Dean Health Systems, Inc.

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID ***, and have
determined that this does not resolve my complaint. For your reference, details of the offer I reviewed appear below. It appears that they need the patient name and date of birth: Eleanor *** 10/10/
[To assist us in bringing this matter to a close, we would like to know your view on the matter.]
Regards,
Teresa ***

This letter is in response to your letter dated February 14,
2017, regarding the complaint against SSM Health Dean Medical Group filed with
your agency by *** ***. Ms***’s
complaint states they were told SSM Health Dean Medical Group accepts their
insurance, which is United Health
CareAt
the time a patient presents to chefor an appointment, reception staff
takes a copy of the patient’s insurance card.
If the patient does not have an insurance card, reception staff calls
the number on the insurance card to verify effective dates, where to send
claims, etc. This is verification of
insurance, not verification of whether or not SSM Health Dean Medical Group is
a preferred provider. SSM
Health Dean Medical Group accepts most insurances and files claims to more than
2,insurance companies on behalf of our patients. Each insurance company has multiple plans/policies
Some are run by third party
administrators who have contracts with clinics even though the insurance
company does not. We do not know coverage information until after the
claim is processed. Given the complexities of insurance, it is patient’s
responsibility to confirm and understand coverage and preferred provider status
with their health benefit plan, insurance company, or employer, preferably
before seeking treatment. I
am sorry Ms*** did not know SSM Health Dean Medical Group was not part of
her preferred provider network. As a
one-time goodwill gesture, we have applied a 20% discount to the outstanding
charges.If you have any questions regarding this matter or require
additional information, please feel free to contact me. Thank youSincerely,Mary *** ***Patient Relations Specialist

July 5, 2017 Revdex.com of WisconsinW Greenfield AveMilwaukee, WI 53214 RE: ID ***- Teresa M *** Dear Mr***: This letter is in response to your letter dated July 5, 2017, regarding the complaint against SSM Health Dean Medical Group filed with your agency by Teresa M ***. Ms***’s complaint states she objects to paying for the wart treatment on date of service 12/29/for her daughter, stating it was not effective and she was not informed of the fee for the service prior to treatment. SSM Health Dean Medical Group is required to follow the billing guidelines of the American Medical Association (AMA). Each service for which a physician bills, has strict criteria which must be met. The AMA dictates that we bill separately for each individual service. According to provider documentation, patient presented to Dr*** for her scheduled appointment on 12/29/16. The purpose of the visit was to evaluate a persistent wart on the plantar surface of her foot. Mom stated they had tried numerous over-the-counter medications as well as treated previously with cryotherapy in dermatology; however the wart came back. Treatment options were discussed. Dr***’s recommendation was to pare the wart with a blade and keep an eye on it. If further problems return, discuss other options to treat at that time Our goal is to best manage our patient’s health care needsSSM Health Dean Medical Group realizes that patients need to be able to make educated decisions on their health care. If, during any visit, there is a procedure, lab test or supply that is discussed patients have the option of postponing the service until they have had a chance to verify costs, and or insurance coverageThis may result in needing to return for the service at another timeUnfortunately, SSM Health Dean Medical Group clinical staff is not able to quote fees for procedures at the time the patient is in the office receiving care. However, fee estimates can be obtained by contacting our Patient Account Services department at ###-###-#### or ###-###-####; option *. If you have any questions regarding this matter or require additional information, please feel free to contact me. Thank you Sincerely,Mary *** *** *** ***

Are you able to provide me with the patients name and date of birth.  Thanks.Mary [redacted]SSM Health Dean Medical Group[redacted]

April 20, 2017   Revdex.com of Wisconsin [redacted]
  RE: ID [redacted]   Dear Mr. [redacted]:   This letter is in response to your letter dated April 19, 2017, regarding the complaint against [redacted] filed with your...

