Dermatology Associates of Wisconsin, S.C.

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 account. The 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.

Patient was seen on 11/17/15 in our Muskego clinic by [redacted].  To prevent additional and unnecessary testing, [redacted] PA-C requested the patient's medical records at that time for previous labwork that had been completed.  The records were not received over the next 48 hours...

and as the clinic is only open on Tuesdays and Wednesdays, it was found that the records had still not been received on 11/24/15.  The patient hand-delivered these to the office that day; however due to the extended holiday weekend, [redacted]'s first opportunity to review these records was in the afternoon of 12/1/15. Writer attempted to call patient at the only phone number they have provided to discuss [redacted]'s treatment plan and notes; however there was no response and no ability to leave a message.  Writer will continue to attempt to contact the patient.

[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. 
Regards,
[redacted]

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 complaint. We are not balance billing the patient, we are simply billing the patient for the amount the insurance company put to the patient’s balance. We 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

Revdex.com:
I have reviewed the response made by the business...

in reference to complaint ID [redacted].I need to clarify - in response to the company's response to the Revdex.com:  I would like it noted that I am not fully satisfied with the company's overall handling of this complaint, which would seem to be the takeaway from their statement that all my questions were addressed satisfactorily.  I am not fully satisfied as I still believe the charge to insurance for services rendered was excessive.  Additionally, the result was ineffective and the response to that from the doctor (when learning of the concern over the result and the bill's charges) was to come back for additional paid services.  I did state at the end of the call to manager, Angela, that I would pay the bill *however* I still had concerns that the charges billed my insurance were excessive. I did appreciate finally receiving a call from a manager and having her more fully explain the charges appearing on the bill and what insurance did and did not pay and what insurance discounted - but did not pay - the doctor's office.  This was not clear to me from the explanation of benefits received from my insurance company for this visit nor the doctor's office bill and was not clarified as a result of the 2-3 calls I'd made to the billing department previously.  My initial call to billing was months prior to the manager's follow-up call, which was finally received yesterday, 7/18/17.Overall, follow up from the billing department could have been better and sooner.  I would have considered this complaint fully satisfied had there been an offer to reduce this bill or otherwise for an offer to have me come in -  as a result of the initial [ineffective] treatment - at no additional charge.You may close this complaint; thank you.
Regards,
[redacted]

Review: I was seen 11/17/15 for complaint of facial rash and hair loss. I was told the labs were going to be performed - the provider did not know at the time which ones and needed my recent health records. I signed a release form. 1 week later, I called the office to find out what lab were going to be ordered and where. They still could not give me an answer- stating- they did not get any health records. So I printed off my medical records and brought them into the clinic on 11/24- hoping that now they could provide me with a plan of care. I did not hear from them and did another follow up call the next day. They told me that they did not receive my medical records. I informed them, I physically handed my record to the front desk personal. They said they would look into it . So yesterday, I called Dermatology associated corporate, I stated my complaint and they reassured me my complaint would go to Nicole the manager and she would call me. I never received a call from her. The secretary also told me my medical records were scanned in on 11/24/15, and not to worry - that my records were not "lost" in the midst of things. I received a call from the Muskego clinic this am - letting me know that they received notification of this situation. They told me - they do not have my medical records- they couldn't see anything scanned in and that they would let me know what my plan of care was(labs to be ordered??). Well, today is over and still have not heard back. I called the corporate requesting to speak with Nicole the manager, and they told me I couldn't. The office doesn't call back and neither does corporate/manager. I just want to know what is the plan of care and where and what labs are going to be ordered. Horrible costumer service- Horrible professionalism!Desired Settlement: See above.

Business

Response:

Patient was seen on 11/17/15 in our Muskego clinic by [redacted]. To prevent additional and unnecessary testing, [redacted] PA-C requested the patient's medical records at that time for previous labwork that had been completed. The records were not received over the next 48 hours and as the clinic is only open on Tuesdays and Wednesdays, it was found that the records had still not been received on 11/24/15. The patient hand-delivered these to the office that day; however due to the extended holiday weekend, [redacted]'s first opportunity to review these records was in the afternoon of 12/1/15. Writer attempted to call patient at the only phone number they have provided to discuss [redacted]'s treatment plan and notes; however there was no response and no ability to leave a message. Writer will continue to attempt to contact the patient.

