Marshfield Clinic

[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]
 
 Spoke with Marshfield Clinic on 7/20/15,  they have changed the coding to level 1 office visit, bill will be under $100.00 and there will be no impact to my credit report.

The patient's concern has been reviewed and a response has been sent.Privacy regulations prevent Marshfield Clinic from providing additional information without authorization.Thank youKathy [redacted]Manager - Patient Financial Services

I attached pictures of both accounts that were sent to collections. As you can see the one from May was never sent to my insurance.

Revdex.com: I reviewed the response made by the business in reference to complaint ID [redacted], and have determined that this does not resolve my complaint. For your reference, details of the offer I reviewed appear below. We do disagree on coding and cost. And if it is true Marshfield Clinic bases their billing on the Evaluation and Management Coding and Documentation Guide (E/M) then the coding is most assuredly off. The repeated claim the coding isn't based on time is incorrect. The E/M's own website specifically shows that Time is a KEY factor in determining cost. According to their site the most appropriate code for my visit is a 99212, the coding for an Outpatient Established Outpatient Evaluation Level 2. The E/M's own site states that this coding is for a visit that is "10 minutes or less" with "minimal complexity". The AMA's PDF on understanding the E/M coding system ([redacted]) describes the 99212 code as follows "For code 99212, the office or other outpatient visit is for the evaluation and management of anestablished patient, and requires at least two of these three key components be present in themedical record:o A problem focused historyo A problem focused examination;o Straightforward medical decision making"  Whereas, a level 3 coding (99213) for an existing patient is described as "For code 99213, the expanded assessment for office or other outpatient visit requires at least twoout of these three key components to be present in the medical record:o An expanded problem focused historyo An expanded problem focused examination o Medical decision making of low complexityA tip for code 99213 is to think of expanded visits as a sum of the continued symptoms oranother extended form of the problem. Usually, the presenting problem or problems are of low tomoderate severity. Typically 15 minutes are spent face-to-face with patient and/or family."  If it were not for the fact that I had to actually see my doctor, my visit would easily have fit the description of 99211 coding, which is described as a 5 minute visit with minimal issues.I do not have an "expanded problem", I did not have an examination of any sort. Nor did the decision to switch back to Adderall constitute a complex decision (it was not based upon medical issue but cost of Strattera which I could not afford under my current insurance).  And this all presumes that you used the correct type of code (coding for an Established Patient). Marshfield Clinic is notorious for coding established patients as new patients which allows you to charge them an extra “new patient” charge. Since you refused to give me an EOB, that is a LINE-ITEM Break Down of my Bill, which you are required to give by law upon request, I can only conclude the goal of Marshfield Clinic is to defraud me. As of now, if Marshfield Clinic does not change the coding to a level 2 (99212) code and reduce my bill accordingly (a level 2 (99212) averages only 90$ prior to applied insurance in the state of Wisconsin), I will be reporting Marshfield Clinic to the State of Wisconsin District Attorney's office, the American Medical Association, and I will pursue other legal options to resolve the issue. Be aware, continued refusal to change the coding to an appropriate level and code will constitute predatory billing. Marshfield Clinic has a history of predatory billing which fits this very situation, which only makes this inappropriate coding more suspicious.  Regards, [redacted]

I have reviewed the concern of Ms. [redacted] and would like to speak with her.  I have left her a message.  Please ask her to call me at [redacted].This concern should be resolved for Ms. [redacted].Thank you[redacted]

Here is the release of information form.

Review: I will report my recent discussion with Marshfield Clinic of Minocqua,WI.An Explanation of Benefits sent to me said the $250.60 for my doctor visit of 11/06/14 was denied due to non-covered charges.I called my insurer WPS,their representative said because of the billing entries by Marshfield technicians,the doctor's charges wouldn't be paid by my plan. I then called Marshfield Clinic in Minocqua,spoke with a representative for Dr. [redacted] who saw me on 11/06/14 and I asked exactly how the office visit fee was billed and what codes were entered which resulted in non-coverage.She said she didn't know.I informed her that in all my communication with the doctor's appointment that my primary reason to be seen was regarding a specific site which I sought to discover if a tissue could be surgically removed.The clinic representative again said she could not explain.Then I asked to be transferred to the Customer Service department where I spoke with a Mrs. Hill who told me she could not explain the reason forbilling my doctor visit that was not according to the reason I made the appointment.I asked who could I talk with regarading the way my office visit charges were inaccurately billed.She said that "customers (patients) are not permitted to speak with the back office representatives that enter the billing codes".When I originally scheduled my 11/06/14 appointment I stated I only wanted to see the doctor for services that were covered by my WPS plan,and I restated that again to the doctor's medical assistant prior to seeing the doctor.A second concern came up during my doctor visit,but this was secondary to the primary reason for seeing the doctor and was already being handled by my primary physician.No services were received for this secondary concern. I am extremely frustrated, not only with the billing issue, but also with the lack of ability to speak with anyone who can handle this situation at Marshfield Clinic.There should never be a situation where a consumer cannot speak with someone regarding a billing situation as this.I hope you can offer me some advice or some help in this matter

