------ Forwarded message ----------From: S***, LindaDate: Mon, Dec 5, at 10:AMSubject: 2nd ResponseTo: "***@myRevdex.com.org" Cc: "S***, Linda" ***, Attached is the response prepared by the manager who has historical responsibility for all of inpatient and outpatient codersIt addresses the specifics of *** ***’s case and the article used by the *** to question the coding process. As stated previously the charging and coding of the services in December, and the resulting balance is correct. *** *** is welcome to apply for our Financial Assistance Program if payment of the claim presents a financial hardship. Thank youLinda MS***Team Manager, Customer ServicePatient Financial ServicesPenn State HealthPenn State Milton SHershey Medical CenterPO Box 853, Mail Code A-410Hershey, PA 17033Phone: ###-###-####Fax: ###-###-####
October 23, 2017Dear *** ***,This response is written to address the concerns noted in the complaint ID *** for services provided at Penn State Health, Milton SHershey Medical Center.The charges in question are for services rendered in August of After insurance processing there was
a balance due from the patient in the amount of $The patient contacted our office to establish a budget plan in October of 2016, but the first payment was not received until December of Two statements were sent notifying the patient of payment due on the budget plan she had established, before the first payment was actually received,Payments were made as the patient states in her letter in December, January, February, March, July and OctoberPayments were missed in April, May, June, August and SeptemberIt appears as if the account was reset at least once, which explains why the account did not age to bad debt earlier than it did.Under the new guidelines within the Affordable Healthcare Plan, when an account is placed with a collection agency the patient must be given a final opportunity to apply for Financial Assistance, which is the letter the patient referencesUnfortunately, we just discovered and agree the wording is miss-leading because it references the current balance and not any payment activity that might have occurredWe are going to be making changes to the verbiage, so it is not as confusing to our patients.In addition the patient is granted an additional days before the account can be credited reportedThis means the patient will have an additional days to pay, even though the account has been placed with a collection agencyThis days is in addition to the time that had already been allowed, which in this case was over year from when the patient received the first bill and contacted our office about a payment plan.We recognize that payment of medical bills can present a hardship to families; therefore, we do offer a generous Financial Assistance ProgramI could not tell by the notes whether this had ever been discussed with the patientIn addition it is noted that the patient is an employee of Penn State Health, Milton SHershey Medical Center, which means she could take advantage of a payroll deduction plan.I will request that a Financial Counselor reach out to her to discuss these options.Thank you for allowing us the opportunity to research the patient's concerns and respondRespectfully,Linda S.Team Manager, Customer Service
February 17, 2017Dear *** ***,The inquiry submitted on behalf of *** *** has been investigated.It is correct that hospital-based billing was implemented across all payers in 2010; however, previously Medicare patients seen in on-site clinics have been billed by this method since the mid
1990'sHospital-based outpatient refers to the billing process for services rendered in a hospital outpatient clinic or locationThis is a national model of practice for large integrated health care delivery systems like Penn State Hershey where the hospital owns the practice and employs the support personnel, including the physicians, involved in patient careThe billing method applies to all clinics within a mile radius of the hospital,Flyers are available in the various practice sites which give the patient some background information and answers to the most frequently-asked questionsA copy is enclosed if *** *** has not seen a copyEven though this billing method has been in place for seven years for all non-Medicare payers we are still occasionally finding instances where patients are unaware of how this method will impact their personal situationWe are continually seeking ways to ensure that patients are aware, but obviously we have not always been successful.In *** ***'s case he was seen in the hospital outpatient clinic setting for the first time on January 25th, He states he did inquire about the potential out-of-pocket cost prior to the appointment, but unfortunately there is no record of that call documented in the billing systemThere are detailed notes about the information he has requested about out-of-pocket costs for future services.As a result of receiving an Explanation of Benefits for the January appointment *** *** called our office on February 7thAt the time, even though he had the Explanation of Benefits, the payments/adjustments processed by his insurance company were not yet posted to the accountIn an attempt to clarify exactly what his responsibility would be an offer was made to do a Conference call with the insurance company, because not every insurance plan processes the technical component of the hospital visit the way it was processed under *** ***'s planIn some cases there is no additional out-of-pocket, other than the office visit co-pay.It is out typical policy to do a one-time adjustment on the technical balance if the patient was unaware of how their insurance would process, so that adjustment has been completedIt was not done at the time of *** ***'s call, because the insurance had not actually completed processing of the claim at that point,This is done as a one-time courtesy, so if *** *** continues to receive care at a PennState Health Facility he would be responsible for any out-of-pocket as assessed under the terms of his specific plan.Thank you for bringing *** ***'s concerns to our attentionPlease advise if any additional information is needed.Thank youRespectfully, Linda STeam Manager Customer Service and Cash Posting
October 23, 2016Dear *** ***,First, I want to extend my sincere apology for the delay in the response to this complaintAs we have discussed *** ***'s name has been removed from your records as the contact for our organization since she is no longer employed at Penn State Health-Milton S
