D & D Automotive Inc

Initial Business Response /* (1000, 6, 2016/05/10) */
[redacted]
[redacted]
A Lifetime of Care

www.southbendclinic.com
Allergy,Asthma . & Immunology
Audiology Cardiology
Clinical Research Dermatology Endocrinology
Family Medicine Gastroenterology May 10, 2016
Better Business...

Bureau
ATTN: [redacted]@nothemindiana.Revdex.com.org
RE: Revdex.com Complaint — Case#XXXXXXXX — [redacted]


We first became aware of Ms. [redacted]'s concerns in February 2016. Her first complaints were regarding the billed charges for her infant daughter's pediatric visit on February 4, 2016. It is documented that during that visit included: "this 5 week old female presents for Well Visit, spina bifida, hip dysplasia, horseshoe kidney and hydrocephalus." The.provider assessment and her plan included a review of "spina bifida and recommendations for neurosurgery, horseshoe kidney per recommendations of urology, hydrocephalus discussion of signs and symptoms with morn such as inconsolable, emesis, irritability, poor feeding, and hip dysplasia where they are awaiting orthopedic recommendations." Also documented was that the patient should "return for 4 weeks checkup". As is our regular process when a patient has a concern about charges, our billing and pediatric offices coordinate a review of the documentation, medical codes applied and charges. This was completed, and it is documented that a discussion did occur with Ms. [redacted] on 2/23/16 and an explanation provided.
To be sure, after receiving this Revdex.com complaint we had a Clinic Certified Coder further provide an explanation of the codes used for this visit (which determines the appropriate charges). Per the "Coding for Pediatric Preventative Care — American Academy of Pediatrics" - The following is an excerpt further explaining the codes that were used for this visit:
"If an illness or abnormality is encountered or a pre-existing problem is addressed in the process of performing the preventive medicine services, and if the illness, abnormality, or problem-oriented evaluation and management (E/M) services (history, physical examination, medical decision making), the appropriate office or other outpatient service code [redacted] — XXXXX) should be reported in addition to the preventative medicine service code. Modifier 25 should be appended tO the office or other outpatient service code to indicate that a significant, separately identifiable E/M service was provided by the same physician on the same day as the preventive medicine service."
This patient has Spina Bifida, Horseshoe Kidney, Hip Dysplasia, congenital issues, all which are managed by other physicians. However, she also has Hydrocephalus (which was stable on

South Bend • Granger • Ironwood Road • New Carlisle • Portage Road
Berrien Springs • Elkhart • Mishawaka
(XXX) XXX-XXXX
www.southbendclinic.com

this visit) being managed by the Clinic's pediatrician. The Hydrocephalus qualifies as above and beyond the preventative care, and can be billed as an E/M XXXXX. Medical decision making qualifies this as one "stable chronic illness", but can also be considered as "nature of presenting problem" due to the other diagnosis the patient has that can play a part in the treatment of the patient during any medical visit.
As such, it has been determined that the patient was appropriately cared for during this visit, and that it was appropriately coded and charged for. Copayments are not determined by the Clinic, but by the patient's insurance companies.
Ms. [redacted] returned with her daughter on March 7, 2016 for a routine child health exam. It is documented that during that exam the discussions included, child care, crying/fussy period/pacifier, establish bedtime routine, prepare for future immunizations, skin/nail care, sleep patterns (back), and smoke-free home and care. Due to the medical complexity of the patient, this was also more than a "well visit" as described by coding requirements above.
Ms. [redacted] called back to the clinic on 3/8/2016 regarding the status of her prior phone call on 2/23/2016 (above). Per the message on 2/23/2016 the billing office had a final discussion on this with Ms. [redacted] at that time. At that time, as is the regular process, the pediatrician was also notified of this phone call and indicated.that because of this patient's medical conditions and complex care, each visit discussion requires more time and a different way to Code. Noted was that the more stable the patient condition is and no "ill issues" the less time is spent in the
office. When Ms. [redacted] was informed of pediatrician's response, she claimed "discrimination due to her daughter's medical condition". It was further explained to Ms. [redacted] that universal codes are used by all Of the Clinic's physicians and the Clinic. The Clinic and our physicians hold high standards and treat everyone as equally as possible. This may be how Ms. [redacted] felt, but certainly this is not a true fact. As indicated above, the clinic codes and bills based on the required established laws and regulations.
Due to Ms. [redacted]'s claim of discrimination, the physician felt this represented the parent's lack of trust. To provide the best medical care possible, it is mutually beneficial that the patient and physician have a cooperative and trustful relationship. As is the policy (and regular process) of the Clinic, if a breakdown in the relationship between patient and physician occurs the patient can be dismissed from the practice so the patient can seek another provider where a mutually beneficial relationship could occur. The letter that is sent to the patient (in this case the parent) includes urgent coverage for 30 days and referral numbers so the patient can find another provider. This is what occurred in Ms. [redacted]'s case.
As a result of our review, our final decision is that the care and treatment rendered to Ms. [redacted]'s daughter by the physicians and Clinic was appropriate. As such, we cannot fulfill her request to remove charges. We also feel no further response is necessary. We do apologize that we have not met the Ms. [redacted]'s expectations.

