Mahoning Valley Manufacturing Inc

We have conducted an internal investigation of the complaints brought to your attention by Consumer ID #*** I have reviewed the records related to her visit to the Sharp Memorial Hospital Emergency Department and the following is a summary of our investigation
We understand
that times of medical care are stressful and it is important that the medical team takes the time to communicate with the patient and family and ensure they understand the plan of careThe patient’s chart was reviewed and her concerns were discussed with the Hospital Grievance Committee Physicians on staff at Sharp Memorial Hospital are private practitioners, not agents of the hospital, and are a self-governing body; therefore, the patient’s concerns regarding the medical care were also forwarded to the medical staff committee that addresses grievances against physicians We are not able to provide specific details of the committee’s review as those records and proceedings are confidential under California law; however, please be assured that her concerns are taken seriously.
After thorough consideration, the hospital care was determined to be appropriate; therefore the patient’s request for reimbursement and waiver of the bill for this visit has been denied We understand that this is not the outcome that she was hoping for and we are sorry that her experience was anything short of excellent
Patient satisfaction is a high priority at Sharp Memorial Hospital and we appreciate the opportunity to evaluate and improve our systems and processes Please do not hesitate to contact me should you have any additional questions or concerns.
Regards,
*** ***, MPH, MSW
Patient Relations Specialist

The consumer indicated to the Revdex.com that this complaint has been resolved

I am in receipt of your letter addressed to Ms. [redacted], Legal Secretary, Sharp HealthCare. Ms. [redacted] has requested that I respond on her behalf to your correspondence.Sharp HealthCare responded directly to Mr. [redacted] on January 11, 2017. Additionally, Mr. [redacted] Was provided with instructions to...

communicate directly with his insurance provider.Should you have any questions regarding this matter, please contact me at ([redacted]) [redacted]. I would be happy to speak with you.Sincerely,[redacted] Sharp HealthCare Manager, [redacted]

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID [redacted] and find that this resolution would be satisfactory to me.  I will wait for the business to perform this action and, if it does, will consider this complaint resolved.
Regards,
[redacted]

On 03/15/17 I rcvd a FINAL NOTICE, DELINQUENT ACCOUNT bill from Sharp Rees Stealy (SRS), a Sharp Healthcare provider for $193.79. I called billing 0n 03/16/17, and was told the bill includes a charge of $40 for Date of Service (DOS) 10/11/16 which I paid on 01/03/15, a charge of $40 for DOS...

01/23/17, for which I had not yet rcvd a bill and which my [redacted] medical insurance had not yet finished processing when I spoke with BC a week prior, and a charge of $113.79 for which I rcvd a bill 01/14/17, but because that bill incorrectly included the a charge of $40 for DOS 10/11/16, I had contacted SRS, and was told not to pay the $113.79 until my account was credited for the $40 paid on 01/03/17. In my call to SRS 03/16/17, I was also told that I should not have rcvd a FINAL NOTICE DELINQUENT ACCOUNT letter unless I rcvd 3 prior bills, however I had not rcvd a bill since 01/14/17. The billing rep verified I had paid the $40 for DOS 10/11/16, but said it had been applied to a DOS 09/23/16. The bill I paid on 01/03/17 included a balance of $10 for DOS 09/23/16 and I paid on 1/03/17. I asked to speak to a manager, the billing rep said a manager would call me that day, and I rcvd no call. I also spoke to [redacted] (619-644-6928) 03/16/17. She offered no help. In 2016 I was in SRS billing and [redacted], in an attempt to resolve multiple billing errors on my account. SRS made mistakes such as failing to file a claim with BC for over 6 months (DOS 07/07/16) on my behalf, moving money I paid for specific dates of service to other dates of service without my permission, and failing to bill accurately for doctor visits. On multiple occasions SRS billed BC for medication provided and paid for through my prescription coverage [redacted] (DOS 04/07/16, DOS 07/07/16) which resulted in BC (correctly) denying claims. I spent many hours trying to resolve mistakes made by SRS billing.On 03/17/17 I paid $193.79 (conf. #[redacted]), and have now paid the $40 for 10/11/17 twice. I want SRS to perform a thorough review of my account. It’s extremely upsetting to receive a FINAL NOTICE DELINQUENT ACCOUNT letter, and especially unfair and insulting in light of the many hours I’ve spent trying to resolve multiple and continuing mistakes made by SRS billing, and the fact I did not receive a bill since 01/14/17, and was told by SRS billing not to pay the $113.79 on that bill until they could properly credit my account. I want an apology from SRS for the stress they’ve caused me, and an extensive review of their billing and customer service processes. SRS should not be allowed to threaten my credit by sending a FINAL NOTICE DELINQUENT ACCOUNT and threaten to send my account to a collection agency when the mistakes are made by SRS.