Business

Response:

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 platform. Thank you for your patience.

Consumer

Response:

[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.]

I have reviewed the response made by the business in reference to complaint ID [redacted], and find that this resolution is satisfactory to me.

Regards,

Review: I received a bill from them with a balance ($126.41) of the exact amount that was on the previous statement. I ignored it because I assumed it was a bill that was out of date and didn't reflect my recent payment. The next month came and another bill showed up, same amount. I called to ask why they are asking for a duplicate amount. I double checked my credit card bill and saw it definitely was charged. After the representative on the phone looked into it, he found that this second charge was for a followup visit. This followup visit consisted of about 3 minutes and the doctor saying everything looked good; no tests, no prescriptions, nothing. After asking why I was charged the same amount as the original visit, the representative offered no logical explanation and said that is just what code the doctor put into the system. After a lot of back and forth over it, the representative offered a $25 credit towards the bill, which I accepted, but doesn't even close to make up for the lack of justification of the charge. No other doctor I've been to charges this way. Had I known this is what they would've done, I would've stayed home.Desired Settlement: A billing adjustment that is reasonable and reflecting of a followup visit

Business

Response:

I am writing in response to the complaint previously submitted to the Revdex.com by Mr. [redacted], assigned id [redacted]. While Dermatology Associates of Wisconsin, S.C. (“DAW”) has a policy that prohibits discussing any particular patient’s situation without the proper releases, I can give you a general answer that would apply to all patients. When patients come in to one of our offices for multiple visits for the same problem, we follow CPT guidelines and charge for a “follow-up visit” for each office visit. CPT does not require any specific test or prescriptions be ordered in order to bill in this manner. We follow CPT guidelines to ensure we are acting in accordance with appropriate industry standards. On occasion we provide patients discounts as well, not as a result of our wrongdoing, but because we make it a practice to assist patients that either earn such discounts by paying in full or are undergoing financially difficult times.

Consumer

Response:

I wish I would have read the reviews on Forefront Dermatology's billing practices and pricing before my appointment with them. Their pricing for services rendered is unconscionable. After multiple evasive interactions with their customer service department and no response from the president to the registered letter I sent, my warning is: "buyer beware." They are taking advantage of the unwary. They can and are charging whatever they want. You as a consumer have NO recourse in resolving their exorbitant charges. I could have done what they charged $500 for with a can of
Medical Freeze Spray from Amazon.com for $16.

I went to Dermatology Associates to have 2 simple moles removed, they were nothing suspicious, but I just wanted them gone. After seeing the physician assistant for about 2 minutes and he took the moles off and sent them for "pathology", I got well over a $500.00 bill in the mail. That is insane if you ask me. I could have done it myself for free. They never let me know how much this would all cost me, and I assumed MAYBE $100.00. I made payment arrangements with the billing person on the phone and was told that was all I needed to do, only to be turned into a collections agency a month later. Really horrible customer service and VERY VERY expensive! There is no reason at all this short of an exam should cost so much. I work in healthcare as well and this is just crazy. Would highly recommend going elsewhere!

Review: Forefront Dermatology attempted to over charge me for services that are listed through [redacted] health insurance (In network) at a specific cost. Tissue exam for 4 moles removed costing $2,796.64

Per Signa network agreement cost should be $11.00 for each mole.

Forefront Dermatology also charged a specimen handling fee of $36.50 which was denied by [redacted] as it was not a valid charge.Desired Settlement: Adjust cost of tissue exam to reflect the $11.00 cost of in network insurance price.

Business

Response:

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.

