ Patient Balance Deductible $ Patient Paid $ Balance remaining to patient $ Professional Fee Services Ticket [redacted] Date Description Amounts 3/21/New Patient Visit Level III $ Total Charged $ United Health Care Allowed $ United Health Care Contractual Discount ($62.71) United Health Care Payment $ Patient Balance $ Patient Paid ($60.00) Balance Remaining to Patient $ Ticket [redacted] Date Description Amounts 3/26/Aspiration of Ganglion $ Total Charged $ United Health Care Allowed $ United Health Care Contractual Discount ($51.69) United Health Care Payment $ Patient Balance Deductible $ Patient Paid $ Balance Remaining to Patient $ The Crystal Clinic Orthopedic Center's billing practices represent industry standardsThe pricing structure for the services received by this patient represents a standard pricing methodology and is recognized by most insurance carriersThe patient would have received similar billing at any other hospital outpatient clinic facility locationIt should be noted that we are only balance billing the patient for the contracted amount covered and deemed appropriate by his insurance carrier In an effort to educate all patients regarding the split billing, notifications are presented to the patient titled "Important Billing Notice" to inform them of the CCOC structure and to encourage them to contact their insurance carrier to evaluate their hospital outpatient benefitsI have enclosed a copy of this form that was signed by the consumer before services were renderedIn addition, the patient was presented with a facility cost estimate for the treatment room charge which occurred on 3/28/This form serves as an acknowledgment that the patient was advised relevant to the facility charge associated with his procedureI have also enclosed a copy of this cost estimate that was signed by the consumer prior to his procedure Exceeding the patient's expectation is an important aspect of our mission at CCOC, so patient dissatisfaction is equally disappointing to usHowever, all of the charges associated with this patient's date of service were charged accordingly to services renderedUnfortunately we cannot offer a waiver of the patient's deductibleAs per the patient's contract terms with United Health Care, these charges were deemed to be the consumer's responsibility As explained to the patient at the time he contacted our billing office, we will be happy to work out a payment plan that is mutually beneficialPlease feel free to contact Latrell J [redacted] directly at [redacted] Initial Consumer Rebuttal / [redacted] (3000, 7, 2016/06/10) */ (The consumer indicated he/she DID NOT accept the response from the business.) The itemized "Clinic Room Charge" is $plus $co-pay office visit= $Your "Clinic Room Charge" that day was a minute consultation that I need the Gangleon cyst remove, yet your actual aspirated procedure including medication on 3/total of $is actual CHEAPER then the minute consultation? That is outright ridiculous price gouging! I had the EXACT same procedure years ago with the EXACT same insurance company but at a different clinic and the only charge me the $office visitMy total procedure cost was less then $You don't see there is a vast price difference? Your nurse gave me an "estimate" cost by showing me the standard chart cost for ganglion cyst removal of approximately $220, so as a customer, one would think after partial insurance coverage, the total bill would be $424.59! Your billing practices is very deceiving to a customer! You should provide a more accurate and thorough estimate! I would NEVER recommend your business to anyone now knowing how you deceiving bill customers! Final Business Response / [redacted] (4000, 9, 2016/06/14) */ 6/14/Please see Crystal Clinic Orthopaedic Center's response to the consumer's rebuttal in the attached documentThank you Final Consumer Response / [redacted] (4200, 11, 2016/06/15) */ (The consumer indicated he/she DID NOT accept the response from the business.) Crystal Clinic can dice and slice the costs anyway they wantThe fact is I walk in on 3/and billed $and a $co-payThat math still shows $less the United Heatlh Care adjustment of -$So I have to pay $That is Crystal Clinic itemized cost as "Clinic" on the billThat is for a minute consultation saying that I need to aspirate the Ganglion cystI mentioned to the doctor that it was the same Ganglion cyst I had aspirated years agoThen the procedure itself $less $188.67= $Plus $in doctor feeThe bottomline is it still totaled $no MATTER HOW YOU OR I SLICE THE BILLThe fact is the nurse did show me the cost chart for aspiration of the Ganglion cyst of $BEFORE the UHC adjustmentSo it IS DECEIVING from a customer perspective to see the total bill of $when I had the exact same for procedure for less the $Had to tell me the cost would be approximately $BEFORE I done the aspirate procedure, I would have NEVER approve the surgery and would have gone to another facilityMaybe the billing is not deceiving practice to you, but from a customer's perspective, that is very deceiving!

