Doctors Groover Christie & Merritt Radiologists

I am responding to your letter dated January 2, regarding complaint ID [redacted] .I am very sorry this matter was not resolved to the family member’s satisfactionWe may be able to assist, or at least offer a better explanation.Since the complaint does not provide me with the name of the patient on the account, I am unable to provide specific details or resolutionHowever, I can speak to the general points of the complaintWe are a radiology group, contracted by the hospitalWe interrupt medical images ordered by attending or referring physiciansApparently, while the patient was being treated at the hospital, a chest x-ray was ordered by a physician involved in her careThe exam was completed by hospital staff, and interpreted by our radiologist, We then billed Medicare for our interpretation services ($33.00).We provided our services for the patient’s care, as ordered by her physician(s)I would assume that the ordering physician had medical reasons why he/she felt the chest x-ray was necessary, or in the best interest of the patient, though I cannot speak directly about thatMedicare has its criteria of what is considered medically necessaryThey do not reimburse for any treatment or exam that does not fall within the criteriaMany insurance companies have similar policies, though each set their own criteria.As noted in the complaint, it is reported that this x-ray was considered not medically necessary by MedicareAs the daughter stated in her complaint, she appealed the Medicare decisionIn these appeal cases, our billing company places a temporary hold on the account, which is why the GCM billing company requested to know the results of the Medicare appeal decisionDepending on the insurance coverage, the information noted in the explanation of benefits and medical billing rules, the balance is either appropriately billed as patient responsibility, or the account is closedI feel compelled to note that we do not ever report bogus information to credit agenciesThis is simply an untrue assumption.I would welcome contact from the patient’s daughter for details specific to this accountWe can then address the proper actions that need to be takenSincerely,Laura R Director of Operations DrsGroover Christie & Merritt ###-###-####

[To assist us in bringing this matter to a close, you must give us a reason why you are rejecting the responseIf no reason is received your complaint will be closed Administratively Resolved]
Complaint:
I am rejecting this response
because: When my Mom went in for back surgery, the doctor billed us for medically unnecessary services as determined by Medicare (reading x-rays). We appealed the determination with Medicare and Medicare requested additional information from the doctor. Medicare determined the doctor performed a medically unnecessary service during my Mom's hospital stay. We believe this is unethical and fraudulent to charge a patient for services they did not authorize and we believe we are not responsible for the bill. We have no problem paying for services that we authorize but don't feel we should pay for the doctor running up the bill with unnecessary charges. There is also a possibility since we were never were billed for the x-rays but only the reading, that the problem may be the doctor's unwillingness to provide a proper justification to Medicare and trying to stick us for their incompetence
We never authorized any medically unnecessary treatments and the doctor sent the bill to a collection agency when we disputed the billing.
Regards,
Joy Cauffman

While I am still researching why the refund took such a long time, I did find out the following:The refund check in the amount of $was issued to the patient at *** * *** ** on 8/29/The gentleman's Current address is listed as ***
*** ***, so that may account for some of the delay.Our records indicate the check was cashed and cleared the bank as of Oct 13, 2016.I am very sorry for such a delayI will continue to research this refund process, but I wanted to respond with what I have today.Sincerely,

I am responding to your letter dated January 2, 2015 regarding complaint ID [redacted].I am very sorry this matter was not resolved to the family member’s satisfaction. We may be able to assist, or at least offer a better explanation.Since the complaint does not provide me with the name of the patient on the account, I am unable to provide specific details or resolution. However, I can speak to the general points of the complaint. We are a radiology group, contracted by the hospital. We interrupt medical images ordered by attending or referring physicians. Apparently, while the patient was being treated at the hospital, a chest x-ray was ordered by a physician involved in her care. The exam was completed by hospital staff, and interpreted by our radiologist, We then billed Medicare for our interpretation services ($33.00).We provided our services for the patient’s care, as ordered by her physician(s). I would assume that the ordering physician had medical reasons why he/she felt the chest x-ray was necessary, or in the best interest of the patient, though I cannot speak directly about that. Medicare has its criteria of what is considered medically necessary. They do not reimburse for any treatment or exam that does not fall within the criteria. Many insurance companies have similar policies, though each set their own criteria.As noted in the complaint, it is reported that this x-ray was considered not medically necessary by Medicare. As the daughter stated in her complaint, she appealed the Medicare decision. In these appeal cases, our billing company places a temporary hold on the account, which is why the GCM billing company requested to know the results of the Medicare appeal decision. Depending on the insurance coverage, the information noted in the explanation of benefits and medical billing rules, the balance is either appropriately billed as patient responsibility, or the account is closed.
I feel compelled to note that we do not ever report bogus information to credit agencies. This is simply an untrue assumption.I would welcome contact from the patient’s daughter for details specific to this account. We can then address the proper actions that need to be taken.
Sincerely,Laura R
Director of Operations
Drs. Groover Christie & Merritt ###-###-####

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Attached is a copy of the receipt for the $40 co-pay