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Lancaster Pediatric Associates Ltd

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Lancaster Pediatric Associates Ltd Reviews (1)

Review: Physician (Dr. [redacted]) added an additional fraudulant CPT code for an annual child physical due to me answering her questions regarding my daughter's annual visit with a specialist doctor from a different practice. The specialist's visit was not meant to be addressed at this routine annual visit but I assumed her questions were part of my daughter's annual exam. If I had known I was going to be additionally billed for answering questions regarding my daughter's visit to a specialist from a different practice, I would have never answered the quesitons since we were not seeking a diagnosis. I feel the additional CPT code added to the visit was unnecessary and shows the greed and lack of ethics within this practice. I cringe at the fact when an annual physical turns into me having to monitor what I say and ask in fear of being billed separate additional charges. When I called the billing department I was told to contact my insurance company and this was not their problem. I however, disagree. To me, this response means that that this doctor's office is unwilling to negotiate a wrongful charge and is only interested in passing off the angry customer to someone else. This is very poor customer relations. I tried explaining that my complaint had nothing to do with the insurance company and that my complaint was that the additional CPT code was fraudulant but the billing department was not willing to address my complaint with Dr. [redacted].Desired Settlement: $110 for the additional charge that was not covered by my insurance company and I had to pay out of pocket.

Business

Response:

October 11, 2013

Dear [redacted]:

Thank you for the letter of complaint submitted 10/8/2013. The service rendered nearly one year ago has been documented and coded according to the guidelines provided by the World Health Organization and the American Medical Association. CPT and ICD-9 codes are submitted to the insurance company presented at the time of service.

The complaint confirms the additional time spent for discussion with the physician during this visit. Dr. [redacted]'s documentation covers multiple medical issues discussed that took an extensive amount of time.

It appears the dollars in question are a result of the Member's Benefit Plan, which we have no control over. The insurance policy is a contract between the insurance company and the patient. Patients are made aware that some and perhaps all of the services provided may be "non-covered" services according to their insurance policy. However they are still responsible for payment of these services.

Lancaster Pediatrics billing department discussed with mom the member's right to grievance procedures. We are happy to comply with the insurance company for request for benefit determination.

Sincerely,

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Description: Clinics

Address: 2106 Harrisburg Pike Suite 1, Lancaster, Pennsylvania, United States, 17601

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