Consumer

Response:

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. Dermatology Associates of Wisconsin's answer to my complaint is incorrect and doesn't provide the breakdown of my coverage and the amount billed correctly. I have call the office and my insurance numerous time to discuss my bill. I do not have any further questions for the Dermatology Office at this time. When I submitted my insurance information to the office, I was told it was great insurance and covered almost if not everything. I selected this dermatology office because they were in network and the estimated costs associated with my procedures seemed reasonably priced based on [redacted]’s website (attached). When I received the bill in the mail, however, I was shocked at how much was charged after a 30 minute office visit with 4 moles removed. My bill was separated into two services rendered for the same office visit – bill attached. One was for the visit, mole removal, and handling of specimens. The second one was for the test results / pathologies sent out for analysis. This one office visit came out to cost over $4,000! I have seen dermatologist numerous times, in and out of my insurance network, and have never been charged so much for similar services. I am appalled at this business and how they can charge my insurance and their clients this much. It is an unethical business practice to nickel and dime customers and charge for services that are associated with the procedures completed. Yes – I am referring to a “handling charge” of $36. I feel like I was wrongly informed about cost associated with my procedures and I do not want my insurance paying for the costs either. When I spoke with [redacted] Insurance, they stated that I needed to find out how the bill was coded by the dermatology office. They also stated that this was an extremely high price for test results and assumed I had numerous pathologies sent in (more than the 4). I called and it was billed for Lab Analysis instead of Tissue Exam, which should have made a price difference. I have attached further documentation on my bill and what [redacted] states that Dermatology of Wisconsin should charge for the services rendered. Bill came out to be a total of $4,189.98. Insurance adjusted to agreed upon pricing of $2,872.85. Total for me to pay out of pocket came out to $1,069.15. The Dermatology office should at least work with [redacted] to make sure the prices listed for their customers and other insurance companies reflects the correct amount on their website and shouldn’t claim to know how much insurance will cover up front for simple in office procedures. Regards, [redacted]

Business

Response:

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 complaint. We are not balance billing the patient, we are simply billing the patient for the amount the insurance company put to the patient’s balance. We 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

Complete ripoff artists, not doctors. Had a skin tag removed. Procedure took less than two minutes. Bill was over $900! And this was after my insurance reductions!!!
After reading the other reviews here it is quite obvious that they are in the business for the money and should not be trusted with your health. And why the A rating on Revdex.com?
Stay away! Stay very far away or they will steal your wallet!
Shameful!

I made an appointment with Derm. Assoc. of Wis. before finding these Revdex.com reviews. Concerned about their supposed high prices, I called another local dermatologist in New Berlin and requested a price quote for a superficial biopsy of a blister. Their quote was $220. Then I called Derm. Assoc. back and requested the same quote. Theirs was $1,200. Indeed, not only is this company very expensive, but it turns out their competition is NOT. You can do better elsewhere.

Review: I went for a physical examine, during the examine I asked the doctor to look at a growth on my right, which he said was only a wart. He asked to remove it, which I hesitated due to only being a wart and I could get some Compound-W wart remover for $10 dollars at Walgreens. At no time was I informed that they needed, or were going to send the wart out for a biopsy, and that it was standard procedure to do so. I feel that Dermatology Associates is try to up sell and? not fully disclosing to patients what they are doing, or informing them what they need to do when offering service. My up selling comment is based on some cream that I purchased for $99 dollars and my wife found/purchased the identical cream for $35 dollars else where.

I have contacted their billing department twice and also the doctor and no one has gotten back to me. The clerk in billing was curt when speaking with her and explaining the situation and dismissing. I think DA have qualified people, but they are NOT informing patients of the services they are performing. Furthermore, when I had a growth removed 2-years ago by the same doctor, I was told up front that they needed a biopsy. This is NOT the case with this disputed bill. The only part of the bill I am disputing IS the sending out and conducting a biopsy. If I was told up front, I would have not allowed the wart removal.Desired Settlement: As mentioned, I do not want to pay for any costs associated with the biopsy. I have already paid the other part of the bill in full.

