Group Health Cooperative of South Central WI

We have been in contact with the Customer and have resolved her concern stated in this complaint Prior to receiving this complaint, and a similar review posted to the Revdex.com, our Member Services Department and Medical Billing Department were able to confirm Customer's payment, and correct the system error which was indicating non-payment A representative of GHC-SCW communicated with Customer directly and confirmed that this concern had been resolved, and GHC-SCW apologized for the issue and Customer's frustration We believe that the Customer's concerns have been satisfactorily resolved

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 The response from Group Health Cooperative does not address the complaint at allIn my initial complaint, I described to you the entire process that GHC makes you go through in order to pay my son's claim***, the GHC advocacy partner, did help with letters to the hospital but after that, they advised us to not pay anything and wait for the hospital to write off the balance or be sent to a collections agencyWhen the balance was finally set to collections, [redacted] then wanted us to negotiate further to lessen GHC's financial responsibilitySteering a patient to collections and possibly hurting their credit in order to lessen their financial responsibility is a rotten way to do businessNo decent company would do thatMy son is diabetic and going to school in Milwaukee one more yearIf he gets sick again and has to go to an emergency room, GHC said we would have to go through the whole process again to get the claim paidAnd, we just received a bill from the hospital for $GHC said they paid the balance of the claim but they obviously did notThis is an awful way to treat a customerI paid my son's portion of the claimGHC needs to pay the rest in a timely fashion period without putting a patient into collections [To assist us in bringing this matter to a close, we would like to know your view on the matter.] Regards, [redacted]

This letter is in response to the complaint that was filed on June We understand thatone of our members disagrees with Group Health Cooperative of South Central Wisconsin's(GHC-SCW) handling of a claim for serviceWe have been in contact directly with member toaddress his concerns.I assure you that we strive to administer our health plan benefits as accurately, equitably, andfairly as possibleWe make every effort to collaborate with our members and their providers tofully understand the clinical needs of our members while effectively administering the benefitsof the planIn this situation, our Claims Department and our patient advocacy partner have hadongoing discussions with this member regarding the resolution of this claimYou have also beencollaborating with our patient advocacy partner in an effort to resolve these charges with theprovider amicably.Mr [redacted] , thank you for allowing us to respond to this complaintThough the claim wasultimately resolved, we certainly regret any inconvenience or misunderstanding in this matter.Please feel free to contact me directly if personally may be of further assistance or clarificationin this matter

This letter is in response to the complaint that was originally filed on June 19, Weunderstand that our member expressed additional concerns subsequent to our initial response toyour officeWe understand that our member continues to disagree with Group HealthCooperative of South Central Wisconsin's (GHC-SCW) handling of a claim for serviceWe hadbeen in contact directly with the member to address his concerns.The member's recent correspondence indicates that GHC had failed to pay a balance on a claim.Upon further review and upon following up with the provider, we confinned that the providerdid in fact receive the payment that we had remitted for servicesWe suspect that the providermay have submitted a bill to our member prior to posting the payment received from ***.Consequently, if the member did remit payment to the provider, then he should be owed a refundfrom the providerWe've been having ongoing communications with this member about theclaim, and we're certainly happy to continue to address any additional questions or concernsdirectly with the member.Mr***, thank you for allowing us to respond to this complaintThough we encourageour members to seek care from providers who are within our network of contracted providers, weunderstand that it is sometimes necessary for our members to receive care from non-contractedprovidersWe strive to collaborate fully with the provider and member in effectively andefficiently resolving these types of claimsWe certainly regret any inconvenience ormisunderstanding in this matterPlease feel free to contact me directly if I personally may be offurther assistance or clarification in this matter

This letter is in response to your correspondence dated February 15, I received thecorrespondence on February 22, The complaint contained in your letter involved aconsumer who reported to having received continuous harassing sales phone calls.Upon receipt and review of this concern, I
confirmed that our organization has not conducted anytelephone marketing efforts during the time period cited by the consumerI’m confident that theconcerns expressed by the consumer could not be attributable to our organizationI did alsoreach out directly to the consumer in an effort to discuss the matter further and to assure her thatour organization does not engage in the marketing activities cited in her complaint.Please contact me if you have questions or concerns regarding this matter.Sincerely,*** ***