Hershey Medical Center.In response to the general concerns presented it should be noted that this organization is a University-affiliated teaching hospital; therefore, students and/or residents often participate in the observation or management of the patient's careGenerally, patients are asked at the beginning of the appointment if they are willing to allow the student participationThey can accept or declineResidents are permitted to engage in a certain level care of care which is bilable to insurance as long as there is an attending physician present to supervise the work performed by the resident.Whether you are seeing the same physician has to do primarily with the scheduling of the appointmentsIt has been verified with the Pediatrics Department if the patient is being seen for well-child or routine care at specifically scheduled intervals the appointments can generally be scheduled with the physician requested by the family, but acute appointments, where time is of the essence, the child will be seen by the physician on duty at the time of the appointmentIt should be noted that the specific appointment being questioned was scheduled as an acute visit with the appointment being made the day of the call.The specific appointment, 7/29/2016, was investigated as requested by the patient's mom, Justine Moyle and it was found that there was a charge on the bill for removal of cerumen, which is not correctCharges for the technical and professional component totally $have been removedA corrected claim is being submitted to the insurance carrier and refunds in the amounts of S$and $are being issued to *** ***Finally, enclosed please find a fact sheet explaining hospital-based billing which should be available in all clinics.We apologize for the inconvenience this billing error has caused *** *** and thank her for taking the time to have the concern brought to our attention, allowing us the opportunity to take the proper corrective actionPlease advise if any additional information is neededI can be reached directly by either phone or email.Thank you Respectfully,Linda S.Team Manager, Customer Service
The patient's concerns are not financial related so the complaint has been forwarded to the appropriate departments who will respond directly to the Revdex.com.Thank youLinda *S*Team Manager, Customer Service###-###-####
Revdex.com:
I have reviewed the response made by the business in reference to complaint ID ***, and find that this resolution is satisfactory to me. Regarding HMC's assertion that they don't know how to improve the form it's not difficult (HMC is still trying to deflect responsibility!). They simply need to disclose that the fee will be submitted as an outpatient hospital service rather than a doctor's office service. Their "Hospital-based outpatient billing questions" notice has the essential information: "you will incur a co-insurance liability to the hospital that you would not incur if the facility were not hospital-based."I do appreciate it that HMC has zeroed out all charges for the allergy shots. Please extend my thanks to them
Regards,
*** ***
October 23, 2016Dear *** ***,The wife of *** ***, *** ***, was seen on February 23, for a Routine Annual Medical ExamAs part of that routine visit the physician ordered lab work that is allowable from an insurance perspective as part of that exam, *** *** had the lab work
completed on June 25, and insurance paid for it since it was ordered as part of the routine exam done on February 23rd.Unfortunately, when the results came back there were some test findings that were not within rangesIn order to ensure there were no underlying medical issues causing the results to be outside of the range it was recommended that several tests be repeated.*** *** had the repeat tests done on 12/4/By insurance-industry definition when the tests are done to confirm/rule out a specific problem the tests are considered diagnostic and no longer part of the routine examWhile Routine Annual Exams and associated testing is often a covered benefit with many plans, deductibles and co-insurance amounts generally apply to diagnostic testing.*** *** is being billed for the diagnostic lab work that was done on 12/4/because the insurance plan she is covered under assessed a deductible of $231.70, if payment of this balance presents a financial hardship *** *** may contact our Financial Counselors to determine whether she qualifies for our charity program,Thank you Respectfully,Linda S. Team Manager, 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 ***, and find that this resolution is satisfactory to me.
To:
Revdex.com Representative
*** ***
To: Team Manager-Customer Service and Cash Posting Linda *S*** ls***@hmc.psu.edu
RE:Complaint
# ***
Dear
*** ***,
I
appreciate and will accept the one-time adjustment on the full amount of $
of the remaining balance for this doctor’s visit
I
do understand all the facts that MrsLinda S*** addressed in her response
to my complaintI do understand as she said, they are continually seeking ways
to ensure that patients are aware of these facility fees and also that she is aware
that flyers are not adequate.
I
believe that a resolve to Penn State Hershey Medical Center’s billing department dilemma
could be to become transparent with the fees that might be incurred upfrontA
great way to do this would be to tell potential patients at the time of the
appointment setting that these fees might be incurred so that they have the opportunity
to make financial decisions prior to setting the appointment
I believe that disclosure
of these fees prior to appointment setting would insure a decline in the amount
of their “typical one-time adjustments” needed to be made to patients that were
unawareI am sure that this would save lots of time, money, confusion and bad publicity on
their side
I am thankful that in
result of this complaint there might be some changes made for others to
benefit
I did like the doctor that I met and was
hopeful to seeing her often as I am disabled and do currently have several
medical conditions and the facility is local, but unfortunately will not be
able to continue with her with these excessive fees that most insurers will not
cover
At
the end of Linda S***’s response she mentions a “*** ***”I am not sure
who he isI would like to request an email or something in writing that shows
a zero balance on my account for *** *** with Penn State Hershey
Medical Center
Thank you
Respectfully,
*** ** ***
###-###-####
***@***.com
December 11, 2017Dear Sir or Madam,Your attached letter, dated November 30, 2017, outlining *** *** ***’s concern with the billingpractices of Penn State Hershey Medical Center (PSHMC), has been reviewed.First, we apologize for any frustration or inconvenience experienced by **and *** *** as