Business

Response:

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

Business

Response:

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

Consumer

Response:

Review: I had an appointment at Forefront Dermatology in October 2014. Prior to my appointment the scheduler took my insurance information and advised my insurance would cover the visit. In December 2014 I received a bill for $259.40. I called and was told that the scheduler was incorrect, and my insurance would not pay. I told the billing department my appointment was less than 10 minutes long and asked if there could be any relief with the bill. She explained the reason the bill was so high is that the doctor took bloodwork, so I was paying for the 10 minute appointment plus subsequent testing of the blood. She offered a 'prompt payment' discount of 15% if paying by credit card or 20% if paying cash or check. I promptly paid the bill. After the discount I paid 207.52. A full year later, 10/15/2015, I received another bill for the same items I already paid for, billing an additional $362.11. I called billing 10/15/15 and explained I paid IN FULL a year ago. I was told a manager would call me back. After my call was not returned I called again 10/23/15, 11/16/15, 1/8/16, and 2/11/16. Each and every time I was told a manager was unavailable and would call me back. I expressed concern about collections since this dragged on for months, and was told a bill under dispute won't go to collections. During the 2/11/16 call I advised I intended to go to the Grafton, WI office to report the billing department for neglecting their duties and not calling me back with a resolution. Following that I received a call from Manager [redacted] who said she'd send her explanation of the bill in the mail. On 2/19/16 she instead send a "Demand Account Letter" stating she'd send me to a collections agency. I went to the Grafton office and reported the billing department's actions to Dr. [redacted]. I showed him my original bill, payment receipt, subsequent bill, and demand letter. He indicated he would work to resolve the billing error, but it has not been resolved.Desired Settlement: In order to preserve my credit, I paid the incorrectly billed $362.11 today 3/2/2016 - within the 14 days that the 'Demand Account Letter' allowed. This matter should be resolved with a full refund of the $362.11, and no futher bills from Forefront Dermatology.

Business

Response:

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 account. The 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.

Consumer

Response:

Review: My husband's doctor found a mole that "looked suspicious" last fall. He had it biopsied in her office, and afterwards, was told to go to a dermatologist to have more skin around the mole removed. The doctor's office called Dermatology Associates to make the appointment, which he assumed meant they were a preferred provider. He went to the initial consultation, which lasted less than 5 minutes. There, he signed paperwork indicating that our insurance company would be billed for all procedures. The paperwork also indicated that non-insured patients could expect that "final charges will be determined after the physician sees the patient and a complete assessment is made."

Much to our surprise, our insurance company said the provider was out-of-network, which meant all charges would not be covered by them. I had checked our insurance company website to find out if nevus removal was covered (it is) and what the average cost is ($250-660). I did not check to see if this was an in-network provider, as both the local doctor and the staff at the clinic told us they routinely worked with [redacted]. See below for the cost comparisons of what we found were the "typical" costs versus the charges from this clinic.

Doctors office visit - $75 - 175 ([redacted] allowed amount for initial removal - $108) (Derm Assc charge - $202.79)

Pathology tests/report - $80 - 185 (HP allowed amount for initial path - $150) (Derm Assc charge - $665.87)

Remove benign skin lesion - $140 - 235 (HP allowed amount for initial removal - $253.83) (Derm Assc charge - $1477.21)*

So - HP charges for the initial removal were $511.83 (of which we only paid 10%), while Derm Assoc charge for the second round of removal was $2,345.77.

*Note - on the payment form, Derm Assoc list charges of $130 for a new visit and $300 for a surgery visit - noting these are only down payments. If someone is glancing through it quickly, though, it seems like these are the primary charges, and any incidentals would be charged later on.

We tried appealing to both [redacted] and Dermatology Associates, and both basically said that it was our own fault for not checking to see if the provider was in-network. I wish either the referring clinic or the dermatology clinic told us to check with our insurance to see if they were in-network, but I can accept that ultimately, that was our responsibility (even though both implied they were covered). I also am irritated that the initial visit was originally sent to insurance as a consultation, and when the insurance didn't pay, they re-billed it under new codes so that they would get more money.

