Dermatology Associates of Wisconsin, S.C.

To Whom It May Concern; Thank you for the information regarding the dissatisfaction from patient and complaint ID [redacted] Due to not having a release on file with the Revdex.com we cannot discuss specifics regarding the account After review, it does look as though both providers indicated in the patient’s complaint did bill for their services correctly based on the documentation for the visit We follow the CPT guidelines, established by the government, for all of our coding decisions and this visit was no exception from that rule Forefront Dermatology has a standard fee schedule that all patients are charged and is established to be competitive in the markets that we serve That being said, an insurance company actually dictates what medical providers are able to put forth to patient responsibility for medical services In this case, based on the codes that we billed for the visit, the insurance company has directed Forefront Dermatology to bill the patient the amount indicated by the patient in their complaintWe are not balance billing the patient, we are simply billing the patient for the amount the insurance company put to the patient’s balanceWe apologize that the patient is not satisfied for the fee that was incurred for this visit If patients request an estimate for services prior to them being provided we are 100% supportive of providing this information so our patient’s our informed This is indicated on a form that the patient signed at the time of their appointment At this time we are open to working out payment arrangements with the patient to work out a payment plan that meets their financial situation Thank you for your time and have a great day! Sincerely, Forefront Dermatology

We apologize that the patient is not satisfied with the fee that was incurred for this visit At this time, the patient has exhausted all avenues of discussion about her account charges with the Forefront Dermatology billing department and was also issued a written explanation of all charges on her accountThe billing issues the patient references in her original complaint are between her and an outside laboratory, over which we have no control of the charges Finally, the patient's insurance has made a determination of coverage based on plan benefits, including her deductible amount and plan benefits which is again out of Forefront Dermatology's control

We have contacted the individual and resolved the issueThank you for bringing the concern to our attention, as we strive to maintain excellent customer service

Please have customer contact our billing department to resolve the issueThank you

Forefront Dermatology has been working directly with our patient, as the discussion was in progress before the complaint was submitted to the Revdex.comThe patient is satisfied with the agreement

April 27, To Whom it May Concern: We have reviewed the complaint submitted by our patient referenced as Complaint ID: *** regarding an office visit. We have reached out to the patient and we have resolved the patients concern to their full satisfaction

We were unable to leave a message on the phone number provided to us. Please call our nursing department at ###-###-#### to discuss labs needed and the next steps as we cannot discuss details regarding your medical information via this platformThank you for your patience

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
I was told before the appointment my insurance would cover the cost. I was told during the appointment that bloodwork was routine for new patients. "Routine" implies preventative, not diagnostic, particularly after you told me everything you observed during the appointment showed no cause for concern. I spent less than minutes with the doctor, who told me everything looked fine. He said he believed my symptoms were stress related and told me new patients get blood testing. If he would have found problems, I suspect the appointment would have lasted more than minutes, and I would have had follow up or treatment scheduled.In February when I met with the doctor to report the billing department, he repeated that he found no medical problems and repeated that he believed my symptems were attributed to stress. He gave me a copy of my bloodwork which he described as having or good results. Your office told me I was fine but told my insurance company there was a medical diagnosis. Which is it!?!? I think that contradiction has a better chance of being interpreted as fraud than re-submitting the claim under the pretence you gave me- routine bloodwork for a new patientI felt I was dealing with a reputable company until I was double billed a year after the appointment and ignored for months while trying to resolve the bill. All my requests for paperwork about this bill and about my insurance were ignored. Despite your stonewalling, I located customer service for my insurance, who has repeatedly told me you should re-submit the claim. Feel free to attach this Revdex.com record to show you stance and resistance to doing so. I have made them aware of this dispute and they tell me your re-submittal is the next step to a resolution
Regards,
*** ***

To Whom It May Concern;In reviewing this patient's complaint and the service that was provided it looks as though all was billed properly by the physicians involved. In general, every patient that has any sort of removal performed is provided with a wound care and removal fact sheet. On
the form itself it indicates what will happen with the specimen that was removed from the patient and what they can expect. We apologize for any misunderstanding, as that is not the intention of the services we provide. The balance that remains is still due at this time as the services that were billed are documented and were provided to the patient. Thank you.Sincerely,Dermatology Associates Billing Department