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.   The response from Group Health Cooperative does not address the complaint at all. In my initial complaint, I described to you the entire process that GHC makes you go through in order to pay my son's claim. [redacted], the GHC advocacy partner, did help with letters to the hospital but after that, they advised us to not pay anything and wait for the hospital to write off the balance or be sent to a collections agency. When the balance was finally set to collections, [redacted] then wanted us to negotiate further to lessen GHC's financial responsibility. Steering a patient to collections and possibly hurting their credit in order to lessen their financial responsibility is a rotten way to do business. No decent company would do that. My son is diabetic and going to school in Milwaukee one more year. If he gets sick again and has to go to an emergency room, GHC said we would have to go through the whole process again to get the claim paid. And, we just received a bill from the hospital for $1246.82. GHC said they paid the balance of the claim but they obviously did not. This is an awful way to treat a customer. I paid my son's portion of the claim. GHC needs to pay the rest in a timely fashion period without putting a patient into collections. 
[To assist us in bringing this matter to a close, we would like to know your view on the matter.]
Regards,
[redacted]

We have been in contact with the Customer and have resolved her concern stated in this complaint.  Prior to receiving this complaint, and a similar review posted to the Revdex.com, our Member Services Department and Medical Billing Department were able to confirm Customer's payment,...

and correct the system error which was indicating non-payment.  A representative of GHC-SCW communicated with Customer directly and confirmed that this concern had been resolved, and GHC-SCW apologized for the issue and Customer's frustration.  We believe that the Customer's concerns have been satisfactorily resolved.

This letter is in response to the complaint that was filed on June 19.201 5. We understand thatone of our members disagrees with Group Health Cooperative of South Central Wisconsin's(GHC-SCW) handling of a claim for service. We have been in contact directly with member toaddress his concerns.I...

assure you that we strive to administer our health plan benefits as accurately, equitably, andfairly as possible. We make every effort to collaborate with our members and their providers tofully understand the clinical needs of our members while effectively administering the benefitsof the plan. In this situation, our Claims Department and our patient advocacy partner have hadongoing discussions with this member regarding the resolution of this claim. You have also beencollaborating with our patient advocacy partner in an effort to resolve these charges with theprovider amicably.Mr. [redacted], thank you for allowing us to respond to this complaint. Though the claim wasultimately resolved, we certainly regret any inconvenience or misunderstanding in this matter.Please feel free to contact me directly if 1 personally may be of further assistance or clarificationin this matter

Review: On July 18, 2013 I received correspondence from State Collection Services Inc. stating that I owe Group Health Cooperative $40.00. I am disputing this correspondence for numerous reasons: (1) I am a current member of Group Health and health care insurance is deducted every two weeks. (2) Every month I receive a zero balance invoice stating I do not owe money for any services. (3) I have never been notified of any payments due (as stated in item #2); (4) I have a 100% credit rating never paying a bill late. I am very upset that this firm has not contacted me and has turned this minute amount over to a credit collection agency which could damage my credit rating. I would like this amount removed from my records; I request that this collection agency be notified and if this is reflected on my credit report I will file a complaint with every known regulatory agency that exist State and Federal.Desired Settlement: That these false allegations be removed from my record; that the collection agency be notified and the record be removed.

Business

Response:

Revdex.com of Wisconsin, Inc.

August 23, 2013

RE: Case #: [redacted]

Dear Revdex.com of Wisconsin,

We are responding to the above complaint received from

your office via email on 8/20/13, and in the mail on 8/23/13. Group Health Cooperative of South Central

Wisconsin (GHC-SCW) reviewed this Consumer’s desired resolution of removing the

charges in the amount of $40.00.

We will respond to each of the consumer’s points below:

1.

The consumer is correct when stating to be a

current member of GHC-SCW. This coverage

is purchased through the consumer’s employer.