Initial Business Response /* (1000, 5, 2016/06/09) */
Contact Name and Title: Ronald S[redacted], Pres/CEO
Contact Phone: [redacted]
Contact Email: [redacted]
06/07/2016
Re: Revdex.com Case #:...

[redacted]
Please know that this patient's concerns were very carefully reviewed.
The consumer is disputing the pricing associated with medical services rendered on March 21, 2016 and March 28, 2016 at one of the Crystal Clinic Orthopaedic Center's outpatient clinic locations.
According to the consumer: "Service provide was much more than previous experience. I had a Ganglion cyst Aspirated on 3/28/16. There were a total of 3 bills; 2 Clinic bills and 1 doctor bill, totaling $424.59. Approximately 1.5 years I had the exact same procedure, with the insurance company, including consultation and surgery from a different clinic for less than $200. The doctor at that time no longer works at that clinic therefore I choose Crystal Clinic instead. That turns out more than twice the price! I call the billing department and Anna couldn't provide me with the details of the billing. I request to speak the office manager, Diana, and as of today, she has not call me back. I wanted to know why the consultation alone was $221 PLUS $60 office copay so $281! The aspirated procedure itself cost less then the consultation. On top of that, the day I came in for the surgery, you wanted another $60 in copay!
Upon review of the consumers account, it was confirmed that the charges billed were a true and accurate representation of the services provided. We do have record of the patient contacting our billing department with a request that an itemized breakdown of resources be provided that substantiated the billing associated with the clinic room charges (such as employee costs, utilities, misc. overhead expenses, etc.). Our billing office explained that exact cost amounts in each expense category could not be provided but did provide an overview of what category of expenses are considered.
Patients who are seen in any of the CCOC hospital outpatient clinics receive two (2) bills; one from the CCOC for the facility services, and one from CCI for the physician's professional services. These two bills are in no way duplicative. The CCOC charges cover the costs for the building, equipment, support personnel, supplies, insurance, etc. The CCI charges cover the costs for the professional services of the physician and/or mid-level provider. This billing model is both legal and common throughout the country, and many examples exist throughout Northeast Ohio.
Consumer's Itemization of Account
Facility Services
Account # [redacted] (DOP)
Date Description Amounts
3/21/2016 Clinic Room Charge $221.00
Total Charged $221.00

United Health Care Allowed $124.20
United Health Care Contractual Discount ($96.80)
United Health Care Payment $0.00
Patient Balance Deductible $124.20
Patient Paid $0.00
Balance remaining to patient $124.20
Account # [redacted] (DOP)
Date Description Amounts
3/28/2016 Betamethasone Vial Medication $26.75
Treatment Room Charge $404.00
Total Charged $430.75

United Health Care Allowed $242.08
United Health Care Contractual Discount ($188.67)
United Health Care Payment $0.00
Patient Balance Deductible $242.08
Patient Paid $0.00
Balance remaining to patient $242.08
Professional Fee Services
Ticket [redacted]
Date Description Amounts
3/21/2016 New Patient Visit Level III $150.00
Total Charged $150.00

United Health Care Allowed $87.29
United Health Care Contractual Discount ($62.71)
United Health Care Payment $27.29
Patient Balance $60.00
Patient Paid ($60.00)
Balance Remaining to Patient $0.00
Ticket [redacted]
Date Description Amounts
3/26/2016 Aspiration of Ganglion $100.00
Total Charged $100.00