a result oftheir recent appointments in the Camp Hill office.In both cases it had been some time since either **or *** *** had been seen and the addresses onfile at the time oftheir appointments in August were not currentAccording to the systemdocumentation **Hasan's address was updated at the time of the appointment, but *** ***’s wasnot.The accuracy of the patient’s address is not what caused the insurance company to reject the claimsubmitted on behalf of *** ***The reason for the rejection was the fact that the insurancecompany had sent a form to *** ***, asking her to confirm she was not covered under any otherinsurance planThe form is referred to as a Coordination of Benefits requestThis is common forinsurance companiesWhen they did not receive a response within their allotted time, they rejected theclaimWhen the insurance company rejects a claim because of needing information from the patient thebill is dropped to the patient as another reminder that they need to follwith their insurancecompany.Not having the correct address on file for *** ***, at this point, created a problem, because she wasunaware that we were trying to reach her until after the account had been sent to an outside collectionagency.The insurance company requests for the completion of the Coordination of Benefits from would havebeen sent to the address that the insurance company had on file in their system for *** *** andwould not necessarily have been the same as the address we had on fileit would appear as iftheirwritten requests for the completion of the Coordination of Benefits were received by **and **s.Hasan, because subsequently, and without any intervention on our part, the insurance company didprocess and pay the outstanding claims, leaving no out of pocket due from the patient.The address for *** *** has been updatedAgain we apologize for the error in not updating thepatient’s address information at the time of service.Thank youPlease advise if any there are any additional outstanding questions or concerns.Respectfully,Linda S. Team Manager, Customer Service
October 10, 2017 To Whom it May Concern,The letter dated October 2nd, concerning the account of *** *** for services provided at Penn State Health Hershey Medical Center has been reviewed and the following response is offered:*** *** states in her letter that she has outstanding
balances for treatment provided to her son which span the period from March 9th through July 10th, The total current outstanding for three separate visits is $1749.50.We recognize that payment of medical bills can be challenging so we have options available to assist familiesFirst, we offer formal budget plansDepending on the amount outstanding we work with families to span their payments out over several months, up to a maximum of months, in most cases.In this case there is no evidence the family ever agreed to a formal payment plan, even though it was offered in April when the balances were much lower and just recently when *** *** called our office to discuss ***'s accountThe account history reflects several small payments totaling approximately $have been paid since March.We also have a very generous Financial Assistance Program, which is offered to all patients who qualify whether they have insurance or notAgain, according to account documentation an application was mailed in April and another one was just sent in OctoberBased on conversations between staff in the Call Center and *** ***, it is likely the family would qualify based on income and family size, but again there is no evidence that the family ever followed through with the completion of the application and supporting documentation needed to confirm their eligibility.It seems, in this case, due to a lack of response in setting up a formal budget and/or completing the Financial Assistance Application, the oldest account with an outstanding balance aged to bad debtIt should be noted that at about the same time the complaint was filed with the Revdex.com, *** *** also called our office again and that is when a second Financial Assistance Application was sentIf the family follows through with the completion and providing the supporting documentation it is likely all outstanding balances, including the bad debt can be adjusted, but it is dependent on the family following through with the process.Thank you for forwarding these concerns to our attention and allowing us the opportunity to investigate and respond.Respectfully, Linda S.Team Manager, 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 would like the company representative to know that every time I have been here I have never seen an actual physicianIt has been student/resident, I have never been asked if it was okay to have them in the roomEvery time I would schedule an appointment they would say an actual doctor name but I never seen them this is one reason I do not attend this facility anymore and this is hidden loop hole the facility is doing by saying the actual doctor name when they were not presentAlso to know how many times I was double charged and for services never done makes me very skeptical of their practiceI have even heard other moms in my area complain about the same thing but have never came forwardI appreciate her response and urge her to investigate their departmentI will look for the refund in the mail and will no longer be at this place. I have reviewed the response made by the business in reference to complaint ID ***, and find that this resolution is satisfactory to me.
Regards,
*** ***
December 19, 2017Dear [redacted],This is in response to the customer complaint received in our Patient Financial Services Department on December 11, 2017 , concerning the above referenced patient, in...
relation to services provided in the Penn State Health, Milton S. Hershey Medical Center. Patient Relations, in collaboration with the clinic, has reviewed the patients concerns listed below. We are offering the following responses to the Desired Outcome/Settlement of this concern:1. Patient requests the original forms be updated with the correct dates and explanations signed by her doctor and resubmitted to [redacted]:Action: Forms have been amended, signed by her doctor and resubmitted to [redacted].2. Patient requests a copy of her medical records be sent to her: Action: Per Medical Records staff, medical records requested have been mailed to the patient.3. Patient asks for corrective action to be taken against the employee who mishandled her disability claim:Action: Any action to be taken in reference to a Penn State Health employee will be addressed internally as deemed appropriate.Thank you for allowing us the opportunity to review and respond to these concerns. As an institution, it is our goal to ensure every patient receives high-quality compassionate care and exceptional service. We appreciate receiving feedback, as it allows us to review our processes and service to our patient community.If I am able to address any additional concerns, please contact me at ###-###-####.Sincerely, Lori YPatient Relations Representative
I believe we probably will not get any further with our
complaint. Until the doctor's office
will discontinue billing our insurance with "hospital fees" for every
time my wife walks in the door, we will...
be continued to be "extorted"
in this legal but yet improper practice.
We would like this to stop. If my wife wanted to pay for "hospital
fees" she would drive to Hershey to the actual hospital, NOT Camp Hill to
a doctor's office. So obviously if the
facility is going to bill that way, the insurance company is not going to
review it as an office visit but a hospital visit.
I appreciate all that you've done. If there is anything more you can do to
address this borderline fraudulent practice, we can be in touch, but again, I don't
think we will get much further.
Everything with them is a "hospital fee" unfortunately.
And the bill was paid but I believe the office might have
responded prior to processing.