Sincerely,

[redacted]. [redacted]Desired Settlement: Remove the entire charge of $250.60, as my copay is zero due to my deductible has been met for 2014.

Business

Response:

I had the

opportunity to review the concern expressed by Mr. [redacted] regarding her

service on 11/6/14.

Review: On 5/3/14 I went to the [redacted]. I gave the receptionist my insurance card and the charges were never billed to my insurance. I started making payments in August after once again giving my insurance information in person at the Marshfield Center in Chippewa Falls in case my insurance did not cover the full amount. However in December it was sent to collections even though it was never properly billed.

When the charges from 5/3/14 were sent to collections, it automatically sent a second account that I had a balance on for my son that was from 7/26/14. This should have never been sent to collections due to the improper billing on the first account.Desired Settlement: I want both collections removed from my credit report along with my husbands, properly billed to our insurance, and I will immediately pay the full amount that my insurance that does not cover. I would also be willing to immediately pay the accounts after they are removed from my credit report and put in a claim with my insurance.

Consumer

Response:

I attached pictures of both accounts that were sent to collections. As you can see the one from May was never sent to my insurance.

Business

Response:

I have reviewed the concern of Ms. [redacted] and would like to speak with her. I have left her a message. Please ask her to call me at [redacted].This concern should be resolved for Ms. [redacted].Thank you[redacted]

Review: Debt collection. Rebilled after made payments. No resolveDesired Settlement: I have made several payments, and then I will receive the same bill again for the same service. I have contacted them in this matter. No resolve. Not properly billing insurance. I even have statement 40.00 left and then the same amount 159.16 came with credit of 40.00. They have sent to creditors, and I was making or made full payments. Alliance collection agency.

Business

Response:

I had the

opportunity to review the concern expressed by [redacted] regarding her

account with Marshfield Clinic.

My son was on vacation up in marshfield when he went ill, and it was discovered he had the onset of lyme's disease. The staff and doctors were great and ordered all the right tests.
My experience is with their insurance claim handling. I am a upstanding citizen that pays my bills, and pay for my employer provided insurance, along with any deductible I owe in a timely matter. Marshfield repeatedly sent the claim into the wrong repricing network and I spent several occasions on the phone with them to get them to send the claims to the multiplan repricing network. They also spent time themselves on the phone talking with CIGNA on how to send this into the right repricing network. Because this was not done in the timely manner CIGNA has the right to not pay the claim because it was not within the timely manner dispute timeframe (200 days), and now marshfield is sending my a "patient responsibility" bill, and is sending me to collections based on not repaying. I have filed an appeal with CIGNA through their process which will take more than 30 days for a review, and in the process my credit is being damaged due to the fact that the Marshfield did not get their staff the training needed in order to know which insurance needs which repricing network information. As a consumer I am the one that is hurt by this financially, but there is no way for me to have the training the Health Care Providers and Insurance companies have on file claims. I am at the disadvantage and I can not get the Clinic and the Insurance Company one the same page to just get the paperwork to the right area. I am 34 years old, fairly educated, I know enough about filing an appeal, elderly citizens or young adults just coming into the world of insurance without their parents involvement would not know enough to file an appeal and would pay the hefty fees of a full price bill (even though they have health insurance). Marshfield Clinic in offering services without knowing how to file insurance claims correctly is a problem for the residents of Wisconsin.