For which, this member states a certain dollar amount is deducted every

two weeks. This deduction they speak of

is NOT administered or collected by GHC-SCW.

2.

We are unsure as to what the consumer is

referencing regarding an invoice with $0.00 balance as it is not our practice

to mail patient statements which have a $0.00 balance.

3.

GHC-SCW has mailed four patient statements which

included the above mentioned $40.00, to the consumers address, for which we

verified is the same address that was given by this consumer, to the RevDex.com of Wisconsin, regarding this complaint. These patient statements were dated 2/28/13

for $40.00; 4/4/13 for $40.00; 5/4/13 for $40.00; 6/8/13 for $60.00 (for which

the $40.00 mentioned above is added with another $20.00 outstanding amount).

GHC-SCW also mailed two

Explanation of Benefits, regarding this owed amount on 2/7/13, and 2/8/13. The Explanation of Benefits is not a bill but

it notifies the member that there is a Member Responsibility for a certain Date

of Service. Then the Patient statement

is mailed.

GHC-SCW made two attempts to

contact this consumer via the phone on 3/28/13 and 6/27/13 to discuss the

amount due. However, there was no answer

and no answering machine to leave a message.

4.

GHC-SCW does not have information related to

this consumer’s credit rating, so we cannot verify the consumer’s statement of

having 100% credit rating. However,

there have been five past amounts due to GHC-SCW that were sent to State

collections dating back to 2003.

GHC-SCW will not be removing this $40.00 amount from

state collections, and with the information provided to you above, there are no

false allegations made by GHC-SCW to rectify.

GHC-SCW Member’s always have the right to file a grievance within

GHC-SCW, by contacting Member Services Department at ###-###-####.

Thank you for allowing GHC-SCW the opportunity to respond

with the facts surrounding this complaint.

Sincerely,

GHC-SCW Member Services

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.

To date, I have not received any correspondence from Group Health; I pay all copayments and pharmacy bills via credit card. I will reference each charge with the appropriate credit card and provide the information to you. I am at work during the day and Group Health has that number; if they really wanted to discuss these charges with me.

Review: I work in Madison at the [redacted] and have Group Health Cooperative as my family health insurance. My diabetic son [redacted]. During a bout of the stomach flu at school on 3/31/14, he went to the emergency room at Aurora Health Care in Milwaukee. A few days later on 4/3/14, he had to go in again for an IV. His stomach was not absorbing food properly and he had another diabetic sugar low. We contacted GHC as they request when a patient is seen out-of-area. Per my policy, an emergency office visit is $75 each visit which is paid to the hospital and GHC then pays the rest.I sent Aurora Health 2 checks for $75 for each visit. I assumed GHC was going to pay the entire difference and that would be the end of it. GHC did make a payment to the hospital but it was not the full balance. What I was told later is that GHC and Aurora do not have any agreement between each other and Aurora would not negotiate on the cost of the emergency office visits. Aurora then started billing my son in December, 2014 for that difference which was $2611.80. I called GHC to get them to take care of this amount. I was told that GHC now uses a company called [redacted] to deal with these situations. I then had to call a Scott S[redacted] at [redacted]. He said the first thing I have to do is file a dispute letter for each appointment. This would prompt Aurora to negotiate the balance or write it off entirely. I was assured by him that 99 times out of 100, the hospital would just write off this balance. He e-mailed me 2 separate dispute letters and I sent them to Aurora. Got another bill in January, 2015. Called Scott. He said not to worry. They will be writing it off soon. And even if they sent my son's account to collections, the laws now would not allow Aurora to report this debt to the credit agencies. Got another bill in February. Called Scott. Same story again. If they sent the account to collections it wouldn't appear on his credit report. If it got sent to collections, GHC would pay that balance immediately. Received a bill in March and April. Called Scott. Same thing. Be patient. In May, my son received a letter from the State Collection Service for $1364.98, half of what the original balance was. Called Scott. He said now my son had to call State Collections and negotiate further and get the bill lower and then GHC will pay it. That was enough. I called GHC and talked to a Victoria. I told her that this is a terrible way to do business. GHC needed to negotiate with Aurora a long time ago and get this balance paid. My son is in collections. She asked what the amount was and I told her. She said she would talk to her boss and see if GHC would pay it. She called me back and said they would pay it off. I said does everyone in this situation go through this same crap. She said yes but there aren't that many. They just started using this [redacted] company a little more than a year ago. I said would you like this if this happened to your son? She said well it doesn't get put on his credit report. I said that my son has got one more year of school in Milwaukee. What if he gets sick again and has to go to the hospital. Will he have to go through this all over again? Victoria said yes. I said this is an awful way to do business and I wanted to file complaint with GHC. I talked to another woman and voiced my complaint. This would go to a Sarah, Victoria's boss. After telling this woman my complaint, she said that this collections notice wouldn't be on my son's credit report. I told her my diabetic son is now worried about going to an emergency room when he is sick because he will be sent to collections again for something GHC should have paid for in full to begin with.Desired Settlement: In the future, GHC should stop using this kind of business practice or method to settle an obligation they have to their customer. GHC should negotiate with Aurora and any other hospital if necessary and then pay that balance off in full for the patient. This balance was always GHC's responsibility and should be taken care without having a patient sent to collections.