October 19,2017Dear [redacted]:This letter is In response to complaint ID...
number [redacted].The customer's complaint includes both patient care concerns and HIPAA Privacy concerns. As Privacy Specialist for Penn State Health, Milton S. Hershey Medical Center ("MSHMC"), my response will specifically address only the customer's privacy related concerns. The patient care related components of the customer's complaint have been forwarded to the Medical Center's office of Patient Relations for that office to respond to you directly.I previously spoke with the customer regarding her privacy concerns in June 2016. When she requested a unique PIN be assigned to her daughter's medical record, to ensure that patient Information was only disclosed to authorized Individuals, I explained that our organization does not assign unique PINs to an outpatient's record for identification verification purposes. The use of unique PINs is not a requirement under the HIPAA Privacy Rule. The Rule does not include specific or technical requirements for identity verification and allows covered entities to rely on their professional judgement and Industry standards in designing reasonable verification processes.When scheduling appointments and requesting information over the phone, MSHMC patients are asked to provide a minimum of two personal identifiers, such as name, date of birth or medical record number, to verify who they are. Limited information about a child will only be disclosed to the parent if the Individual representing themselves as the parent provides sufficient Information about their child, such that the person being provided the information can reasonably verify them as the parent.Following my conversation with the customer, I added an alert to her daughter's medical record instructing staff to carefully verify the mother's Identity prior to releasing any information regarding the daughter. The MSHMC Medical Group added a similar alert to the daughter's account in the scheduling system Additionally, Medical Group leadership sent an email communication to Medical Group workforce members as a reminder to not volunteer information when verifying patient registration information.With regard to the customer's general claims that the Medical Center does not follow its privacy policies, and has violated HIPAA, I am unable to address these statements without further details on the practices she believes are out of compliance.Regarding the customer's concern about the Medical Center not permitting her to record phone calls, the Medical Center does have a policy concerning recording by patients and visitors. In compliance with Pennsylvania State law, the Medical Center requires that parties participating in audio recording have given permission to being recorded. If clinical staff or other workforce members have not given permission to being recorded, a patient or visitor is not permitted to record them.The Medical Center is unable to comply with the customer's requested resolution of her complaint to remove her medical records and other information pertaining to her from Medical Center systems. In accordance with federal and state guidelines, medical records cannot be "removed" from an account. As stated previously, we do not assign unique PINs to an accountfaridentification purposes.Please let us know if there is any further information you need in order to assist in resolving the customer's concerns.Most Sincerely,Laura SPrivacy Specialist
July 27, 2017Dear [redacted],I offer my sincere apology for the delay to the additional concerns/questions presented by [redacted].Balances on the allergy injections have been adjusted as noted in [redacted]'s original letter. The affected dates are; 4/27/17, 5/4/17, 5/8/17, 5/11/17, 5/15/17 and 5/18/17. She is still being billed for the balance on the visit of 4/26/17, which was not a charge for an allergy injection. A copy of that visit is also enclosed.By adjusting the balances believe We were acknowledging that we agreed with [redacted]'s concern. I apologize that following the process outlined on the Immunotherapy Start Consent form, contacting the insurance carrier in advance, [redacted] did not get the result she was anticipating.I have spoken to representatives in the department that initiated the form and we are not certain what information could have/should have been contained on the form that would have improved the outcome, because every insurance carrier, every insurance plan processes claims differently. Even within our own organization clinics outside of the 35 mile radius are billing as physician practices, not as hospital-based, so if these allergy injections would have been given at the State College location these same claims would have processed differently and paid with no out of pocket according to [redacted].We will continue to assess the form for possible revisions and appreciate that this issue has been brought to our attention.A copy of the flyer referenced in the first letter is enclosed. [redacted] is correct, I believe it was overlooked in the first letter,Thank you. Please advise if any additional information is needed.Respectfully,Linda S. Team Manager Customer Service and Cash Posting
[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]
July 7, 2017Dear [redacted],The inquiry submitted on behalf of [redacted] has been investigated.It is correct that hospital-based billing was implemented across all payers in 2010; however, previously Medicare patients seen in on-site clinics have been billed by this method since the mid 1990's....