Per your request I have reviewed the complaint that was referred to you, the BetterBusiness Bureau. I have researched to see where we could improve in our process offollowing up with our patients.I have listened to every call that the patient's mother made to Customer Service, aswell as those calls...

we made to her and the insurance company ..Please see below for a list of calls.06.20.2014 site Representative CAY JO called [redacted]s 800.67 6.2583 spoke with Til aReference#[redacted] speech therapy was quoted at $50.00 COPA Y, No deductible andservice covered at 100%. Visits are based on Medical Necessity and Pre Certification is notrequired. [redacted]s representatives do not check on OX codes however procedure code92521, 92522,92523 and 92507 are all valid and billable.09. 11 .2014 patient mother called spoke to [redacted] to inform that onsite advised her only a $ 15.00copay would apply to the visit. However she is getting a bill for $388.00, CSR explained that perthe insurance Explanation Of Benefits the service was not a covered benefit and directedpatient mother to the site that first assisted her.09.22.2014 Site Rep called PFS Customer Service and asked that we call patient mother for claimreview09.23.2014 CSR [redacted] called Insurance [redacted]s and was directed to a different number,CSR called mother and left message that she is working on account and to please allow time forher to contac t insurance.09.23.2014 Patient mother returned call to Customer Service Representative ([redacted]) LUNJE5took the call and advised patient mother [redacted] is working on the account09.23.2014 [redacted] placed call to patient mother to advise she is working on account and willcall insurance on 09.24.201410.03.2014 Patient mother called, ROBTE2 took call and call dropped10.03.2014 Patient mother called again [redacted] took call and advised patient mother she wouldlet [redacted] know to call her back with an update.10.03.2014 [redacted] called [redacted]s 800.444.2726 spoke with [redacted] and explained per call on06.24.2014 REF#[redacted] benefits for Speech Therapy were verified and noprecertification was required, [redacted] advised she would send the claim back for reconsideration,she explained to [redacted] to allow 14 days for response and provided REF#[redacted]10.06.2014 Patient mother called spoke with [redacted] advised CSR that her insurance denied theclaim and explained to CSR that she is waiting on a call from [redacted], CSR explained topatient mother to a llow more time for insurance to reprocess the c laim10.07.2014 [redacted] called patient mother to advise that she spoke with insurance and theyare reprocessing the c laim to allow time.10.10.2014 Patient mother called advising she is waiting on a call back from [redacted] CSRHILMO explained time frame and advise to allow time11.06.2014 Patient mother called to inquire on status of c laim [redacted] explained to mother that asof 10.28.2014 SRS received a letter from [redacted]s advising the claim was received andreviewed. CSR advised she would delay dunning level and asked to check status of claim withinsurance in two weeks.12.18.2014 Patient mother called to follow up on claim [redacted] took information and advisedpatient mother he would relay message to [redacted]01 .07.2015 Patient mother called to make credit card payment on the balance of $388.0001 .1 2.2015 [redacted] called patient mother to review account and see how she can assist her.Pt mother advised of everything that has happened during her calls [redacted] advised patientmother that she will research account and get back to her in two business days. [redacted]reviewed account and submitted coding request to make sure that DX code used wasappropriate and also submitted refund request in the amount of $164.93.01.14.2015 TL [redacted] called [redacted]s at 800.444.2726 spoke with [redacted] who advised claimwas sent to home plan on 10.03.2014 for reprocessing, 10.06.2014 home plan advised claim wassent to technical team for review, 10.09.2014 final decision was made advising claim wasprocessed correctly as developmental delay is not a covered benefit.At this time, we have decided to refund [redacted] $388.00. Though the denial forservices was appropriate per the insurance, we do not feel we provided the very best customerservice we could have.If you have any questions please feel free to contact me. [redacted] Team Lead CCD

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID[redacted], and have determined that this proposed action would not resolve my complaint.  
 In very simple words , I believe Sharp hospital has commited fraud by misdiagnosing and mistreating me while at their care and charging me and my insurance for their profit not honest medical care , I am extremely disappointed and dissatisfied by them. 
Regards,
[redacted]

Dear Ms.[redacted],
 
This letter is in response to the appeal brought to your attention by Consumer ID #[redacted].  The complaint has been carefully reviewed by the Sharp Memorial Hospital Executive team and our Patient Grievance Subcommittee.  After thorough investigation, the care was deemed to be appropriate.  Therefore, Sharp Memorial Hospital’s position remains the same.