Business

Response:

This letter is in response to the complaint that was filed on June 19.201 5. We understand thatone of our members disagrees with Group Health Cooperative of South Central Wisconsin's(GHC-SCW) handling of a claim for service. We have been in contact directly with member toaddress his concerns.I assure you that we strive to administer our health plan benefits as accurately, equitably, andfairly as possible. We make every effort to collaborate with our members and their providers tofully understand the clinical needs of our members while effectively administering the benefitsof the plan. In this situation, our Claims Department and our patient advocacy partner have hadongoing discussions with this member regarding the resolution of this claim. You have also beencollaborating with our patient advocacy partner in an effort to resolve these charges with theprovider amicably.Mr. [redacted], thank you for allowing us to respond to this complaint. Though the claim wasultimately resolved, we certainly regret any inconvenience or misunderstanding in this matter.Please feel free to contact me directly if 1 personally may be of further assistance or clarificationin this matter

Consumer

Response:

Review: I didn't think it would come to this, so I did not document exact dates, but I know GHC has this information. I went to a free skin care screening clinic and was told, with a sense of urgency, that I needed to schedule an appointment ASAP with dermatology for removal of this wart. That was failure #1. I was encouraged to do something that would cost $$$ rather than first be advised for an over-the-counter option. I had the small common wart for over a decade, so I'm not sure why it was an issue anyway. I called in to GHC to inquire further. Now I was told different info. I was told that my primary could do it. I happened to have my annual physical coming up (those visits are covered under my health care plan) and they said the doc could just do it then, FREE OF CHARGE. This all made perfect sense. I am a healthy woman and my appointments only take about 1/2 of the allotted time, so it made sense there would be extra time for a quick treatment. The treatment took less than 1 minute, and didn't work. But I could look past that it doesn't work (although still upset I was never advised to try over the counter...so I feel deceived by the skin care docs and their advice to see a derm doc asap), but I was told it would be free. I ended up getting a bill for $144 and some change. I went through the dispute process, and was denied. I am a good customer that pays all my bills on time, but in this situation I was deceived, and I do not feel it is right that I was charged $144. It did not take extra time and resources even. If it had, I may be more willing to pay, despite the wrongful nature of this whole thing.Desired Settlement: I would be willing to pay $20 of this. That is what it would cost to do an over the counter treatment (or less). I believe this is fair, since I was never given that advice, but since have found out that would be the first place to start. At home. I would expect GHC in good faith to remove this bill from my account. They would not be at a loss for services, and I would be treated fairly as a consumer and human.

Business

Response:

Revdex.com of Wisconsin, Inc.