Regardless of how they billed, I do not believe we were given adequate information to make an informed decision. Certainly, had we known they were not in-network, we would have simply seen a provider that was in network. And, after that initial consultation with the dermatologist, had we been told the costs of the removal procedure prior to performing the service, we would have gotten a second opinion. What is really upsetting is the cost of care. Our final bill came to $2,345.77 - about 4X the max cost indicated by our insurance company as "typical" for this type of care and what we were charged for the initial removal. We went ahead with the procedure under the impression the total cost wouldn't exceed about $660, as indicated on our insurance page, and seeing the charges of $150 and $300 on their payment form. While I knew that our insurance did cover the nevus removal, I was prepared to pay up to $660 if for some reason insurance didn't cover it. Had we been told the final charges prior to the procedure, there is no way we would have gone through with it.

At this point, I've tried appealing through both [redacted] and Dermatology Associates. For the most part, their customer service representatives have been kind and responsive. In fact, Dermatology Associates did offer to reduce our final bill by 20% to $1902.34. While I can appreciate this goodwill gesture on their part, I'm still stuck on the fact that we were led to believe the whole thing was covered, and if it wasn't, the total bill would be a max of $660. I feel utterly misled. Patients who are referred for this procedure are told they could have skin cancer, which is very emotionally upsetting, putting them in a vulnerable position when making decisions about care. The clinic should be making sure all patients are well informed of potential costs prior to going through with the procedure, especially as their costs are so significantly higher than others.Desired Settlement: I just paid the $1902.34, but I still wish they were able to reduce their costs to something more comparable to what [redacted] would have (and did!) charge for similar procedures. My ideal outcome would be to pay the $660 max we thought we'd be charged or the $511.83 [redacted] allows for such procedures.

But, whether or not we are able to get any further reduction in cost of care, which I believe we are entitled to due to their business practices not giving patients enough information to make informed decisions, I would hope that their payment forms become much clearer about the total cost of procedures. I've noticed we are not the first to file a complaint with this company regarding their practices of not sharing cost information up front, and I would hope it doesn't take more complaints before their change their business practices.

(please note - dates on the next page of when I spoke to their customer service department are estimates)

Business

Response:

I am writing in response to the complaint previously submitted to the Revdex.com by Ms. [redacted], assigned ID [redacted]. While Dermatology Associates of Wisconsin, S.C. (“DAW”) has a policy that prohibits discussing any particular patient’s situation without the proper releases, I can give you a general answer that would apply to all patients. DAW has many agreements with different payors (such as HealthPartners) to provide medical services to their members. Often times these agreements do not permit all of a given payor’s membership to see DAW. In this case, DAW’s agreement with HealthPartners permits about 95% of their patients to see DAW providers as “in-network providers.” That said, HealthPartners does have a narrow network that DAW has no agreement with and, as such, cannot see those members as in-network. Unfortunately, [redacted] did not make DAW aware of this narrow network immediately upon its contracting with [redacted] and, as such, some patients that fell into this narrow network may have been seen by DAW providers as out of network. [redacted] advised DAW to bill each patient directly, as those patients were responsible for checking eligibility with [redacted] prior to the visit, which is what we in turn did. Patients that met certain criteria were offered 20 % discounts (the same discount we provide out uninsured patients), and many of them did take advantage of that offer. The policy of insurance companies to require their members to call the payer and verify insurance is standard across the industry. It is the responsibility of the consumer, not the provider, to verify that a given provider is in-network. While DAW tries its best to provide information in this regard to its patients, they are told that it is their obligation to verify coverage. Of course, failure of patients to call and verify coverage often leads to disenfranchised patients, but the fact remains, whether those patients call their insurance provider is completely outside of the control of DAW. An unfortunate side-effect of this failure to call is patients unhappy with their provider, despite receiving the highest-quality service. As mentioned above, while we cannot comment on specific patients without the appropriate releases, Ms. [redacted] even takes responsibility for her failure to verify coverage in her complaint to you, stating “it was our own fault for not checking to see if the provider was in-network.” DAW never takes steps to defraud its patients or payers and, as such, would never re-bill “under new codes so that [we] would get more money.” In the event a coding error is uncovered prior to payment, which in the case of [redacted] would include using a consult code ([redacted] does not accept consult codes), corrections are made and revised claims are sent to the party responsible for payment. In the case of HealthPartners, changing a consult code to a new patient office visit code actually results in a lower billed amount. In fact, the amount is actually lower by approximately 30%. Unfortunately, we do realize that when a patient realizes that their failure to verify coverage results in much higher personal expense it is a very tough situation to deal with, but again, we advise all patients to verify coverage. In the case of all HealthPartners patients that fell into the narrow network we followed the recommendation of billing the patient for the amounts outstanding for services rendered. We would encourage any consumer unhappy with their coverage to contact their payor and, perhaps more influential, their employer, to explain the difficulties encountered with their current coverage and ask for accommodations or changes to such policies. Thank you for your time.