agency by Stacy [redacted].  Ms. [redacted]’s complaint states she had a colonoscopy on 2/10/15 and she has been going back and forth between SSM Health Dean Medical Group and her insurance ([redacted] to correct her billing and this is still not resolved.   SSM Health Dean Medical Group filed Ms. [redacted]’s 2/10/15 colonoscopy charge to UHC, which they paid in full on 3/4/15.   On 3/19/15 UHC recouped the payment with no explanation.  SSM Health Dean Medical Group staff reached out to UHC on 12/2/15, 1/12/16, 2/24/16, 3/17/16, 4/19/16, 4/20/16, and 6/2/16.  Each call to UHC the same response was received; they could not see on their end that the payment was recouped.  An explanation of benefits was requested from UHC during each of the inquiries to show the payment, however UHC did not follow through on these requests.  On 9/6/16 SSM Health Dean Medical Group staff reached out to Ms. [redacted] and informed her that all efforts had been exhausted and requested that she file an appeal with UHC.       If you have any questions regarding this matter or require additional information, please feel free to contact me.  Thank you.   Sincerely, [redacted] Patient Relations Specialist

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID [redacted], and have determined that this does not resolve my complaint.  For your reference, details of the offer I reviewed appear below.While I do appreciate the response from Dean, I do not except this answer because it is not factual to say they "accept" United Healthcare insurance. If they did accept this insurance, why am I being billed for 100% of the services?  I understand it is my responsibility to find out if my insurance is covered by Dean, that is why I contacted Dean to find out if my insurance company was accepted, United Healthcare. I would truly hope that in the future no one else experiences this,  quite frankly it is disingenuous to say you accept a particular type of insurance, when indeed you do not. To give you the best example, it is like saying you accept Visa then upon checkout you tell the customer you can't actually use the Visa card, what is the point in bringing the visa card when you can't use it, but are told it is accepted. Once again, thank you for taking the time to review this issue, I really do hope that some kind of resolution is completed. The outcome I desire is to pay my co-pay, with United Healthcare.
Regards,
[redacted]

SSM Health Dean Medical Group does accept United Healthcare Insurance, however we do not know the patients level of benefits.  We did accept the insurance and filed a claim; the claim processed according to their benefits, which was applied towards their deductible. As stated in the letter dated February 20, 2017, we did apply a 20% discount to the outstanding balance. Please let me know if you have any additional questions.Thanks,Mary [redacted]

I have been going to my internist for over 23 years. His office has moved into a Dean office building with several other doctors. When my pharmacy sends in a request to Dean Clinic, It takes 48 to 72 business hours to get the refill approved by the doctor. The most recent and to date the most horrific problem I am still in the middle of began on Wed. 6/3/15 morning at 6:30 am, I called my pharmacy to refill my Tylenol 3. As of today, 6/9/15, I still do not have my prescription approved because no one took it off the fax machine until Monday 6/8/15. I have been without my meds now since Saturday morning. I called the clinic, called the pharmacy 4 times each. I am even thinking that although I love my doctor, this kind of stress just to get my meds isn't worth the hassle anymore. If you can avoid becoming a patient of Dean in Baraboo, you won't get refills on time and they take forever to answer the phone. With as much money that Dean has spent on building their new building, they forgot to update how they handle refills. My pharmacy also told me that this clinic does not know to handle narcotic refills. Law requires a phone call for narcotic refills, faxed in refill requests are not considered legal requests. When my doctor was in the other building with just himself, his partners and staff, this NEVER happened to me. Greed over good patient care, shame on you.

Review: In 2012, I was under my mother's insurance. I had gone to a clinic to see a doctor and he recommended a CT scan. Before they set up an appointment, we called our insurance to ask if this would be covered and they said yes. We made an appointment and called our insurance the day before to ask again and they assured us it would be covered. I had my scan and paid the copay. A few weeks later I received a bill for the amount owed after the insurance would pay their part and we paid that amount. Five months later we received a second bill stating that the insurance company had rejected the claim due to the tardiness of the claim being filed by Dean Health System. In other words, they sat on my claim until it was invalid as far as the insurance company was concerned (they have a 90 day window in which a health care provider can file to have the claim paid for), and then attempted to bill me for their own mistake. I spoke with my insurance company (UnitedHealthcare) and they assured me Dean Health Systems Inc had no right to bill me over this matter and advised not to pay as that was the responsibility of Dean Health Systems Inc. Two years later, I received a claim from Americollect, stating that I owed the amount of $825.21. Furthermore, it was filed on my credit report for the amount of $780. Dean Health Systems giving enough information to Americollect for them to add it to my credit report WITHOUT contacting me prior, if I am not mistaken, represents a breach in HIPAA.Desired Settlement: I would like this bill to be erased, a message to Americollect telling them to erase the claim on their end and a hand-written letter of apology sent to me over the stress it has caused and the damage to my credit.