Hospital-based outpatient refers to the billing process for services rendered in a hospital outpatient clinic or location. This is a national model of practice for large integrated health care delivery systems like Penn State Health where the hospital owns the practice and employs the support personnel, including the physicians, involved in patient care. The billing method applies to all clinics within a 35 mile radius of the hospital.Flyers are available in the various practice sites which give the patient some background information and answers to the most frequently-asked questions. A copy is enclosed if [redacted] has not seen a c???.Specifically, in [redacted]'s it would appear that she would be familiar with this method of billing, because as far back as 2011 all of her services, including allergy-related have been billed with a technical component. During that time she has been covered by several different insurance plans, but each have assessed a patient pay on a portion of the technical component. Examples include; 6/28/11, $169,89; 2/28/12, $118.09; 12/10/13, $18.85; 10/8/14, $28,48; 9/24/15, $31,24;5/27/16, $30.00 and 1/26/17, $30.00.In the case of the allergy serum and injections there is physician involvement in the establishment of the diagnosis and development of the serum, but as [redacted] has described administration of the injection does not require the expertise of a physician; hence billing for technical component only to reflect the nursing staff time.Based on the history of this account and as a gesture of goodwill the balances remaining on the allergy injections have been adjusted noted in [redacted]'s later have been adjusted. The affected datesare;4/27/17, 5/4/17, 5/18/17, 5/11/17, 5/15/17 and 5/18/17.Thank you for bringing those concerns to our attention. Please advise if any additional information is needed.Thank youRespectfully,Linda S.Team Manager Customer Service and Cash Posting
------ Forwarded message ----------From: S***, LindaDate: Mon, Dec 5, at 10:AMSubject: 2nd ResponseTo: "***@myRevdex.com.org" Cc: "S***, Linda" ***, Attached is the response prepared by the manager who has historical responsibility for all of inpatient and outpatient codersIt addresses the specifics of *** ***’s case and the article used by the *** to question the coding process. As stated previously the charging and coding of the services in December, and the resulting balance is correct. *** *** is welcome to apply for our Financial Assistance Program if payment of the claim presents a financial hardship. Thank youLinda MS***Team Manager, Customer ServicePatient Financial ServicesPenn State HealthPenn State Milton SHershey Medical CenterPO Box 853, Mail Code A-410Hershey, PA 17033Phone: ###-###-####Fax: ###-###-####
October 23, 2017Dear *** ***,This response is written to address the concerns noted in the complaint ID *** for services provided at Penn State Health, Milton SHershey Medical Center.The charges in question are for services rendered in August of After insurance processing there was
a balance due from the patient in the amount of $The patient contacted our office to establish a budget plan in October of 2016, but the first payment was not received until December of Two statements were sent notifying the patient of payment due on the budget plan she had established, before the first payment was actually received,Payments were made as the patient states in her letter in December, January, February, March, July and OctoberPayments were missed in April, May, June, August and SeptemberIt appears as if the account was reset at least once, which explains why the account did not age to bad debt earlier than it did.Under the new guidelines within the Affordable Healthcare Plan, when an account is placed with a collection agency the patient must be given a final opportunity to apply for Financial Assistance, which is the letter the patient referencesUnfortunately, we just discovered and agree the wording is miss-leading because it references the current balance and not any payment activity that might have occurredWe are going to be making changes to the verbiage, so it is not as confusing to our patients.In addition the patient is granted an additional days before the account can be credited reportedThis means the patient will have an additional days to pay, even though the account has been placed with a collection agencyThis days is in addition to the time that had already been allowed, which in this case was over year from when the patient received the first bill and contacted our office about a payment plan.We recognize that payment of medical bills can present a hardship to families; therefore, we do offer a generous Financial Assistance ProgramI could not tell by the notes whether this had ever been discussed with the patientIn addition it is noted that the patient is an employee of Penn State Health, Milton SHershey Medical Center, which means she could take advantage of a payroll deduction plan.I will request that a Financial Counselor reach out to her to discuss these options.Thank you for allowing us the opportunity to research the patient's concerns and respondRespectfully,Linda S.Team Manager, Customer Service
February 17, 2017Dear *** ***,The inquiry submitted on behalf of *** *** has been investigated.It is correct that hospital-based billing was implemented across all payers in 2010; however, previously Medicare patients seen in on-site clinics have been billed by this method since the mid
1990'sHospital-based outpatient refers to the billing process for services rendered in a hospital outpatient clinic or locationThis is a national model of practice for large integrated health care delivery systems like Penn State Hershey where the hospital owns the practice and employs the support personnel, including the physicians, involved in patient careThe billing method applies to all clinics within a mile radius of the hospital,Flyers are available in the various practice sites which give the patient some background information and answers to the most frequently-asked questionsA copy is enclosed if *** *** has not seen a copyEven though this billing method has been in place for seven years for all non-Medicare payers we are still occasionally finding instances where patients are unaware of how this method will impact their personal situationWe are continually seeking ways to ensure that patients are aware, but obviously we have not always been successful.In *** ***'s case he was seen in the hospital outpatient clinic setting for the first time on January 25th, He states he did inquire about the potential out-of-pocket cost prior to the appointment, but unfortunately there is no record of that call documented in the billing systemThere are detailed notes about the information he has requested about out-of-pocket costs for future services.As a result of receiving an Explanation of Benefits for the January appointment *** *** called our office on February 7thAt the time, even though he had the Explanation of Benefits, the payments/adjustments processed by his insurance company were not yet posted to the accountIn an attempt to clarify exactly what his responsibility would be an offer was made to do a Conference call with the insurance company, because not every insurance plan processes the technical component of the hospital visit the way it was processed under *** ***'s planIn some cases there is no additional out-of-pocket, other than the office visit co-pay.It is out typical policy to do a one-time adjustment on the technical balance if the patient was unaware of how their insurance would process, so that adjustment has been completedIt was not done at the time of *** ***'s call, because the insurance had not actually completed processing of the claim at that point,This is done as a one-time courtesy, so if *** *** continues to receive care at a PennState Health Facility he would be responsible for any out-of-pocket as assessed under the terms of his specific plan.Thank you for bringing *** ***'s concerns to our attentionPlease advise if any additional information is needed.Thank youRespectfully, Linda STeam Manager Customer Service and Cash Posting
