LA Weight Loss Center

The patient’s wife called the providers office previously and spoke at length with DrC***’ assistant, who explained that the x-rays done in our office were necessary because DrC [redacted] needed standing views of the patient’s knees These views were different from the images done at the primary care doctor’s office Also, the charge for the x-rays done was $130, and we did a contractual write off of $58, which left a balance of $72, which the insurance company applied to the patient’s deductible We are unable to adjust any additional monies from the patient’s account Valerie S*Director, Professional Billing Services

Hey [redacted] Would you please reopen this Revdex.com? When I had spoken with ***, she said that she was pulling this account back from [redacted] I spoke with [redacted] at UMG and paid $something dollars and she put me on a payment planNow, I just received a call from [redacted] where the rep was very rude and told me that I still owe the full amountThe rep told me that I can go on their site and see that I am still owing this amountThe rep said that UMG had not pulled this backI can show proof that I made a payment to UMGThis is dual collections, which is an illegal practice, not to mention that I have already paid approx 20% of this debt to UMG to pull this back and [redacted] is attempting to collect the full amountThanks, [redacted]

***, I have done some research on this account and have discovered the problem with the payment of services with *** This patients charges for the mammogram have been cleared on the GHS/PIH side.Thanks you for your assistanceMarsha D***Manager, Radiology ServicesUMG Greenville Radiology

This is a UMG complaintI am not sure who your contact is there.I understand that the patient was offered a discount and the patient did not agree to the offerPlease let me know if you do not have a contact for UMG

Below is the response to patient complaint ID# [redacted] for the patient calls to the OBGYN CenterPatient called the OBGYN Center on 3/25/two times and each call was returned within less than minutes The first call came at 11:09am and returned by the nurse at 11:am and the nurse left a voicemail The second call came at 11:and the nurse returned the call at 11:56AM and again had to leave a voicemail It is documented that the nurse spoke to the patient at 12:15PM on the same dayPatient called the OBGYN Center on 3/30/to schedule appoint to speak to a doctor regarding the Miscarriage Patient seen in our office on 4/5/and reassured and counseled to wait 3-months before getting pregnant againFrom the documentation in the chart the nurses returned the patients phone calls in a timely mannerAs previously mentioned in less than minutes in each of the accounts abovePlease let me know if I can be of further assistance KathyKathy Lum, MBAClinic ManagerOBGYN CenterGrove Road, Greenville, SCP:864-455-8802F: 864-455-

This refund was keyed to our system on 09/15/Once the refund is keyed, typically we receive the check from accounting acouple days later, once we confirm all checks have been received that we requested we then place thm in our ootgoing mail binThe mail is picked up by a courier and sent to our downtown location to be stamped and mailed outThese checks received were completed by our business office on 9/22/15, we are estimating they were sent to be mailed 9/23/Patient shoudl be getting this week if not alreadyThank-You

According to the desired outcome of the original response, all outcomes seem to have been met at this time, please read below and advise if satisfiactory.1. Claim to be filed-Claim was filed electronically submitted on 8/17/152. Has my insurance company take care of the bill?- All 3 claims were paid & money was posted to account on 09/02/15, all three claims have a zero balance.3. For GHS to permanentaly remove remove me from collection agency's file- email was sent to [redacted] on 8/31/15 @3:42pm, and they responded to confirm this was done 8/31/15 @ 5:58pm4. For GHS to remove the negative information from my file-These debt's were never reported to your creditIssues addressed in last message:1. Last response states letter stating she is out of collections was not recived from UMG- This letter was just mailed on 8/31/15 after our mail had already been picked up by courier. Our mail gets sent to our downtown GHS location to be stamped and mailed out, so mail from our office can take up to 7-10 days, depending on quantity. But the letter has been sent.2. Mother requested bill showing she has a zero balance: Insurance just paid the claims yesterday so a zero balance itemized bill is being placed in mail bin today3. Mother states she told us that baby was covered: We can not go by what a patient tells us, we have to go by eligibility and by what an Insurance company tells us.4. Mother states we should have contacted her when we received response that policy not active: Our way of contacting patients is by sending them a statement to let them know that Insurance has not paid or has not been filed. There would not be enough people to call evey patient that we get an ineligible response from.5. Mother states we should have communicated with the insurance company: I pulled the recorded call, when the Insurance rep [redacted] called she told us the child had coverage, and the rep verified the subscriber and the ID#, we ran the eligibility with exactly what the [redacted] rep gave us and it still came back that the child was inactive. We are only able to be as effiecient as the information we recieve. When we told the insurance rep this she was confused and didn't know why it was showing that and said she would call us back when she found out why it was saying that. We get our eligibility repsonses straight from [redacted] web service.6. What was the resolve in the conversation between UMG and [redacted] on 07/09/15?: [redacted] stated "let me go back to this members home plan and advise them we are having troble and see if an update is needed" My rep even asked [redacted] to call her back and gave her her direct phone # which we do not typically do but my rep was doing her best to help resolve this. The fact that she didn't not want her to have to call back and hold in que or have to explain situation to another rep indicated good customer service to me.I apoligize if you feel you were not given good customer service and that is not what we strive for, we always want everyones issue to be resolved, but also understand that we have policies and procedures we have to follow and one of the policies is to not file claims to Insurances that are getting an inactive response. I apoligize that your insurance company was sending us bad information. I know this has been frustrating but the claims are now paid.Please let me know if there is anything else I can do to help resolve this situation. [redacted] ***