I am in receipt of your second letter to Ms. [redacted], Legal Secretary for Sharp HealthCare (SHC). Ms. [redacted] has requested I respond on her behalf to your correspondence.Sharp HealthCare has again communicated directly with our patient in writing. We have once more directed our patient to review the Conditions of Admission (COA) agreement previously provided, directing the patient to item number two, where the legal relationship is explained between a Hospital and Physicians.Should you have any questions regarding this matter, please contact me at [redacted]. I would be happy to speak with you.Sincerely,[redacted] Sharp HealthCare Manager, Patient Financial Services

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID [redacted], and find that this resolution would be satisfactory to me.  I was able to speak directly with a representative of the hospital, who listened to my issues, adjusted what was...

being billed accordingly, and accepted my payment.  I am also in receipt of documentation from Sharp Hospital and the collection agency that the matter has been resolved and had been removed from my credit reports.
Regards,
[redacted]

Dear Mr. [redacted],Thank you for your letter to the Revdex.com (Revdex.com) regarding your concern at Sharp Rees-Stealy (SRS). Theconcern was forwarded to the Quality Department for review and investigation. We are very sorry to hear that our servicesdid not meet your expectations.SRS has an...

extensive Quality Management Program, which includes the evaluation of all issues of concern brought to ourattention and a thorough evaluation of your grievance was conducted by the SRS Quality Management Department based onyour dissatisfaction with SRS billing issues.Your concern was reviewed with Sharp Health Plan. In the Summary of Benefits, which I have enclosed, you are responsiblefor a $100.00 Emergency Services copay. If you are admitted to the hospital then the copay is waived.In addition, I reviewed your concern indicating you received a bill that did not have to be paid. In speaking with yourinsurance company, Sharp Health Plan, and the SRS Patient Financial Services Dept., you do not have any current charges.The document you received is called an Explanation of Benefits and provides you with billing information. The charges havebeen paid by your insurance plan.In your statement to the Revdex.com, you indicated changing physicians. Within SRS, you have the right tochange your Primary Care Physician if you are dissatisfied.If any further assistance is needed, please contact Sharp Health Plan, Customer Services Dept. at 800 359-2002.Sincerely,[redacted], L VNCare CoordinatorQuality ManagementSharp Rees-Stealy

Thank you for contacting the Revdex.com regarding your healthcare experience. We are very sorry to hear that our services did not meet your expectations. Your concern was received in the Quality Management Department for review.SRS has an extensive Quality Management Program, which...

includes the evaluation of all issues of concern brought to our attention. We are dedicated to providing high quality medical care and patient satisfaction.An evaluation of your concern has been conducted by the SRS Quality Management Department. A thorough evaluation helps to determine if the care you were provided met the community standard of care. Furthermore, it helps SRS to review the current Standards of Practice to identify any potential opportunities for growth and betterment. Please be aware that we take your concern very seriously.Information generated from the Quality Management Department review is confidential, as expressed in the California Evidence Code, the Health and Safety Code and the California Business and Professionals Code. For this reason, SRS is unable to discuss the outcome of Quality Management reviews or the disciplinary steps that may be taken within SRS.All patient concerns are cumulatively tracked regardless of the outcome. This is a component of the overall Quality Assurance monitoring program which evaluates medical care provided to our patients. Communication is an essential component of medical care, and through communication, we can improve the services provided to our patients.On 2/25/16, you were contacted via phone by the PFS Dept. to inform you that you would be responsible for a copay of $250.00 due at the time of service, 2/29/16.In addition to the phone notification from the PFS Dept., a copy of the approval for surgical referral authorization was mailed to you on 1/18/16 stating, “Please note that payment for services is dependent upon your eligibility with Sharp Rees-Stealy Medical Group and Health Net at the time services are rendered. You may have a co-payment at the time services are rendered. For questions regarding benefits or co-payment information, please call Health Net, Customer Service Department at 1-800-522-0088”.You made the copayment of $250.00 on admission, but you were also responsible for a 20% co-insurance on the out-patient procedure, for which you are being billed in the amount of $2,524.54.The PFS Dept. has spoken with you on several occasions and you have been offered the following payment options:Discount 20%: $2,019.63Monthly payment plan 12 months $210.38Loan 24 months $112.34Loan Pt Pref. 24 months$114.00Upon review of the concern with Patient Financial Services (PFS) Department, it has been determined that you are responsible for the 20% co-insurance for services performed on 2/29/16.To discuss this matter directly with the PFS Dept. or for any questions, please call [redacted].You also have the right to initiate an independent review with your health plan by contacting them in writing. If so, please address your concerns to your health plan, Appeals/Grievance Department.Sincerely,[redacted] Care Coordinator Quality Management Sharp Rees-Stealy

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID [redacted], and find that this resolution would be satisfactory to me.  I will wait for the business to perform this action and, if it does, will consider this complaint resolved.
Regards,
[redacted]

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID [redacted], and have determined that this proposed action would not resolve my complaint.  For your reference, details of the offer I reviewed appear below.
Regards,
[redacted]
Sharp Memorial is admitting the doctors who practice at their facility are guilty of deceptive practices regarding non disclosure of their non-participating status with Blue Cross Blue Shield.  They are accepting no guilt based on the Doctor's are contract and they have no control over their billing practices.  These Doctors wear Sharp Smocks, they hand out Sharp business cards, and they have Sharp business addresses.  So they think it's OK for these Doctors to financially destroy patients and their families because the Doctors are contract.  Is this the type of businesses Revdex.com has as members?  The same goes for Alvardo Hospital.
[redacted]