Since -ely,
[redacted] CPHRM, CHC
Sr. Director of Compliance and Risk Management
Initial Consumer Rebuttal /* (3000, 8, 2016/05/17) */
(The consumer indicated he/she DID NOT accept the response from the business.)
The business's response continues to show disregard for customer service and improper attitudes towards client relationships, as well as disregard for possible ethics complaints.
While the business is adamant in defending the billing of the visit, they have offered no explanation as to the improper handling of this entire scenario. The following issues still exist:
- The billing codes used for the February 4th visit do not match the billing codes used for the child's visits during January and March, even though the same 'medical complexities' existed. The practice has never acknowledged or addressed the obvious confusion that families would experience when being billed differently for identical visits where the same medical history was discussed.
- It is the doctor's responsibility to review medical history as part of standard well care, not to bill for discussing it when no need was present or requested by the patient.
- The doctor's notes do not accurately reflect the visit, as no discussion of the patient's medical conditions were requested or initiated by the family. The doctor was only visiting these 'medical complexities' as part of her own desire to ask questions for her education about the conditions.
- The doctor terminated the patient's care because of an alleged 'relational breakdown'; however, the doctor herself never communicated with the patient about the billing codes and instead relied on hear-say from the nurse in reaching this decision. This puts the doctor at fault for petty, aggressive, and dismissive attitudes towards the patient's family - thereby undermining the provider-patient relationship - and not making a good faith effort to protect the child's health and wellbeing through continued care. The initial misunderstanding could have been easily prevented through proper communication.
- The practice manager made promises to the family that upper management would address her concerns, which never took place. She specifically committed to having upper management personnel contact the family to address the billing issue and actions of the doctor, and yet those individuals never followed up. The management specifically ignored ethics complaints made against its care provider.
- The Director of Primary Care refused to return my phone call to investigate poor customer care and the allegations of unethical behavior by their provider.
- A preventative exam is to include a review of past medical history. Also, I was not made aware in advance of the additional charges or even the possibility of additional charges for comments or discussions taking place at a preventative/well visit. This is the practice's responsibility to inform patients of its billing/coding policies, and the doctor should have also made me aware that any discussion of my daughter's pre-existing conditions - even in the context of simply acknowledging them - would result in additional charges. Because there was no notification, and because this was simply a part of reviewing her medical history, this additional billing code is not legal or appropriate.
In summary, this practice is failing to address the root of my complaint in their response, and is guilty of failing to investigate an ethics complaint and failure to provide customer service.
Final Business Response /* (4000, 10, 2016/05/26) */
Dear Ms [redacted] As indicated in our response letter of May 10, 2016 we have thoroughly reviewed this individual's concerns, communicated with her on numerous occasions, and provided consistent medical care to her daughter in an ethical, professional manner as we would with all patients. As such we determined that the appropriate care was provided and the bill the patient is requesting to be adjusted off will remain since appropriate services were rendered and the appropriate coding/billing was done. As with any other patient bills, if the bill isn't paid in full and/or payment arrangements made through our billing office, it will be moved on into the collections process.
This is our final response. Thank you.
[redacted] CPHRM, CHC
Senior Director, Compliance and Risk Management

The vehicle was diagnosed with a blown intake manifold gasket.I voiced concern at that time as to the head gaskets being blown out as well and was told that they were not. After intake manifold was replaced at a cost of over $700 I went to pick the van up on 08/02/2011 and it started overheating immediately upon leaving D and D's repair shop. I returned the van and was told to replace the water pump which I agreed to have them do at a cost of over $200. Meanwhile, I am still voicing concern about the head gaskets being blown, but I am told they are not a concern. I picked the van up the second time after the water pump had been replaced and it seemed to have stopped overheating for the next three days. The van then began to overheat and was promptly returned to them. It was then they told me that the van would need new head gaskets. I feel they should have replaced the head gaskets and intake gasket at the simultaneously which would have saved me quite a bit in labor cost and I do not believe the water pump was ever an issue. I have now paid D and D almost $1000 and my van still needs new head gaskets. A large portion in the cost of that repair includes labor for removal and replacement of engine components that had to be removed during the intake manifold gasket replacement.