Review: I was in the hospital and the doctors who saw me, put their charges on my clinic bill, but the saw me in the hospital ! One of the doctors charged me to come in my room for a few seconds, to tell me he was going on vacation and was handing me over to another doctor. If a doctor can bill from the hospital to the clinic bill then why wouldn't I have a co-pay (like I do when I see a doctor at the clinic.) Now my bill is high, and what I'm sending for a payment is not enough. The sent me a letter trying to make me go on a payment plan that I cannot afford. I have been giving them a payment that I can afford, but they want me to give them more, but I surely cannot do so.Desired Settlement: My desired outcome of this event, is to try to resolve this problem. I cannot see why a clinic doctor that is in the hospital seeing me as a patient would send me a clinic bill, but doesn't fall under my co-pay? Also I cannot see how a doctor who comes in your room, just long enough to tell you that he is handing you over to another doctor because he is going on vacation, can charge you a unreasonable amount. Lastly, I cannot understand why three doctors that seen me during my stay, could rank me on different levels of care. Even though they may have seen me during the same day the all gave me a different level of care and charged me accordingly.

Business

Response:

I had the

opportunity to review the concern expressed by [redacted] regarding her

statement with Marshfield Clinic.The

concern was previously brought to our attention and has been discussed with Ms.

[redacted].

Review: I have been trying to get this is[redacted] resolved since 10/24/14 for a 10/8/14 visit to Marshfield Clinic. On 10/8/14 I went to see Dr. [redacted] to just have a blood draw to check my thyroid level. All the appointment was made for was to get a blood draw to check my thyroid level as I had moved from another state and needed a Dr. to give the order for the draw. Received statement on 10/24/14 for the 10/8/14 visit. Billed for level 5 in the amount of $345.20 plus level 1 billing of $114.88 and preventive care of $337.80, lab test of $146.20 and venipuncture of $30.00. Called Marshfield Clinic stating that Dr. [redacted] never performed preventive care and didn't understand the level 1 and 5 billing. The amount of $114.88 plus the $30.00 minus the $16.99 insurance adjustment should be the amount charged for the visit. Preventive care as explained to me is for a pelvic, breast exam and all of those were performed in Arkansas.

On 11/25/14, received letter from Marshfield Clinic stating the coding staff reviewed the documentation and discovered and error. They removed CPT99215 (level 5) and replaced with CPT99386 Initial Preventive care and CPT99201-25 Initial office, level 1.

On 12/9/14, contacted Marshfield clinic requesting a copy of office notes, medical records to see what Dr. [redacted] wrote down and an addendum form as instructed by [redacted]. I signed the release and faxed it back on 12/9/14 at 4:08 pm to 715-221-6992.

On 12/17/14, I received my medical records for this visit. After reviewing my records, it was very obvious that I was being billed for services that were never performed. The majority of the information was based on the paperwork that I had to fill out as a new patient which was not included with the records sent to me.

On 12/26/14 spoke with [redacted] in Customer Service about being over billed and she stated that she would send out an amendment form. Speaking with [redacted] she also stated that Dr. [redacted] would review the amendment/correction health information request and he would be the one to make the decision of whether it would be corrected. I find this as very strange that the Dr. that overbilled would be the one making the decision as to whether or not I was overbilled. This seems very unethical to me. Again I stated that I had only went to see Dr. [redacted] to get a blood draw to check my thyroid level as all preventive care had been completed by Dr. in Arkansas. The form was signed and dated 1/5/15. They were also asked to stop billing my insurance company until the issues were resolved.

Received letter from Marshfield Clinic on 2/6/15 stating that my request for amendment/correction of health information had been accepted, the appropriate amendment had been made and added to my medical record. Dr. [redacted] had signed the amendment to change to 99204-new expanded.

On 3/5/15, received another letter from Marshfield Clinic that the staff had reviewed the documentation for service and the documentation supports the charge as billed. Therefore, they would not make any adjustments to the charge in question.

I have been going back and forth with them stating that I would pay the $114 plus the $30.00. They keep telling me that I owe the $384.56 and they will not make any adjustments. I don't dispute that I owe for the office visit, but I do not owe for preventive care as billed.Desired Settlement: Adjust the bill to where I pay the correct amount for services performed of $144.00, offer a letter stating the account will be paid in full once they receive the $144.00 and make any corrections to my credit report.

Business

Response:

I had the opportunity

to review the concern expressed in the submission by Ms. [redacted]. She may call

me at ###-###-#### to discuss a resolution or she may wait for a letter to be

mailed to her.

Review: I went in for a preventative appointment that is covered by my HealthPartners insurance. Marshfield Clinic coded my appointment wrong and HealtPpartners is refusing to pay the bill.