October 23, 2016Dear *** ***,First, I want to extend my sincere apology for the delay in the response to this complaintAs we have discussed *** ***'s name has been removed from your records as the contact for our organization since she is no longer employed at Penn State Health-Milton S
Hershey Medical Center.In response to the general concerns presented it should be noted that this organization is a University-affiliated teaching hospital; therefore, students and/or residents often participate in the observation or management of the patient's careGenerally, patients are asked at the beginning of the appointment if they are willing to allow the student participationThey can accept or declineResidents are permitted to engage in a certain level care of care which is bilable to insurance as long as there is an attending physician present to supervise the work performed by the resident.Whether you are seeing the same physician has to do primarily with the scheduling of the appointmentsIt has been verified with the Pediatrics Department if the patient is being seen for well-child or routine care at specifically scheduled intervals the appointments can generally be scheduled with the physician requested by the family, but acute appointments, where time is of the essence, the child will be seen by the physician on duty at the time of the appointmentIt should be noted that the specific appointment being questioned was scheduled as an acute visit with the appointment being made the day of the call.The specific appointment, 7/29/2016, was investigated as requested by the patient's mom, Justine Moyle and it was found that there was a charge on the bill for removal of cerumen, which is not correctCharges for the technical and professional component totally $have been removedA corrected claim is being submitted to the insurance carrier and refunds in the amounts of S$and $are being issued to *** ***Finally, enclosed please find a fact sheet explaining hospital-based billing which should be available in all clinics.We apologize for the inconvenience this billing error has caused *** *** and thank her for taking the time to have the concern brought to our attention, allowing us the opportunity to take the proper corrective actionPlease advise if any additional information is neededI can be reached directly by either phone or email.Thank you Respectfully,Linda S.Team Manager, Customer Service
The patient's concerns are not financial related so the complaint has been forwarded to the appropriate departments who will respond directly to the Revdex.com.Thank youLinda *S
*Team Manager, Customer Service###-###-####
Revdex.com:
I have reviewed the response made by the business in reference to complaint ID ***, and find that this resolution is satisfactory to me. Regarding HMC's assertion that they don't know how to improve the form it's not difficult (HMC is still trying to deflect responsibility!). They simply need to disclose that the fee will be submitted as an outpatient hospital service rather than a doctor's office service. Their "Hospital-based outpatient billing questions" notice has the essential information: "you will incur a co-insurance liability to the hospital that you would not incur if the facility were not hospital-based."I do appreciate it that HMC has zeroed out all charges for the allergy shots. Please extend my thanks to them
Regards,
*** ***
October 23, 2016Dear *** ***,The wife of *** ***, *** ***, was seen on February 23, for a Routine Annual Medical ExamAs part of that routine visit the physician ordered lab work that is allowable from an insurance perspective as part of that exam, *** *** had the lab work
completed on June 25, and insurance paid for it since it was ordered as part of the routine exam done on February 23rd.Unfortunately, when the results came back there were some test findings that were not within rangesIn order to ensure there were no underlying medical issues causing the results to be outside of the range it was recommended that several tests be repeated.*** *** had the repeat tests done on 12/4/By insurance-industry definition when the tests are done to confirm/rule out a specific problem the tests are considered diagnostic and no longer part of the routine examWhile Routine Annual Exams and associated testing is often a covered benefit with many plans, deductibles and co-insurance amounts generally apply to diagnostic testing.*** *** is being billed for the diagnostic lab work that was done on 12/4/because the insurance plan she is covered under assessed a deductible of $231.70, if payment of this balance presents a financial hardship *** *** may contact our Financial Counselors to determine whether she qualifies for our charity program,Thank you Respectfully,Linda S. Team Manager, 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 ***, and find that this resolution is satisfactory to me.
To:
Revdex.com Representative
*** ***
To: Team Manager-Customer Service and Cash Posting Linda *S*** ls***@hmc.psu.edu
RE:Complaint
# ***
Dear
*** ***,
I
appreciate and will accept the one-time adjustment on the full amount of $
of the remaining balance for this doctor’s visit
I
do understand all the facts that MrsLinda S*** addressed in her response
to my complaintI do understand as she said, they are continually seeking ways
to ensure that patients are aware of these facility fees and also that she is aware
that flyers are not adequate.
I
believe that a resolve to Penn State Hershey Medical Center’s billing department dilemma
could be to become transparent with the fees that might be incurred upfrontA
great way to do this would be to tell potential patients at the time of the
appointment setting that these fees might be incurred so that they have the opportunity
to make financial decisions prior to setting the appointment
I believe that disclosure
of these fees prior to appointment setting would insure a decline in the amount
of their “typical one-time adjustments” needed to be made to patients that were
unawareI am sure that this would save lots of time, money, confusion and bad publicity on
their side
I am thankful that in
result of this complaint there might be some changes made for others to
benefit
I did like the doctor that I met and was
hopeful to seeing her often as I am disabled and do currently have several
medical conditions and the facility is local, but unfortunately will not be
able to continue with her with these excessive fees that most insurers will not
cover
At
the end of Linda S***’s response she mentions a “*** ***”I am not sure
who he isI would like to request an email or something in writing that shows
a zero balance on my account for *** *** with Penn State Hershey
Medical Center
Thank you
Respectfully,
*** ** ***
###-###-####
***@***.com
December 11, 2017Dear Sir or Madam,Your attached letter, dated November 30, 2017, outlining *** *** ***’s concern with the billingpractices of Penn State Hershey Medical Center (PSHMC), has been reviewed.First, we apologize for any frustration or inconvenience experienced by **and *** *** as