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
I received a call from the business accounting. The caller, ***, went into a nonstop repetitious script attempting to explain why they re-billed at a different amount than the first. I had to interrupt repeatedly in order to ask a question. When I asked why the zero amount had been changed, the response was because they listed an amount in the insurance column, I was supposed to somehow understand that it meant the zero amount for my amount was going to change. There was no answer for the question how do I know this with no explanation supplied on the statement. The indication was that it has always been done like this. When I again interrupted to ask why when the insurance EOB was completed for all line items at the same time, Forefront did not reflect that on the statement, the answer supplied was the insurance payment differed from what they had expected by more than $and they had a second level appeal which took from October till February. Since the time period was about what it takes for a second level appeal with the insurance along with the same terminology, I again interrupted to ask if the appeal was with the insurance. The response was that it was an internal appeal. I am verifying this with insurance as it seems suspicious. I concluded the conversation saying that there would have been no problem had the statement initially reflected the insurance EOB or the zero amount should have been listed as TBD, not 0. I indicated I am not satisfied with the billing, I will not be doing any further business with them, and to cancel the upcoming appointment. I have just checked the website and the appointment has not been cancelled. This again demonstrates the inability to listen to the patient. I initially thought the amount was a billing adjustment because I was less than satisfied with the procedure that developed into an infection. I was wrong. They do not put patient satisfaction on their to do list. Mark this as unresolved.
Regards,
*** ***

To Whom It May Concern,With regard to consumer complaints of this
nature, we take each and every complaint seriously, ensuring that all
complaints are investigated and taking reasonable steps to resolve them
consistent with company policies and applicable laws and regulations. Despite
our commitment to resolving consumer complaints, as a physician practice,
Forefront Dermatology must also adhere to protecting the privacy,
confidentiality and security of health information. As a "covered
entity," Forefront Dermatology is governed by privacy regulations
including the Health Insurance Portability and Accountability Act
("HIPAA") and, accordingly, without the proper releases, we are
unable to provide insight into any specific patient’s situation. With that said, we can generally say that many
common growths can have a similar appearance to the naked eye and
differentiating between these lesions requires submitting tissue for pathology
(biopsy).  This is a routine practice and is done to protect the patient
as removal without pathologic confirmation of diagnosis can lead to
under-treatment of cancerous growths.  This could potentially lead to a
cancer spreading and even death.  For that reason, sending a biopsy to the
lab to get a firm diagnosis is considered standard of care.  Of note, OTC
treatments work in only a portion of warts and are completely ineffective
against other benign and cancerous growths that can mimic warts by visual
inspection. Many
common growths can have a similar appearance to the naked eye and
differentiating between these lesions requires submitting tissue for pathology
(biopsy).  This is a routine practice and is done to protect the patient
as removal without pathologic confirmation of diagnosis can lead to
under-treatment of cancerous growths.  This could potentially lead to a
cancer spreading and even death.  For that reason, sending a biopsy to the
lab to get a firm diagnosis is considered standard of care.  Of note, OTC
treatments work in only a portion of warts and are completely ineffective
against other benign and cancerous growths that can mimic warts by visual
inspection. Sincerely, Forefront Dermatology Management

I understand the solution seems as simple as changing a code, however when tests are ordered for diagnostic testing and not for preventative or routine screening purposes we must submit the bill with the proper coding. The patient presented to the office with a medical concern and labs were ordered for diagnostic purposes. We cannot change the billing codes used as that would constitute billing fraud. At this point there is no further action that can be taken on our part. Any changes to the billing codes would constitute billing fraud.