HealthPartners sent me to Marshfield Clinic and said my preventative appointment would be covered just like it has been covered several times in the past.

HealthPartners told me to contacted Marshfield Clinic to appeal the bill and to have them change the billing code to preventative coverage. Marshfield Clinic refused to change the billing code.Desired Settlement: Marshfield Clinic change their billing code to preventative so HealthPartners will pay the clinic bill in full.

Business

Response:

I had the opportunity

to review the concern expressed by [redacted] regarding the billing for

her services in question.

The

concern has previously been brought to our attention and has been addressed

with Ms. [redacted]. Privacy regulations prevent Marshfield Clinic from disclosing

further information regarding this account. If she has additional concerns, she

may call our customer service department at ###-###-####, select option 2.

Sincerely,

Manager -

Patient Financial Services

Consumer

Response:

I have reviewed the response made by the business in reference to complaint ID [redacted], and have determined that this does not resolve my complaint. For your reference, details of the offer I reviewed appear below.

I just received this email. I do not accept the response and would like to continue to pursue the complaint. Marshfield Clinic just has to change their billing code to preventative and resubmit it to HealthPartners and the bill will be paid.

Review: I had my wisdom teeth removed at the Marshfield Clinic office in Stevens point WI, after I received my bill from them I had called the office right away and wondered why my insurance did not pick up, including my medical and dental insurance. The patient representative explained to me that a new girl had been working the day the prior auth should have been done, so it was not done by them, so they appologized and stated that they will re submit the claim and what ever was not covered because of their neglect to do a prior auth ,they would write off and not charge me. Well after many calls after this, they still have not fixed the problem and I know have a 500.00 dollar mark against my credit.Desired Settlement: I would like them to keep their promise and take care of the remainder that was not covered because they did not do the prior auth. I would also like them to have it removed from my credit report thru their collection agency. Thank you.

Business

Response:

I am looking into the concern and will contact the patient by phone or mail after the review. Privacy regulations prevent Marshfield prevent us from disclosing further information without authorization.

Review: I have requested multiple times for an itemized statement for my son's Emergency Room Visit. I have never received more than a basic billing statement. Lakeview Medical Center which is also owned by the same people that own Marshfield Clinic is where I received care. I did not go to Marshfield Clinic. I was billed by Lakeview Medical Center for an Emergency Room Visit Level 4. They provided me with an itemized statement per my request immediately. Marshfield Clinic's bill to me was also for an Emergency Room Visit, even though the ER is part of Lakeview Medical Center. But, Marshfield clinic billed it as an Emergency Room Visit Level 5, which does not match his medical records. I have asked for an itemization of what the ER Level 5 is for but have only ever received a basic billing statement. The first two times I requested an itemized bill I was told they do not provide those. I demanded one a third time from a billing manager and she sent me a bill, no itemization included. For the fact that they are both owned by the same medical facility, you would think they could accurately bill according to his medical records. I also do not understand why I have to pay an emergency room visit charge twice. One to Lakeview and one to Marshfield.Desired Settlement: Marshfield Clinic states that they employ the physician used at Lakeview Medical Center. So lakeview bills me as a standard ER would, but this allows Marshfield clinic (same business entity) to also bill for the exact same services. They are double dipping. I explained I was more than happy to pay for the physicians charge of $79.65 after insurance payment. However, the ER visit Level 5, which isn't even accurate to his medical records, of $114.03 I would like adjusted on my bill. I have already received a bill from Lakeview medical (again same business entity) for that charge.

Business

Response:

I had the

opportunity to review the concern expressed by Ms. [redacted].The

concern has been addressed with Ms. [redacted] on several occasions. If she has

further questions, she can contact our Customer Service Department at

###-###-####, select option 1.Privacy

laws prevent Marshfield Clinic from disclosing further information regarding

this account.[redacted]Manager -

Patient Financial Services

On September 25, 2014 I took my son to Lakeview Medical Center for Emergency room care. My son was just over the age of one. Lakeview Medical Center uses Marshfield Clinic's physicians to staff their Emergency Room. The physician who was assigned to my son treated him like he was an animal. My son started screaming during the stitches, at which point I said, "he is in pain still! Can we stop?" They physician started lifting up my sons limbs and dropping them saying I don't think he can feel anything. He just kept treating him like less than a human and being extremely disrespectful to me and most especially my baby. My pets receive better treatment and care from our vet than this physical provided to us. I would have to be bleeding to death before I would use a physician from Marshfield Clinic ever again. I tried to submit a verbal complaint and while the person who took my information seemed to really care about how poorly we were treated, the hospital and clinic brushed us off as if it was no big deal.