a result oftheir recent appointments in the Camp Hill office.In both cases it had been some time since either **or *** *** had been seen and the addresses onfile at the time oftheir appointments in August were not currentAccording to the systemdocumentation **Hasan's address was updated at the time of the appointment, but *** ***’s wasnot.The accuracy of the patient’s address is not what caused the insurance company to reject the claimsubmitted on behalf of *** ***The reason for the rejection was the fact that the insurancecompany had sent a form to *** ***, asking her to confirm she was not covered under any otherinsurance planThe form is referred to as a Coordination of Benefits requestThis is common forinsurance companiesWhen they did not receive a response within their allotted time, they rejected theclaimWhen the insurance company rejects a claim because of needing information from the patient thebill is dropped to the patient as another reminder that they need to follwith their insurancecompany.Not having the correct address on file for *** ***, at this point, created a problem, because she wasunaware that we were trying to reach her until after the account had been sent to an outside collectionagency.The insurance company requests for the completion of the Coordination of Benefits from would havebeen sent to the address that the insurance company had on file in their system for *** *** andwould not necessarily have been the same as the address we had on fileit would appear as iftheirwritten requests for the completion of the Coordination of Benefits were received by **and **s.Hasan, because subsequently, and without any intervention on our part, the insurance company didprocess and pay the outstanding claims, leaving no out of pocket due from the patient.The address for *** *** has been updatedAgain we apologize for the error in not updating thepatient’s address information at the time of service.Thank youPlease advise if any there are any additional outstanding questions or concerns.Respectfully,Linda S. Team Manager, Customer Service
October 10, 2017 To Whom it May Concern,The letter dated October 2nd, concerning the account of *** *** for services provided at Penn State Health Hershey Medical Center has been reviewed and the following response is offered:*** *** states in her letter that she has outstanding
balances for treatment provided to her son which span the period from March 9th through July 10th, The total current outstanding for three separate visits is $1749.50.We recognize that payment of medical bills can be challenging so we have options available to assist familiesFirst, we offer formal budget plansDepending on the amount outstanding we work with families to span their payments out over several months, up to a maximum of months, in most cases.In this case there is no evidence the family ever agreed to a formal payment plan, even though it was offered in April when the balances were much lower and just recently when *** *** called our office to discuss ***'s accountThe account history reflects several small payments totaling approximately $have been paid since March.We also have a very generous Financial Assistance Program, which is offered to all patients who qualify whether they have insurance or notAgain, according to account documentation an application was mailed in April and another one was just sent in OctoberBased on conversations between staff in the Call Center and *** ***, it is likely the family would qualify based on income and family size, but again there is no evidence that the family ever followed through with the completion of the application and supporting documentation needed to confirm their eligibility.It seems, in this case, due to a lack of response in setting up a formal budget and/or completing the Financial Assistance Application, the oldest account with an outstanding balance aged to bad debtIt should be noted that at about the same time the complaint was filed with the Revdex.com, *** *** also called our office again and that is when a second Financial Assistance Application was sentIf the family follows through with the completion and providing the supporting documentation it is likely all outstanding balances, including the bad debt can be adjusted, but it is dependent on the family following through with the process.Thank you for forwarding these concerns to our attention and allowing us the opportunity to investigate and respond.Respectfully, Linda S.Team Manager, 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 would like the company representative to know that every time I have been here I have never seen an actual physicianIt has been student/resident, I have never been asked if it was okay to have them in the roomEvery time I would schedule an appointment they would say an actual doctor name but I never seen them this is one reason I do not attend this facility anymore and this is hidden loop hole the facility is doing by saying the actual doctor name when they were not presentAlso to know how many times I was double charged and for services never done makes me very skeptical of their practiceI have even heard other moms in my area complain about the same thing but have never came forwardI appreciate her response and urge her to investigate their departmentI will look for the refund in the mail and will no longer be at this place. I have reviewed the response made by the business in reference to complaint ID ***, and find that this resolution is satisfactory to me.
Regards,
*** ***
This complaint has been forwarded to the Manager of Patient Relations to investigate.
December 19, 2017Dear [redacted],This is in response to the customer complaint received in our Patient Financial Services Department on December 11, 2017 , concerning the above referenced patient, in...
relation to services provided in the Penn State Health, Milton S. Hershey Medical Center. Patient Relations, in collaboration with the clinic, has reviewed the patients concerns listed below. We are offering the following responses to the Desired Outcome/Settlement of this concern:1. Patient requests the original forms be updated with the correct dates and explanations signed by her doctor and resubmitted to [redacted]:Action: Forms have been amended, signed by her doctor and resubmitted to [redacted].2. Patient requests a copy of her medical records be sent to her: Action: Per Medical Records staff, medical records requested have been mailed to the patient.3. Patient asks for corrective action to be taken against the employee who mishandled her disability claim:Action: Any action to be taken in reference to a Penn State Health employee will be addressed internally as deemed appropriate.Thank you for allowing us the opportunity to review and respond to these concerns. As an institution, it is our goal to ensure every patient receives high-quality compassionate care and exceptional service. We appreciate receiving feedback, as it allows us to review our processes and service to our patient community.If I am able to address any additional concerns, please contact me at ###-###-####.Sincerely, Lori YPatient Relations Representative
To provide a written response to the [redacted] complaint
Dear Mrs. [redacted]
I believe we probably will not get any further with our
complaint. Until the doctor's office
will discontinue billing our insurance with "hospital fees" for every
time my wife walks in the door, we will...
be continued to be "extorted"
in this legal but yet improper practice.
We would like this to stop. If my wife wanted to pay for "hospital
fees" she would drive to Hershey to the actual hospital, NOT Camp Hill to
a doctor's office. So obviously if the
facility is going to bill that way, the insurance company is not going to
review it as an office visit but a hospital visit.
I appreciate all that you've done. If there is anything more you can do to
address this borderline fraudulent practice, we can be in touch, but again, I don't
think we will get much further.
Everything with them is a "hospital fee" unfortunately.
And the bill was paid but I believe the office might have
responded prior to processing.