Refund of [redacted] was keyed to our system todayPatient should receive refund within 7-days

*** ***tome*** ** proof NarrativePage 1- The first page provides information on relatives who have had cancer and what kind of cancer they have had.Page 2- this provides the information that I had the chicken pox *** vaccinationPage 3-4- These are the doctors notes from *** ***She claims that I have a history of cold sores, when in fact I clearly told her that I have never had one, the test just came back positive that I was a carrierShe claimed to had read my medical record, however her notes clearly say other words, and she did not "ask" about me having the chickenpox, when in fact the information was right in front of herAs well as claiming I have a history of cold sores, when in fact I have never had one.*** ** proof NarrativePage 1- In the early weeks of December, I called in because I was in a severe amount of painI spoke with *** (on call RN), and her reply was that she needed to talk to *** about the pain and what to do about itI then received a phone call back and she stated that I could go on birth control which would help with the pain, I could get a pain medication or I could simply do nothingI chose the pain medication and the birth controla few days went by, and the pain was worse on the birth control then off of itI stopped taking the pills and called back and specifically requested a muscle relaxer because the *** (pain medication) was not doing anything*** called in the perscription.Between December 22- January 10, I spoke with *** the on call RNShe told me that the medication to induce my period needed to be taken to obtain ovulationThe other prescription that was prescribed was a fertility medicationShe told me to begin the medication to induce my period, and then on the 10th day to begin the fertility medication.The nurses notes from *** are completely inaccurate and False, and they are filled with opinions*** claimed that I was taking the medication wrong, however, I took it to the specific way *** told me to* *** did not understand thatI also told her that I has spotted in December, she obviously ignored thatshe even went as far to ask me if the *** (medication to induce period) worked which I had taken in November, I told her that it was a week late, and the cycle was extremely lightShe ignored everything I told her, and then claimed that I was not telling the truth as well as lying about everythingShe obviously did not understand or comprehend anything that I had told herShe further went on to state that, I had been rude to everyone and which is probably why I was released from care from *** Which is Not trueI even told her the first office visit that the reason I was at *** was because *** took over a month to call me back for my lab work, and they filed my insurance wrong as well as filing it under someone elses nameI made it very clear that the test results could not be trusted.Pages end of page 1-page 3- these are of the detailed complaints that I sent this office that they ignoredI never received a phone call or anything.Page 4- This is just a flat out lieI called the practice out after talking to lawyers, that they did nothing and the office manager still did not give a darn*** *** claims that I slammed the phone down on the receiver however, that is not in the least bit true as the only phone I have is my Cell phone, and it does not come with a receiver.I also have more then enough reason to be completly pissed with this practice, as they have lied on my medical record, committed negligence, as well as many other things

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. Thank you for your help, it is appreciated.
Regards,
*** ***