Review: I made an appointment for my preventive exam which was covered 100% by my obamacare insurance. I went in for lab draw in the am,appt. with doctor in the afternoon. Yesterday I received a bill for $1200.00 for lab work that they did without my knowledge of, or did I approve it, or was I even asked if I wanted what they were checking for done. This extra lab work was done because of surgery I had 20 years ago. I would have refused it if I was given a choice. I feel my rights to choose what services I am willing to pay for have been violated, as I was never informed they were even running these tests. I will be financially strapped if required to pay this bill for services I didn't really require, as I wasn't having problems from this old surgery. My insurance did cover what was considered preventive. I feel my rights have been totally violated and my freedom of choice neglected by the Marshfield Clinic. They also charge you for a extra office call if your MD. has to write out a prescription so you get charged twice for even seeing someone.Desired Settlement: I am not willing to pay for services provided that I wasn't aware of, or had I been consulted about to see if I wanted to have done. This is fraud in my book

Business

Response:

The

concern expressed by Ms. [redacted] is in review with our patient liaison. Privacy

regulations prevent Marshfield Clinic from disclosing additional information.

Review: My Girlfriend and I are insured and we are being over charged for services as well as being lied to. We had to pay a procedure out of pocket because the way it was billed I was told that no insurance company would pay it. That was a little over $3000.00. We were supposed to be getting a refund back of the over payment. Our insurance company was billed wrong for her annual witch is %100 covered. The was it was billed we could have paid out of pocket $120.00 to family planning instead it cost us just shy of $500.00. So our refund was taken from us. She has an on going workers comp claim that is being argued by attorney so she has some outstanding bills do to that. I understand they want Their money but they have been contacted multiple times from her attorney. She now need surgery to fix her knee. They put her on a cash only status and can't even schedule the appointment without paying over $7000.00 up front. They claim that they are out of network for our insurance. The doctor is in our network that is why we are going to him. Marshfield clinic denies that he is witch is a price difference of $5000.00. The $498.00 appointment was in October of last year and they still haven't billed it right and we still have not received our money back. I called billing today to see if they would do anything and Ryan was kind of a [redacted] and treated me like I didn't matter. I am so sick of being screwed out of money from Marshfield Clinic. I want my Girlfriend to get back to having a normal life and they don't seem to care what so ever. I also called my insurance company and they stated they paid %100 of the bill from Oct. So where is my refund? I work a lot of hours and don't have time to argue with Marshfield Clinic on how they are stealing money from people. I pay my insurance and am sick of having to call them so billing isn't messed up. I have a job already I shouldn't have to help them do theirs. My girlfriend has done everything in her power to keep them updated on bills and the workers comp claim. There are no collection claims or anything so why are we treated like such garbage? She has signed 3 different forms to let me have access to help her because I am the one with the insurance and all of those forms disappeared. All we get is the run around when we call to try and resolve these issues and they say someone will call us back and it never happens. If I ran my business this way I wouldn't have a job. I don't want to be treated like crap anymore. We do not deserve this horrible customer service and she deserves to be able to walk again.Desired Settlement: I want a phone call from someone who can give me answers on where our money is and I want to be able to schedule her surgery so she can get back to having a normal life and to be able to do her job without it costing us thousands of dollars to schedule an appointment. I would also like an apology for all the crappy service we have received. I want answers on why they can't get billing right and a different department that is out of network billed it even tho she was seen by a doctor in our network.

Business

Response:

I had the

opportunity to review the concern expressed by Mr. [redacted]. Mr. [redacted] has

concerns with his account as well as his "girlfriend."

I recently went for a routine yearly exam. No labwork was done only an appointment for a mammogram. Two days later I get a call from the nurse telling me I had a large amount of blood in my urine. I told her I didn't have any lab work done. The next day I get a letter of the results of "my"lab work. This is awful. First of all if I have the results of someone else's labs they may not find out till it's too late that they have serious health issues. They may never call for their results since they may think no news is good news. I've heard this many times. Secondly, this needs to be removed from my medical records. And what if I had had lab work done and now they're going to treat me for something I don't have. The end result of this could also be life threatening for me!!! Disgusting