Modesto Perinatal Medical Associates

Review: I was referred to this office because it is the only office in Modesto that performs amniocentesis. The procedure is covered under the CA Screening Program if a blood screening comes back with abnormal results. This was also confirmed by my normal OB/GYN, that the procedure was covered. At the time the amniocentesis was performed, a technician was also taking measurements of the baby via sonogram as part of the screening. I was told that they were not able to get all of the measurements they needed in order to complete the screening tests and given a follow up appointment. My seconf appointment involved only additional sonogram measurements, in which the technician was extremely rough in doing so. At that appointment, I wsa told there would be a $330 charge, that this appointment was not covered by the CA Screening Program or my insurance, that it was considered a Level 2 screening and not necessary to the first apoointment as I was told. I was not given any indication that this second appointment was not covered, and unecessary in determining if there would be any birth defects, and was going to cost me out of pocket expenses. This office agian tried to schedule me another appointment saying they didn't get all the measurements necessary. I should not have been charged for an appointment that I was told was necessary to complete the screening that took place in the first appointment.Desired Settlement: I would like the Dr's office to refund the $330 I was charged as I was not given any notice that this was not covered by Ca's program and also mislead by this Dr's office as to what was a part of the initial screening.If they did not get all the necessary information in the first appointment, which was covered, I should not have to pay for a follow up. Also, after tests results came back normal, this office still tried to schedule me appointments they deemed as a part of the screeni

Business

Response:

Modesto Perinatal Associates provide care to the high risk Obstetrical patients in a 75 mile radius around Mosdesto, California. The patient who requested assistance from you was referred by her obstetrician to the California Prenatal Screening Program. We in turn are contracted with that program to provide ultrasound verification of gestational age and to identify as many fetal structures as possible at the time of a patient's genetic counseling appointment, These appointments are typically given to the patient by the state program early in the second trimester, to provide enough time for the patient to consider her options early in the pregnancy if her screening test with the program is abnormal. The consequence of this referral pattern is that typically not all anatomic structures can be imaged in enough detail to confirm normality at the time of the visit. This patient's appointment was for 1-23-14. On that day the fetal gestational age was 17 weeks and 1 day. An ultrasound and amniocentesis were performed at the patient's request. Not all anatomic structures could be imaged. My partner explained this to the patient. She was told the state only pays for one visit. A repeat examination was offered for a time when the fetus was larger and more anatomy could be imaged. The patient accepted this offer and scheduled an appointment for herself for 2-13-14. The extent of payment by her health insurance was verified on 2-6-14 and the patient was called on 2-10-14 at 7:45 AM. A message was left on her voice mail that payment towards her visit would be requested at the time of her appointment and how much that would be. The patient kept her appointment. At that time she provided a secondary insurance and the payment available through the secondary insurance was verified. Since this was the start of a new year neither deductible had been met. Consequently, 50% of the charge for that day was requested. This is the standard practice in our office. The patient was again informed when she gave us the secondary insurance information that the California Prenatal Screening Program only covered the previous visit. She stayed and had the ultrasound on 2-13-14. She could have decided not to keep her appointment that day. She does have a return appointment but she can choose not to come. We plan to bill both insurances on the patient's behalf and based on reimbursement from insurance, if the patient is due a refund we will process it and refund the amount due the patient, which is our standard practice for all patients.

Respectfully,

Sent on: 3/10/2014