*** *** was a patient of *** and *** *** *** for several years. She was discharged from ***’s care on Sept24, for failure to keep scheduled appointments. She missed multiple appointments and did not call the office in advance
to cancel and canceled several appointments just before she was scheduled to arrive Failure to keep appointments compromised ***'s ability to take care of her. Her failure to call the office to cancel the appointments reduced ***’s availability to see other patients that needed care. *** has an automatic appointment reminder system. Patients receive a courtesy call several days in advance of their appointment to remind them and to also ask that they call the office if they are unable to keep a schedule appointment.
*** *** was sent a certified letter notifying her of that she was discharged from ***'s care in September and that he would provide emergency care for her through October 23rd. Despite post office notices and attempts to deliver this letter, *** *** never accepted it and it was returned to our practice on 10/29/15. *** ***'es privacy was not violated by any *** employee. When she finally called our office regarding her bill, she was notified that she that her account had additional account balance had been turned over to a collection agency. She told our billing representative that she was not happy with this decision and she planned to cancel all future appointments with ***. She was advised at this time that she had been discharged from the practice for failure to keep her scheduled appointments. *** did attempt to notify her in writing and she would have been aware of this at the time she called our billing office had she claimed the letter we mailed.
*** *** also voiced a complaint that her account was sent to a collection agency even though she was making payments. *** *** has owed money to *** since 2013. Our office attempted to work with her for payment of her account balance. We made numerous phone calls and sent at least letters over a year period (and 2015) attempting to obtain payment on her account. In June of 2014, her account was turned over to a collection agency for failure to make payments despite a written payment agreement she made with us in January of 2014. *** continued to see her as a patient, and her balance continued to escalate. Because her account balance was placed with the agency in June 2014, all her payments were forwarded to them to reduce the amount of her debt. At the same time, a new and seriously delinquent balance began to accumulate again for the services provided by ***. *** *** did not make extra payments to *** on the balances for her care following June of 2014. We again attempted to contact her regarding the new sum owed to *** and attempted to set up separate payment arrangements. Between January and July of 2015, she made a single payment of $to ***. She did not respond to our collection letters or return a call until October of 2015. Because we were unable to reach her or establish a plan to help her reduce the new debt that accumulated between June of and September of 2015, the additional money owed to *** was turned over to our collection agency
I believe *** made extra efforts to work with this patient - specifically, we allowed her to make random, min***l payments on a growing debt for services prior to June of 2014. It was only when she made no effort to pay her bill subsequently that her remaining account was turned over to collections.
Her discharge from *** as a patient of ***'s had nothing to do with the money she owed for the serviced she received from our office. It was clearly for not keeping scheduled appointments. We made every effort to notify her of this decision in writing and to offer emergency care for days following the notice as required by law

Revdex.com,
I have paid the balance at 50% as agreed. I have reviewed the response made by the business in reference to complaint ID ***, and find that this resolution is satisfactory to me. In the future, I hope they contact the consumer directly within a year timeline to be able to get things like this remedied. The healthcare system here is very difficult to navigate, and they have more experience in it than a consumer or receiver of care, and should know when an insurance provider denies something that the customer should be contacted in a timely manner to find out why the provider denied coverage. This coverage should have been covered 100%, and that is why this is so frustrating. Some form letter supposedly sent to me years ago denied coverage that was unbeknownst to me and that is why I am spending my own funds on something that should have been paid by insurance. My current insurance is roughly per month. That is a mortgage. And for that, I don't have a clue what I am getting sadly. But, the hospital sure knows more than I do & if they want their money need to do better about sharing information (within years from the date of service). The insurance company is now bankrupt and there is nothing that I can do other than pay the bill.
Regards,
*** ***

This complaint was thoroughly investigatedDr*** and her Physician Assistant handled all visits and correspondence with this patient appropriately and within protocolI would be happy to discuss further specifics with this patient if he would like to call me directlyAt his
request, I will move forward with processing his termination of carePlease let me know if I can be of further assistance

I will agree to the 50% time courtesy adjustment as I agree my representative could have done a better job at reading all the notes on the account that state insurance denied for other insurance updates, however please note that it the insurance company is the one responsible for notifying the patient that this information is neededTypically the patients will receive an EOB denial from their company and they will receive a separate letter from the insurance company requesting this information and they almost always get this information before we doI have made the adjustment to the accountMr*** can pay the remaining balance by calling 864-***, or he can go on MyChart and pay the balance

The 1st rep that patient spoke to had mis-informed *** *** about how attorney and/or third party liability accounts are handledThis rep is fairly new and was under impression that accounts would be placed on hold which is not the caseI have spoken to and corrected information with the rep so
this does not happen againI have called the patient and agreed to pull this account back from*** *** because of the miscommunication that had been given to *** ***I have given her her pay plan optionsShe has my direct phone # and will be calling me back ***orrow to make down payment and get account placed into a payment plan status
Thank you for bringing this to my attention
*** ***