Consumer

Response:

A health issue brought me to the office of Dr. [redacted], which is part of Dermatology Associates of Wisconsin, S.C. Having finished the examination, I was charged $75.00 by Dr. [redacted], which I paid before leaving. Two weeks later, I receive an additional bill from Dermatology Associates of Wisconsin, S.C. charging me an additional $88.36 for Office/Outpatient Visit. A phone call to the billing department clarified additional charge by saying that this is because I am a new patient, which I am not. I've been seen and operated by Dr. [redacted] previously but apparently poor filing in the office of Dr. [redacted] allows for mistakes like this one to take place.I also complained about Dermatology Associates of Wisconsin, S.C. unclear and what appear to be a scam like billing procedure. Before you will be examined by the doctor, you have to initial the agreement with Dermatology Associates of Wisconsin, S.C. that obligates you to pay $75.00 prior to your examination. The Agreement also states that a statement with the balance due for services provided will be mailed to you within a few days. Why don't they give you a clear bill with a detailed explanation to pay for the rendered services upon the end of your visit, but to send it to you 2 weeks after appears to be the intentional way for them to screw the patients ability to argue and dispute charges. Would it be easier for the patient to overlook charges right at the office, question and possibly settle them in case of some sort of misunderstanding or, as it is being done by Dermatology Associates of Wisconsin, S.C. to send you another bill with a shocking additional fee, that exceed all possible expectations for a 3 minute visual examination of your skin by a doctor, with no other specific tests performed, bringing the total bill to $163.36. As you can see, the essence of this scam-like billing system intents to distract customer attention at the moment of the office visit from understanding that you will be charged big time later, as they try to give you the impression that you honestly paid for the visit ( which honestly makes sense to pay $75.00 for a 3 minute of visual examination) and 2 weeks later upon you receiving the additional bill, you call billing department and they openly tell you that they are not going to argue charges of the bill with you and that you have nothing to do but play their rules. Meaning you're screwed big time, and if you don't pay what we scammed you with you may regret it. The second big part of this scam is that you never know what kind of charges for the rendered services you may incur. For this purpose the agreement you sign prior with a receptionist, states quote: "Procedure Pricing. I understand that the only procedure estimate that will be honored is a written estimate.Written estimates must be requested prior to appointment", meaning if you do not argue the price before even seeing a doctor, aftermath can be that you will not like it at all without the ability to argue it with billing. The third part and the worst one is the ethical part of this scam machine called Dermatology Associates of Wisconsin, S.C. Being a licensed physician in Europe, I clearly understand the specifics of Dermatological practice issues. You see, sometimes, treatment of skin diseases can be a long, treacherous and rather fruitless process. It is a way of multiple trials and possibly often failures, before you finally will find the reason of the sickness and the ability to manage it. Which may bring you to the doctors office again and again, meaning you are going to be billed again and again, incurring tremendous charges, especially if you unfortunately happened to be a patient within Dermatology Associates of Wisconsin, S.C. group, which will take your arm and leg using a flawless scam-like billing brewed on an unethical approach that some physicians who put money and profit over service and healing.

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