Business

Response:

I'm writing in response to the complaint fi led by Jeremiah Daniel [redacted] regard ing the charges for services

provided at Dean Clinic Stoughton from February 14, 2012 through February 27, 2012.

The services included an office visit and lab tests on February 14, 2012 and a follow up office visit on February

27,2012. Claims for these services were sent to Mr. [redacted]'s insurance, United Health Care, the day following

each service. Following is a summary of the explanation of benefits received from United Health Care regarding

how each charge was processed.

Date Charge Description Ins Paid Deductible Coinsurance Ins Adj Patient Due

The total patient responsibility assigned by United Health Care for the services outlined above was $852.48. On

April 12, 2012 a payment plan for 72.00 per month was established. Dean Clinic received one personal payment

in the amount of $72 .00 on April 23, 2012. No further payments were received from the patient. Monthly

statements of account were sent to Mr. [redacted] from March 2012 through November 2012. In addition,

messages were left on May 29, 2012, October 4,2012, and November 9,2012 about the outstanding balance

due and the need to contact Dean Clinic to make payment arrangements in order to avoid collection

proceedings. On November 30,2012 Mr. [redacted]'s account was sent to Americollect. HIPAA allows health ca re

organizations to share information with business partners for the purpose of collecting payment; therefore this

is not a privacy violation.

All claims for service were sent promptly to United Health Care, Mr. [redacted]'s insurance company. United

Health Care processed the claims promptly and Mr. [redacted] received monthly statements of account indicating

the balance due. The CT scan charge referred to in Mr. [redacted]'s complaint is not a Dean Clinic charge.

Thank you for allowing us to review Mr. [redacted]'s concerns and respond. If you have any questions, please feel

free to contact me directly at ###-###-####.

Sincerely,

Review: I have some problems with the way my concerns were handled by "[redacted]" and would like these addressed. I was spoken to VERY condescendingly and repeatedly told "I am sorry your confused" and I want to have this address with both myself and "[redacted]". She was extremely inappropriate when I was trying to give HER information about an error that has been made with payments. This error will affect Dean Clinics, Dean Heal and Dean Saint Mary's (all together). Adjustments will be made to payments that Dean Clinics receives. Important information that she would not even hear, She was RUDE, she cut me off, and (again) repeatedly told me that I (the customer with the important information) am confused. I feel there should be an investigation and corrective action should be taken.

Billing adjustments will need to be made as Dean St Mary's will bill Dean Insurance and this will affect what Dean Clinics are paid. Hard to follow? Yes, because unlike what the TV add claims, these do not work together at all.

Additionally, The advertisement with the Dean Doctor and the Dean Insurance Agent working together for the customer is FALSE advertising. There is no communication between the two, in fact they seam to be working against each other.Desired Settlement: Billing will need to be adjusted with the adjustment in payments from the Insurance Company. I would like to be contacted regarding the nastiness of "[redacted]'s" tone. I would also like some type of corrective action to be taken with [redacted] to council her in her customer service skills.

Business

Response:

I’m writing in response to the complaint filed by [redacted]

[redacted] regarding the telephone interaction she had with [redacted] from the Dean

Clinic Patient Accounts Department.

Review of Ms. [redacted]’s phone encounters on June 11, 2014

indicate she called regarding a past due balance that had been turned over to a

collection agency in September of 2012.

The collection agency was unable to work with the responsible parties to

secure payment and a court date was scheduled for June 12, 2014. Ms. [redacted] requested an itemized

statement. The itemized statement was

generated and sent to Ms. [redacted]. She

also had questions about the policy deductible and was she was transferred to

Dean Health Plan to obtain this information.

Ms. [redacted] called back after her conversation with Dean Health Plan and

stated it was her understanding Dean Health Plan was reprocessing a claim for

date of service August 1, 2012. [redacted],

from Dean Clinic Patient Accounts, contacted the collection agency and reported

this information. However, Dean Clinic

records indicate the claim for date of service August 1, 2012 was processed and

paid on August 25, 2012. Ms. [redacted]

called a third time and stated she “found the problem” with the account. She referred to another account she had with

Dean/St. Mary’s Venture for a surgical procedure. [redacted] attempted to explain this was a

separate statement of account and not the same as the statement of account for

services at Dean Clinic. Ms. [redacted]

stated she wanted to speak to [redacted]’ supervisor. The message was given to the supervisor. The supervisor called Ms. [redacted] and left a

message.