United Health Care Allowed $48.31
United Health Care Contractual Discount ($51.69)
United Health Care Payment $0.00
Patient Balance Deductible $48.31
Patient Paid $0.00
Balance Remaining to Patient $48.31
The Crystal Clinic Orthopedic Center's billing practices represent industry standards. The pricing structure for the services received by this patient represents a standard pricing methodology and is recognized by most insurance carriers. The patient would have received similar billing at any other hospital outpatient clinic facility location. It should be noted that we are only balance billing the patient for the contracted amount covered and deemed appropriate by his insurance carrier.
In an effort to educate all patients regarding the split billing, notifications are presented to the patient titled "Important Billing Notice" to inform them of the CCOC structure and to encourage them to contact their insurance carrier to evaluate their hospital outpatient benefits. I have enclosed a copy of this form that was signed by the consumer before services were rendered. In addition, the patient was presented with a facility cost estimate for the treatment room charge which occurred on 3/28/2016. This form serves as an acknowledgment that the patient was advised relevant to the facility charge associated with his procedure. I have also enclosed a copy of this cost estimate that was signed by the consumer prior to his procedure.
Exceeding the patient's expectation is an important aspect of our mission at CCOC, so patient dissatisfaction is equally disappointing to us. However, all of the charges associated with this patient's date of service were charged accordingly to services rendered. Unfortunately we cannot offer a waiver of the patient's deductible. As per the patient's contract terms with United Health Care, these charges were deemed to be the consumer's responsibility.
As explained to the patient at the time he contacted our billing office, we will be happy to work out a payment plan that is mutually beneficial. Please feel free to contact Latrell J[redacted] directly at [redacted].
Initial Consumer Rebuttal /* (3000, 7, 2016/06/10) */
(The consumer indicated he/she DID NOT accept the response from the business.)
The itemized "Clinic Room Charge" is $221 plus $60 co-pay office visit= $281. Your "Clinic Room Charge" that day was a 10 minute consultation that I need the Gangleon cyst remove, yet your actual aspirated procedure including medication on 3/28 total of $242 is actual CHEAPER then the 10 minute consultation? That is outright ridiculous price gouging! I had the EXACT same procedure 1.5 years ago with the EXACT same insurance company but at a different clinic and the only charge me the $40 office visit. My total procedure cost was less then $200. You don't see there is a vast price difference? Your nurse gave me an "estimate" cost by showing me the standard chart cost for ganglion cyst removal of approximately $220, so as a customer, one would think after partial insurance coverage, the total bill would be $424.59! Your billing practices is very deceiving to a customer! You should provide a more accurate and thorough estimate! I would NEVER recommend your business to anyone now knowing how you deceiving bill customers!
Final Business Response /* (4000, 9, 2016/06/14) */
6/14/16 Please see Crystal Clinic Orthopaedic Center's response to the consumer's rebuttal in the attached document. Thank you.
Final Consumer Response /* (4200, 11, 2016/06/15) */
(The consumer indicated he/she DID NOT accept the response from the business.)
Crystal Clinic can dice and slice the costs anyway they want. The fact is I walk in on 3/21 and billed $221 and a $60 co-pay. That math still shows $281 less the United Heatlh Care adjustment of -$96.80. So I have to pay $184.20. That is Crystal Clinic itemized cost as "Clinic" on the bill. That is for a 5 minute consultation saying that I need to aspirate the Ganglion cyst. I mentioned to the doctor that it was the same Ganglion cyst I had aspirated 1.5 years ago. Then the procedure itself $430.75 less $188.67= $242.08. Plus $58.31 in doctor fee. The bottomline is it still totaled $424.59 no MATTER HOW YOU OR I SLICE THE BILL. The fact is the nurse did show me the cost chart for aspiration of the Ganglion cyst of $220 BEFORE the UHC adjustment. So it IS DECEIVING from a customer perspective to see the total bill of $424.59 when I had the exact same for procedure for less the $200. Had to tell me the cost would be approximately $425 BEFORE I done the aspirate procedure, I would have NEVER approve the surgery and would have gone to another facility. Maybe the billing is not deceiving practice to you, but from a customer's perspective, that is very deceiving!