Loudoun Medical Group, PC

Review: I confirmed with doctors office how much they charge for consultation for new patient I was told $160 and for Follow up visit $138. I had first visit when doctor [redacted] spend 10 to 15 minutes total and advised to have xray and MRI done and come again. I got bill from his office for $450.08 which is not right.I am requesting to investigate these charges for me. Please note that when I called the doctor's office to get more info/which charge code did they used it was Level 4 and which means depends what was done in the first visit which was nothing just consultation .My First visit charged to insurance as $331 Second visit they charged my insurance $233. Please investigate these charges as seems wrong. I will pay my appropriate portion after the final result. Please contact me for status by email at below address [redacted] Doctor's DetailsDr. [redacted]###-###-#### (Office)###-###-#### (Fax)Thanks[redacted]###-###-####Desired Settlement: They should charge me the appropriate bill. It should not be more than $280

Consumer

Response:

[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.]

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,

Business

Response:

November 1, 2013

Dear **. [redacted],

We are writing in response to your letter dated 10/28/2013 (copy is enclosed). Your letter was in response to a billing complaint from a patient seen at this office. As per your instructions, all information that identifies this patient is being kept confidential in this letter. We would be more than happy to provide a complete copy of the patient’s records after receiving a HIPAA Compliant release from this patient instructing us to release the actual medical records to you.

Loudoun Medical Group is a multi-specialty medical group offering general and subspecialty care to residents of Loudoun County and Northern Virginia. Orthopaedic & Spine Surgery Institute is a branch of the Loudoun Medical Group, specializing in conservative and surgical care of the disorders of the spinal column. This complaint pertains to a billing issue of the patient seen at the Orthopaedic & Spine Surgery Institute on June 12th and 26th of 2013.

This patient was first seen in our office on 6/12/2013 for complaints of low back pain and sciatica.

During this visit she completed an 8 page patient intake form, which was reviewed by the physician. The visit consisted of reviewing her chief complaints and history of present illness along with a review of her past medical history, past surgical history, social history, family history, review of symptoms, allergies and medications. Also a musculoskeletal and neurologic examination was conducted. The differential diagnoses were reviewed with the patient. Given the patient’s pain and weakness, the patient was prescribed medications along with orders for an MRI. Per the American Medical Association’s Current Procedural Terminology (CPT) 2013 code book, this level of visit with the complexity of this particular case and the care rendered (inclusive of medication prescription and advanced imaging order) constitutes a level 4 ([redacted]) new patient office visit. Our actual charge for this level office visit is $331. However, the contracted rate of our medical group with this particular patient’s insurance for this level office visit is $299.08.

The patient was seen for a follow-up office visit on 6/26/2013 with continued complaints of low back pain and sciatica. Again, the patient completed a two page intake form, which was reviewed by the physician. The visit again consisted of reviewing her chief complaints and history of present illness along with a review of any changes to her past medical history, past surgical history, social history, family

history, review of symptoms, allergies and medications. Again, a musculoskeletal neurologic examination was conducted. Per the American Medical Association’s Current Procedural Terminology (CPT) 2013 code book, this level of visit with the complexity of this particular case and the care rendered (inclusive of detailed review of all the MRI images - More than 80 individual image scans, referral to physical therapy and further prescriptions orders) constitutes a level 4 ([redacted]) follow-up patient office visit. Our actual charge for this level office visit is $197. However, the contracted rate of our medical group with this particular patient’s insurance for this level office is $151.

As you may be well aware, it is not unusual for doctors’ offices to have different rates of contracted services with various different insurance companies. While the actual office visit charge for all patients is the same given the level of coding, the insurance adjustment is different given the specific nature of the insurance plans and our contracted rates. With all due respect to this patient, the rates that he/she claims in her complaint are incorrect. The only rate that we can quote to patients over the phone is what our full charge is for different levels of visit. Furthermore, not having seen a patient, it is impossible for a receptionist to predict in advance the level of code that will be used. Additionally, each insurance company that we are in network with has a different contracted rate for us, thus, a different insurance adjustment.

This particular patient has a very high deductible insurance plan with her specific insurance carrier. Until such time as he/she has met all of his/her deductible, there is no insurance payment and the patient is responsible for the full fee of the office after insurance adjustments have been made per our contracted services. After the patient satisfies his/her large annual deductible, then the insurance company will start making payment on her behalf for any further care.

Many times, patients are unaware of the nuances of insurance billing, contracted rates, insurance adjustments, and deductibles. We certainly understand this and would be happy to review the billing statement with the patient once again. However, the stated charges are correct and the responsibility of this patient.

Please don’t hesitate to contact us if you have any further questions or concerns. We greatly appreciate your time and expedited attention to this matter.

Sincerely,

Consumer

Response:

[To assist us in bringing this matter to a close, you must give us a reason why you are rejecting the response. If no reason is received your complaint will be closed Administratively Resolved]

Review: [redacted]

I am rejecting this response because: As per my request they ("[redacted]" Office manager) told me the first visit is $160 and next visit will be $138 now they are denying. As I mentioned before docotor spent around 15 minutes for first and 10 minutes for second visit. They are mentioning in the details about so many things.

It is unfair with me . These people just play with the patients. I need justice. Providing wrong information or misleading is not fair and As patient and good citizen I have right to raise this issue so that these people stop lying and grabbing money from the innocent patients. Please help me I am ready to pay the amount which was disclosed to me before the appointment which is $160 +$138 =298 Total.

Regards,

Business

Response:

November 29, 2013

Dear Ms. [redacted],

I hope this letter finds you well. This is in response to your letter dated November 21, 2013. This letter was a follow up regarding a billing complaint from a patient seen at this office. For your reference we have also enclosed our original letter from November 1, 2013.

In our previous letter it was explained in detail the nature of this patient’s office visits and the appropriate level of CPT coding (Current Procedural Terminology - the method by which medical practices charge for services as defined by the American Medical Association). Since your most recent letter, we had our compliance auditor check this patient's records to make sure that the appropriate level of coding was assigned. Indeed we have assigned the proper CPT code for each of his/her office visits and have charged his/her according to the contracted charge with her insurance company. Our office bill reflects the insurance adjustment and the rest is the responsibility of the patient if he/she has not met his/her annual deductible. This patient has a very high deductible plan and as such, after accounting for the insurance adjustments, the remaining balance is his/her responsibility.

The patient claims that we had quoted him/her a charge of $160 for a new office visit and $138 for a follow-up office visit. Respectfully, we believe that he/she is mistaken. There is no way that a receptionist without a medical background can quote a person a charge for the office visit over the phone. The charge for each office visit will depend on what tests are ordered, what tests are reviewed, the medical complexity of the decision making, and many other variables. Furthermore, there is no way that we can be certain what the patient’s share of the charges be until the bill has been submitted to his/her insurance company and the appropriate adjustments have been made.

I must also point out that Dr, [redacted] is an employee of Loudoun Medical Group and Orthopaedic & Spine Surgery Institute. As such he is not responsible for collection and processing of patients invoices.

The remaining balance of $450 has been long overdue since 7/11/2013 without any pay ment on the part of this patient. We reserve the right to pursue our routine collection policy with any delinquent invoice. Please don’t hesitate to contact me if you have any questions or concerns.

Sincerely,