Sincerely,
[redacted]
October 19,2017Dear [redacted]:This letter is In response to complaint ID...
number [redacted].The customer's complaint includes both patient care concerns and HIPAA Privacy concerns. As Privacy Specialist for Penn State Health, Milton S. Hershey Medical Center ("MSHMC"), my response will specifically address only the customer's privacy related concerns. The patient care related components of the customer's complaint have been forwarded to the Medical Center's office of Patient Relations for that office to respond to you directly.I previously spoke with the customer regarding her privacy concerns in June 2016. When she requested a unique PIN be assigned to her daughter's medical record, to ensure that patient Information was only disclosed to authorized Individuals, I explained that our organization does not assign unique PINs to an outpatient's record for identification verification purposes. The use of unique PINs is not a requirement under the HIPAA Privacy Rule. The Rule does not include specific or technical requirements for identity verification and allows covered entities to rely on their professional judgement and Industry standards in designing reasonable verification processes.When scheduling appointments and requesting information over the phone, MSHMC patients are asked to provide a minimum of two personal identifiers, such as name, date of birth or medical record number, to verify who they are. Limited information about a child will only be disclosed to the parent if the Individual representing themselves as the parent provides sufficient Information about their child, such that the person being provided the information can reasonably verify them as the parent.Following my conversation with the customer, I added an alert to her daughter's medical record instructing staff to carefully verify the mother's Identity prior to releasing any information regarding the daughter. The MSHMC Medical Group added a similar alert to the daughter's account in the scheduling system Additionally, Medical Group leadership sent an email communication to Medical Group workforce members as a reminder to not volunteer information when verifying patient registration information.With regard to the customer's general claims that the Medical Center does not follow its privacy policies, and has violated HIPAA, I am unable to address these statements without further details on the practices she believes are out of compliance.Regarding the customer's concern about the Medical Center not permitting her to record phone calls, the Medical Center does have a policy concerning recording by patients and visitors. In compliance with Pennsylvania State law, the Medical Center requires that parties participating in audio recording have given permission to being recorded. If clinical staff or other workforce members have not given permission to being recorded, a patient or visitor is not permitted to record them.The Medical Center is unable to comply with the customer's requested resolution of her complaint to remove her medical records and other information pertaining to her from Medical Center systems. In accordance with federal and state guidelines, medical records cannot be "removed" from an account. As stated previously, we do not assign unique PINs to an accountfaridentification purposes.Please let us know if there is any further information you need in order to assist in resolving the customer's concerns.Most Sincerely,Laura SPrivacy Specialist
July 27, 2017Dear [redacted],I offer my sincere apology for the delay to the additional concerns/questions presented by [redacted].Balances on the allergy injections have been adjusted as noted in [redacted]'s original letter. The affected dates are; 4/27/17, 5/4/17, 5/8/17, 5/11/17, 5/15/17 and 5/18/17. She is still being billed for the balance on the visit of 4/26/17, which was not a charge for an allergy injection. A copy of that visit is also enclosed.By adjusting the balances believe We were acknowledging that we agreed with [redacted]'s concern. I apologize that following the process outlined on the Immunotherapy Start Consent form, contacting the insurance carrier in advance, [redacted] did not get the result she was anticipating.I have spoken to representatives in the department that initiated the form and we are not certain what information could have/should have been contained on the form that would have improved the outcome, because every insurance carrier, every insurance plan processes claims differently. Even within our own organization clinics outside of the 35 mile radius are billing as physician practices, not as hospital-based, so if these allergy injections would have been given at the State College location these same claims would have processed differently and paid with no out of pocket according to [redacted].We will continue to assess the form for possible revisions and appreciate that this issue has been brought to our attention.A copy of the flyer referenced in the first letter is enclosed. [redacted] is correct, I believe it was overlooked in the first letter,Thank you. Please advise if any additional information is needed.Respectfully,Linda S. Team Manager Customer Service and Cash Posting
[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]
July 7, 2017Dear [redacted],The inquiry submitted on behalf of [redacted] has been investigated.It is correct that hospital-based billing was implemented across all payers in 2010; however, previously Medicare patients seen in on-site clinics have been billed by this method since the mid 1990's....
Hospital-based outpatient refers to the billing process for services rendered in a hospital outpatient clinic or location. This is a national model of practice for large integrated health care delivery systems like Penn State Health where the hospital owns the practice and employs the support personnel, including the physicians, involved in patient care. The billing method applies to all clinics within a 35 mile radius of the hospital.Flyers are available in the various practice sites which give the patient some background information and answers to the most frequently-asked questions. A copy is enclosed if [redacted] has not seen a c???.Specifically, in [redacted]'s it would appear that she would be familiar with this method of billing, because as far back as 2011 all of her services, including allergy-related have been billed with a technical component. During that time she has been covered by several different insurance plans, but each have assessed a patient pay on a portion of the technical component. Examples include; 6/28/11, $169,89; 2/28/12, $118.09; 12/10/13, $18.85; 10/8/14, $28,48; 9/24/15, $31,24;5/27/16, $30.00 and 1/26/17, $30.00.In the case of the allergy serum and injections there is physician involvement in the establishment of the diagnosis and development of the serum, but as [redacted] has described administration of the injection does not require the expertise of a physician; hence billing for technical component only to reflect the nursing staff time.Based on the history of this account and as a gesture of goodwill the balances remaining on the allergy injections have been adjusted noted in [redacted]'s later have been adjusted. The affected datesare;4/27/17, 5/4/17, 5/18/17, 5/11/17, 5/15/17 and 5/18/17.Thank you for bringing those concerns to our attention. Please advise if any additional information is needed.Thank youRespectfully,Linda S.Team Manager Customer Service and Cash Posting