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.
THIS IS RIDICULOUS! I AM TIRED OF WASTING MY TIME WITH THIS PROCESS! AT NO TIME DID THE DOCTOR REACH OUT TO ME, AND FOR THE 4TH TIME I WAS NEVER INFORMED OF THEIR PROCESS PLAIN AND SIMPLE, NOT SURE WHAT PART OF "NOT INFORMING THE PATIENT" PEOPLE ARE NOT UNDERSTANDING HERE! THEY HAVE A REAL NICE EXPLANATION ON THE BILL, MAYBE THEY SHOULD THINK ABOUT SHARING THAT WITH THE PATIENT AT TIME OF SERVICE!!!!!!!!!!!! NEVER MET A COMPANY / DOCTOR UNWILLING TO WORK WITH A PATIENT!GLAD FOR SOCIAL MEDIA!
Regards,
[redacted]

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID [redacted], and find that this...

resolution is satisfactory to me.  They have contacted me and explained the situation and were happy to oblige to my request. They also clarified that the corporate response was never passed on to the branch office, and so my complaint was never viewed or handled by them unfortunately.
Regards,
[redacted]

Ms. [redacted] seems to be referring to the billed versus allowed amount of her insurance contracted rate.  Forefront Dermatology bills in accordance with legal billing guidelines and each insurance company agrees to a specific contracted rate that allows for a certain percentage of the amount...

billed.  In this case, Ms. [redacted]'s insurance company was billed $2796.64 for services rendered during an Office Visit with multiple pathologies. [redacted]'s allowed amount for these charges is $894.08 of which, they paid $247.92, put $27.55 towards her co-insurance, and put the remaining $618.61 towards the patient's deductible. One of the items that was billed to Ms. [redacted]'s insurance was for specimen handling at a fee of $36.50. This code is not recognized by [redacted] insurance as a billable code per contracted agreements and therefore was adjusted off by insurance. Ms. [redacted] is more than welcome to call our billing department for further clarification of the charges.

We have reviewed the account in question and have reviewed the information that the patients insurance company has provided to both us and to the patient in November.  There were four items on the response from the insurance company.  Three of the responses we agreed with and the...

appropriate actions were taken and the balances for the three lines were transferred from insurance responsibility to patient responsibility (This created the patients balance of 530.01)  The fourth line item was flagged for further research to ensure appropriate payment.  This line item was left in insurance responsibility at this time and the patients statement sent on 11/27 showed that there was still an outstanding “Insurance Balance”.  Regrettably this does happen from time to time but we feel that it is important to provide the patient with the most accurate information hence we did not want to include this fourth line item on the patient statement until we have verified that it was truly patient responsibility. We researched this account and were able to determine the appropriate amount that should be patient responsibility in February at which point we made the appropriate adjustments to the patients accounts and moved the amount that the patient owed to patient responsibility at this time.  This is what led to the patient getting a second statement showing that the 4th line now has a patient balance (145.35). We have reached out to the patient and explained this process and mailed a copy of Insurance Company EOB and statements to the patient for their review.

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.
[To assist us in bringing this matter to a close, we would like to know your view on the matter.]I was able to locate a customer service phone number for the insurance I had in 2014 to discuss this issue with them.  I spoke with [redacted] who advised all of the charges listed under Dr. [redacted] (the outside laboratory hired by Dr. [redacted]) would be completely paid for by the insurance if the billing department would submit them with correct codes.  He said the codes need to be 'preventative' rather than 'diagnostic'.  He gave me a phone number of ###-###-#### which the billing department can use if they do not know how to code correctly.  He advised once they do that, they should be able to refund me 380.03.  He could not find record of them submitting anything under Dr. [redacted]'s name, so it is possible this was never submitted, and I just was told to pay it back in 2014.  It is possible that once Dr. [redacted]'s portion of the bill is submitted, there could be an additional refund owed.  Please have the billing department follow up on this information.
Regards,
[redacted]

We have contacted the individual and resolved the issue. Thank you for bringing the concern to our attention, as we strive to maintain excellent customer service.

[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...

is satisfactory to me.  I did receive a phone call from Premier appologizing for a computer billing error and they told me the issue has been addressed and no future bills for that amount will be mailed. Thanks for your your time in helping me getting Premier to admitt their error and there being a resolution to the problem without any further delay.
Regards,
[redacted]

It is Forefront's standard policy to contact the patient directly for Revdex.com concerns. We have contacted the patient to discuss this concern and answer all of her questions satisfactorily. No further action needed.