University Medical Group handles the Physician billing for the hospital (GHS), we have extended business hours and we are open until 8:30pm to accomodate many schedules. According to phone call report our average speed of answer is minutes as of last week. The approval letter
that the patient received about hospital sponsorship states in the letter that the sponsorship only covers the hospital charges and that it excludes physicians charges. The sponsorship program is a hospital based program, not a physican programI show that *** *** spoke to our customer servcie dept on 06/24/at 4:12pm and was offerred a month payment planShe was advised if this was not set up on a formal pay plan that it would roll to collections, which is what has happened. The balance can not be adjusted as we do not accept the sponsorshipAlso just to confirm, I do show that we received payment for invoice# *** and the balance for that claim is zero now and I have emailed *** to update them to show it's paidBalance owed for invoice #*** is $***

The complainant contacted *** to file a complaint regarding this. It has been investigated and closed. The complainant received a letter explaining this. The patient received appropriate care. The tests done were completed after consent from the patient. They were
ordered by the primary physician of record for the patient at the practice. The *** allegation was investigated by the office ** *** *** and was unfounded. She willingly submitted to the tests being performed. The bill remains the responsibility of the patient

This response is from the billing office, I can not speak for the Dr's office, only for billing officeIt appears that when a corrected claim was submitted on your wife's 10/15/date of service, the poster miskeyed the contractual adjustmentThis has been corrected and your wife's balance is now
zeroI show that the business office received one letter form you on 02/20/and my customer service rep called you and advised you that at that time the claim was being corrected and was in a "Do not bill status"I do not show any other correspondence being receivedI pulled our caller ID files and I only show calls to the business office from the phone numbers we have listed on the account, both in Feb of I also pulled historical data on our phone system from Jan to today and the longest hold time was minutes, but the average is much lower than that. If you have problems with any physican bills you receive please contact *** 1st so that we can assistContacting the Dr's office first can slow down the process since we handle their billingI apologize this wasn't corrected prior to today.Thanks,*** ***UMG Customer Service Supervisor

Dates of service in queston are Jan datesUMG checked electronic elgibility on 1/16/15, 03/02/15, 06/11/and 07/08/15, 08/10/and 08/11/every time eligibility was checked the electronic response we received from *** showes policy inactiveTypically with Newborn children we will check
eligibility multiple times as it takes insurance companies about 30-days to load eligibility in their systemPatients mother called on 6/11/and was told policy was still coming back inactive and was advised to call InsuranceMother called again on 7/08/and was told it was still coming back inactive, mom stated it should be active, so at this time we placed it on our customer service log to have and Accoutns receivable staff review the claimsOn 7/09/*** from *** called and we advised her that our electrinonic response was still showing inactiveOn 7/10/our accounts receivable rep reviewed claim and logged onto ***' website, website showed policy was not effective until Feb and therefore claims could not be filedOm called back on 08/10/and the customer servcie rep advised her what our accounts receivable rep had statedAbout min later *** from *** called our customer service line and wanted to know why we haven't filed the claims, we advised him that they were nto filed b/c the eligibility response we were getting was showing not activeand that we could not file claims with policy showing not activeOn 8/11/@10:31am Veronica called from insurance company asking for claim forms to be faxedthe customer service rep placed thsi on our customer servcie log for the AR staff to review again.on 8/11/@11:27am the pt's mom called asking for us to send her the claim forms, this request was emailed to our rep that prints the medical claim forms. On 8/17/@ 1:48pm we received a call from *** at *** this time stating that the policy wasn't actually effective until 02/01/but that the child is "covered" under the mothers policy number for the first days, *** advised AR staff member at that time to file claims under the mothers policy #, (This is not a typicla practice of ***) Once we received that info from *** insurance was immediately loaded and filed.Typically accounts are only held days and then sent to collections if not resolved, this accoutn was actually held much longerThsi account did not roll to collections until 08/03/15, almost months laterIf *** had indicated to us back in July that this is how her policy was set up than this account would have been filed a long time agoIt is the guarantors responsibility to understadn their insurance policy, in this case it sounds like even the people at the insurance company did not even understand how this policy was set up*** at *** was the 1st one to exlplain it and that wasn't done until after accoutn had already rolled to collections. I received a voicemail from the mother on Wednesday 08/26/asking for something in writing that account was filed to Insurance and that account was out of collections, she did not ask for a call back she asked for a letter which I have not had the opportunity to write yet. This issue miscommunication was not an error made by UMG, this was and issue between the patient's guarantor and her insurance companyIt is not UMG's policy to file claims to insurance comapnaies when they tell us the policy is not active. These invoices have all been removed from the collections financial class and the collection agency was emailed today by myself and letter was also sent to the patients mother todayI was out of the office on Monday and only part of day on Friday so I am just getting to point of following up on voicemail & email requests. Thank-You,*** ***

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]