10019 W. Greenfield Ave

Milwaukee, WI

53214

August 23, 2013

RE: Case #: [redacted]

Dear Revdex.com of Wisconsin,

We are responding to the above complaint received from

your office via email on 8/20/13, and in the mail on 8/23/13. Group Health Cooperative of South Central

Wisconsin (GHC-SCW) reviewed this Consumer’s desired resolution of removing the

charges, except for $20.00 that the Consumer is willing to pay, from the

charges accrued from an appointment on 05/08/13, for the amount of $124.95.

Our records indicate that the consumer did contact

GHC-SCW on 4/22/13 at 2:17 pm, inquiring if the procedure could be completed

during a future appointment that was already scheduled for an Annual Physical

with the consumers Primary Care Physician on 5/8/13. Our records indicate that an LPN that works

with the consumers Primary Care Physican replied back that the treatment could

be done at the future appointment. Our

records also indicate that there was no question from the consumer regarding

cost for the procedure, nor was there a response from GHC-SCW that this

procedure would be FREE OF CHARGE.

Please Note: This procedure is billed separately than the

Annual Physical because it is not part of an Annual Preventive Health

Exam. However, GHC-SCW was able to

accommodate the consumer’s request.

The procedure was completed on 5/8/13 as requested and

was billed appropriately according to the consumer’s benefit plan.

Our records indicate that the consumer made a contact to

the Member Services Department inquiring on costs for services the day AFTER

the appointment when the procedure was completed, on 5/9/13 at 7:58 am. The Consumer asked about the cost of the

procedure that was completed the day before, and was given a price range for

services that were done or ordered at that appointment and what the future

charges could be due to the consumers benefit plan.

The consumer purchased a Benefit plan that has Maximum

Out of Pocket amounts that need to be met prior to having no patient liability

for services, which is why this procedure processed with a patient

liability. This consumer receives a

Benefit Summary within her renewal packet annually, this explains the benefit

plan. The most recent renewal packet was

processed, and sent to the consumer on 12/19/2012.

Our records show that the consumer filed a grievance with

GHC-SCW regarding this complaint on 7/16/13.

The GHC-SCW Member Appeals Committee reviewed this grievance on

8/13/13. It was determined that this

procedure processed correctly to this members Benefit plan, and denied this

members request to waive these charges accrued from the requested procedure.

GHC-SCW will not be removing the patient responsibility

for the remaining balance of $109.95.

Thank you for allowing GHC-SCW the opportunity to respond

with the facts surrounding this complaint.

Sincerely,

GHC-SCW Member Services

Business

Response:

Revdex.com of Wisconsin, Inc.

10019 W. Greenfield Ave.

Milwaukee, WI

53214

September 13, 2013

Re: Case #: [redacted]

Dear Revdex.com of Wisconsin,

We are responding to the consumer’s clarification

question received 9/5/13, regarding the above mentioned Case. Group Health Cooperative of South Central

Wisconsin (GHC-SCW) has records of the consumer contacting our Receptionist on

4/22/2013 at 12:57 pm for which a clinical message was recorded and sent to the

Consumer’s Care Team as a referral request for an appointment within our

_________ Department (because of HIPPA requirements, I am not able to disclose

certain information), for a treatment.

This message also mentions that the consumer offered information to the

receptionist about a future appointment with their Primary Care Physician (PCP)

on 5/8/13, and may get treatment done at that time. On 4/22/13 at 2:17 pm a nurse contacted the

consumer back and was notified that the treatment can be done at the

appointment with PCP. There was no

discussion regarding costs within either of these contacts, nor was there a

question raised by the consumer of home care possibilities.

This consumer has the Preventive Care benefit, which

means they do receive one annual physical examination per year for which the

consumer does not incur patient liability.

If there are any other services/treatments/procedures done during that

appointment, they are appropriately coded separately on the claim, and are processed

according to the consumer’s benefits.

This treatment is not considered to be part of the preventive care

benefit for which did incur patient liability, accurately.

GHC-SCW will not be removing the patient liability for

these services.

Thank you for allowing GHC-SCW the opportunity to respond

with clarifying facts surrounding this concern.

Sincerely

GHC-SCW Member Services

Consumer

Response:

Unbelievably bad care. It actually concerns me that these people are responsible for people's well being.