Geisinger Wyoming Valley

October 16, 2014Dear [redacted] :Your letter referencing complaint ID [redacted] was referred to me for review and responseThe complaint was in regards to a patient receiving a bill for services provided on July 15, at one of Geisinger Health System’s hospital-based outpatient facilities.As you are likely aware, the model of provider-based or hospital-based outpatient is a common, legal practice throughout the countryGeisinger employs most of their physicians and this model provides for more appropriate payment for Services provided by staff physiciansThere are typically two charges for care rendered in a hospital-based outpatient setting, one for the facility and one for the professional (physician).It has been confirmed that the Neurosurgery Department does have several posters posted throughout the office notifying patients that they are a hospital-based outpatient locationIn addition, I have attached the brochure that is given to patients when they present at one of Geisinger’s outpatient hospital locationsIt provides answers to common questions, as well as a phone number and website the patient can use should they have additional questions.Currently, there is a total balance due of $35.90: $for professional charges and $for facility chargesThis amount is the patient responsibility.Should you need any further information, I can be reached at [redacted] .Diane ARevenue Cycle Supervisor

October 16, 2014Dear [redacted]:Your letter referencing complaint ID [redacted] was referred to me for review and response. The complaint was in regards to a patient receiving a bill for services provided on July 15, 2014 at one of Geisinger Health System’s hospital-based outpatient...

facilities.As you are likely aware, the model of provider-based or hospital-based outpatient is a common, legal practice throughout the country. Geisinger employs most of their physicians and this model provides for more appropriate payment for Services provided by staff physicians. There are typically two charges for care rendered in a hospital-based outpatient setting, one for the facility and one for the professional (physician).It has been confirmed that the Neurosurgery Department does have several posters posted throughout the office notifying patients that they are a hospital-based outpatient location. In addition, I have attached the brochure that is given to patients when they present at one of Geisinger’s outpatient hospital locations. It provides answers to common questions, as well as a phone number and website the patient can use should they have additional questions.Currently, there is a total balance due of $35.90: $10.00 for professional charges and $25.90 for facility charges. This amount is the patient responsibility.Should you need any further information, I can be reached at [redacted].Diane ARevenue Cycle Supervisor

Review: The surgical/gastro team at Geisinger Wyoming Valley improperly placed a biliary stent in my liver resulting in a delay in treating my gall bladder, prolonging a hospital stay from what should have been a day or two to almost two weeks, resulting in months of abdominal distress as the improperly placed stent worked it's way out of my body and caused the necessity to seek out another set of doctors to fix my problems. I spent almost two weeks in the hospital and none of my original symptoms were relieved or managed. They were in fact, worse than when I was admitted. They did not provide the services they are charging for. Another group of doctors took over and in short order, I knew what the problem was and it was taken care of. I contacted my insurance company and asked if they could refuse to pay Geisinger, but apparently that's not an option for them. I spoke to a lawyer and was told that because I did not die or suffer a life-long debilitating injury, there was no point in trying to sue the hospital, it would cost more to teach them a lesson than I would expect to recover. I am turning to you as a last resort to address something that could certainly be malpractice, but I'm reducing it to simply not getting what was paid for. I asked Geisinger to review the case because I was not about to pay them the money that the insurance company didn't. They almost killed me. It's only about $2500, but this is about principle. The medical piece of this is far worse than what I have included here so far - I endured 11 days of morphine and nothing being done, I had dozens, maybe a hundred boils on my legs weeping bile because the stent wasn't working, I'll have scars for years from them, I had gall bladder surgery scheduled 3 times and cancelled, I spent 8 hours in pre-op one of those times (which I'm sure cost thousands of dollars) and much more. I simply refuse to pay for the problems they caused me.Desired Settlement: I don't want to have to pay the amount of money my insurance didn't.

Review: I called for a consultation with a neurosurgeon for an office visit to review my MRI to discuss surgical options to treat my condition. I was given an appointment at an outpatient facility that was attached to a hospital. It was not explained to me when I scheduled the appointment that because the facility was not a separate building from the hospital that they would have the legal right to charge for hospital services. When I went to the facility they treated me as if this would be billed as a regular office visit. They copied my insurance card, they took the copay for an office visit with a specialist, at no time during the check in process did they inform me that I would be charged hospital charges. I have been to other outpatient facilities attached to hospitals and never been charged for hospital services so I would not have had any reason to ask. When I received the bill I discovered that they wanted additional money beyond my copay because they did not bill for an office visit, they billed hospital charges. I understand that they have the legal right to bill in such a fashion, however they never informed me that they would bill as such and they behaved as if this would be billed as an office visit. I feel that their behavior resembles bait and switch fraud because they presented their service as if it would be billed as an office visit and at no time did they inform me that this would be billed for hospital charges costing me more out of pocket money and the insurance company additional fees.Desired Settlement: I would like them to correct the bill to reflect a specialist office visit. Refund my insurance company and adjust the balance due. In the future they should be required to inform people that when they go to the clinic attached to the hospital they will be charged hospital charges and not office charges.

Business

Response:

October 16, 2014Dear [redacted]:Your letter referencing complaint ID [redacted] was referred to me for review and response. The complaint was in regards to a patient receiving a bill for services provided on July 15, 2014 at one of Geisinger Health System’s hospital-based outpatient facilities.As you are likely aware, the model of provider-based or hospital-based outpatient is a common, legal practice throughout the country. Geisinger employs most of their physicians and this model provides for more appropriate payment for Services provided by staff physicians. There are typically two charges for care rendered in a hospital-based outpatient setting, one for the facility and one for the professional (physician).It has been confirmed that the Neurosurgery Department does have several posters posted throughout the office notifying patients that they are a hospital-based outpatient location. In addition, I have attached the brochure that is given to patients when they present at one of Geisinger’s outpatient hospital locations. It provides answers to common questions, as well as a phone number and website the patient can use should they have additional questions.Currently, there is a total balance due of $35.90: $10.00 for professional charges and $25.90 for facility charges. This amount is the patient responsibility.Should you need any further information, I can be reached at [redacted].Diane ARevenue Cycle Supervisor