I’m sorry Ms. [redacted] thought [redacted] cut her off. It was not [redacted]’ intention to upset Ms.

[redacted] but rather to 1) explain the claim for date of service August 1, 2012

had been paid and 2) the Dean/St. Mary’s statement of account was a separate

bill.

If you have any additional questions, please feel free to

call me at ###-###-####.

Consumer

Response:

Review: After a meeting related to my appeal Anthem Blue Cross Blue Shield agreed to pay the in network cost of the services I received which totaled $590.87. I spoke with [redacted] from patient relations at Dean Care and asked if they will accept the in network agreement from Anthem Blue Cross Blue Shield and she replied “No.” She then stated, “I told you that regardless what happens you are responsible of paying the total bill. You came to Dean Care asking for treatment from one of our providers and received it. It does not matter if your insurance covers it or not it is your responsibility.” I told her that I asked staff several times if they accept Anthem Blue Cross Blue Shield and they all said yes. But, when I talked to Sandy in billing who works with [redacted], the supervisor, she stated, “Whoever told you that we accept Anthem Blue Cross Blue Shield is lying to you and you should have never been accepted. Dena Care has not been contracted with Anthem Blue Cross Blue Shield for over 10 years.” [redacted] again advised me that there is nothing more she can do and the bill is my responsibility and I need to pay it. I asked her about appealing the bill with Dean Care and she became very agitated and short with me. She told me again that there is nothing more she can do. I asked for any way to get the bill reduced and she said that she is going to send a community care form but she does not think it will do me any good and ended the conversation. I am writing this because I have been working to get this bill processed through my insurance to which they cooperated because I did not receive my insurance cards when treatment was needed preventing me to find a provider. Dean Care said they accept Anthem Blue Cross Blue Shield and accepted me as a patient several times and wants me to pay $3,124.00. I feel like this a case of bait and switch and that the medical provider, Dean Care, needs to be upfront with their patients and tell them if their insurance is accepted. When I stated this it [redacted] told me, “Even though we are not contracted with Anthem Blue Cross Blue Shield we will still accept the insurance and try to process the claim. But, it is up to you to know if the claim will be able to be processed.” I was unable to find a provider because Anthem Blue Cross Blue Shield did not have my application processed preventing my cards to be issued when I should have had them. I relied on Dean Care to be honest and upfront in giving me the correct information about my insurance to which they failed. I am asking that Dean Care accept the in network cost for the treatment I received totaling $590.87 and eliminate the rest of the bill. Thank You, [redacted] Resolution : I am asking that Dean Care accept the in network cost for the treatment I received totaling $590.87 and eliminate the rest of the bill.Desired Settlement: Resolution : I am asking that Dean Care accept the in network cost for the treatment I received totaling $590.87 and eliminate the rest of the bill.

Business

Response:

Please see the attached response to Mr. [redacted] complaint.

Dean Clinic

Review: Hello,

Prior to having numerous blood work done at Dean Clinic in Waunakee (my primary office) I contacted WPS insurance to make sure that these tests would be covered under my husband's employer's plan (WPS The Alliance). The representative I spoke with said that as long as it is not coded as "infertile" then these can be routine tests. I put off having the tests until my annual physical this spring. I received numerous explanation of benefits and waited fo rmy bill from Dean Clinic to arrive. I was shocked that the bill was over $700. I started by calling WPS to ask why these were not covered. They said it was a coding issue and to contact Dean Clinic. I contacted Dean Clinic and they said that the coding would have been done by the provider and clinic I went to (Waunakee Dean Clinic) so I contacted them via phone and MyChart messaging and they said they would look into it. It basically came down to me contacting Dean Clinic again and them telling me to have my provider code them as routine exam tests and then they would be covered. I did this and was told I would get a new Explnation of Benefits in the mail. I received a letter in the mail on 8/1/14 indicating that a coding manner was brought to Dean Clinic's attention and it was corrected, but this was only one code. I did receive the EOB statements as well as a bill that was only about $26 less than the original bill, charging me just less than $700. I don't understand why I am dealt with this bill even though I did my homework from the beginning by calling WPS. I want to continue to refuse this bill, but do not want to have any issues in the future. Please assist. Your time and investigation is appreciated.

Consumer

Response: