NewYork-Presbyterian Hospital, Radiology Group

Review: I went for my 40 year old annual mammogram and ultrasound on 8/**/15 at [redacted] Imaging Center at [redacted]. I was called by the imaging center to come back as they needed to take further images on the left breast. I went back to the imaging center on 8/**/15. I had proper prescriptions for both visits. On the second visit I was told about additional fees that may be incurred. As they were quite high I questioned if I was covered and the receptionist gave me a [redacted] phone number to call for benefits to determine coverage. I stated that my Insurance was [redacted] Choice POS and was told that I was fully covered, no co-pay. I continued with the appointment and the results were that the spots in question were benign. I received a bill for both visits from Weil Cornell In October 2015 in the amount of $39.52. I paid that bill in full on 10/**/2015. That should have completed the transaction. Over two months later I received another bill for the same dates of service. The bill was dated 12/**/15. It showed an adjustment by [redacted] and that I now owe $288.33. I was confused. I called [redacted] Imaging ###-###-#### and inquired. I was told that they would give me extra time to work it out with [redacted] to find out what was going on. I called [redacted] to determine the cause of the adjustment. [redacted] advised that [redacted] requested an audit of [redacted] in reference to all of their patients who had [redacted] coverage. That audit led to the adjustment which led to me owing [redacted] Imaging an additional $288.33. [redacted] advised that they received the original billing from [redacted] on 8/**/15 and that they processed the claim which led to my bill of $39.52. They stated that the audit request came after that. I then called [redacted] Imaging back at the same phone number and inquired about the audit request. The woman in the office knew nothing about the audit. The issue remains unresolved.Desired Settlement: I would like the bill in the amount of $288.33 to reflect an amount due of $0. I am still uncertain as to the origination of the new billing amount. I would like a full accounting and explanation of what led to the new billing and a count of how many patients this affected if in fact an audit was performed. I would like to know specifics about the audit including request date and completion date and what specifically was audited and the findings.

Business

Response:

[redacted] processed WCINYP claims at the incorrect rates for a period of time (mid- August service dates to early November) and subsequently reprocessed the claims at the correct contracted rates, which might have resulted in higher out-of-pocket responsibilities for some patients. That is what happened in this case – [redacted] initially processed it at a much lower rate and after it reprocessed at the correct rate under our contract, the patient responsibility was higher. There was no change to our billing – but when it was requested that [redacted] correct their system issue and reprocess claims the patient responsibility amounts changed.

Consumer

Response:

I have reviewed the response made by the business in reference to complaint ID# [redacted], and have determined that my complaint has NOT been resolved because:

I am still expected to pay an additional $288.33 to [redacted]. At the time of service, I was told by [redacted] that I was fully covered. Based on that information I had the tests completed. I work extremely hard for my salary. I pay my health insurance premiums monthly. I make sure to complete my due diligence when getting tests performed. I received a bill in the amount of $39.52 in October 2015 for these services which I did pay. After my services were performed, after I received and paid my bill, alleged errors were discovered, by whom I am still not 100% sure. These errors were not the fault of the patient (myself) nor where they communicated to me. Instead, I receive an additional bill on Christmas Eve in the amount of $288.33 with no explanation. In fact, the bill was stating that my account was seriously passed due and that I may be sent to a collection agency. When I did call [redacted], no one could provide me with an explanation. I called [redacted] who advised me that [redacted] requested an audit. I called [redacted] back and still was not able to obtain any information. If these additional expenses were known to me at the point of service I would not have had the procedures performed at [redacted] at that time. I would have had the option to look elsewhere that would better suit my budget to have these tests performed. I should not be held accountable to now pay this bill based on the erroneous information that was communicated to me by [redacted]. I went to the imaging center in good faith and had the tests performed based on what I was told, that I was filly covered. [redacted] should now honor that and consider the payment they have already received from me for these services in the amount of $39.52 as payment in full. A total of $327.85 is substantially different than a total of $39.52. Better audits and processes should be put in place by [redacted] so that they are communicating the correct information to patients and when a patient is asking questions or requires further information they are able to provide it. I request again, that I not be held accountable for the mistakes of others and the misinformation that I was given when I did complete my due diligence regarding these services. Thank you. [redacted]

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Sincerely,

Review: I was recently referred to an MRI test at a facility that serviced [redacted]. I have undergone two of these tests in the pasts but at other facilities. In this instance, no billing or notification of potential charges was issued to me up front. However, upon completion of the tests, it appears they were a total of $7,000+. This alarmed me greatly given that I had certainly never been given any indication of the nature of the charges, nor that I would subsequently be responsible for over $1,100 in charges personally.

In the past, [redacted] has been incorrect on billing in a number of circumstances and, having spoken with their billing representative, they replied that they would have only known what the tests were in advance but not the charges. I noted that, in no other circumstance, anywhere in my life or in any part of the world would it be permissible for someone to charge another person $7,000 without letting them know in advance the charges or their personal share. To put this in context, the median salary in the united states is 26,695. Basically they felt it was ok to charge someone 27% of the median GROSS annual salary without any indication of pricing in advance.

Upon discussing this matter with their billing department, they said I would be able to speak to a [redacted] but merely put me through to voice mail with no follow-up.Desired Settlement: I am happy to pay a reasonable amount of money for hospital tests up to and including $100. I am not comfortable, nor is it ethically responsible, for them to charge me $1,143 in charges with no notice whatsoever.

Business

Response:

RE: Complaint ID [redacted]Customer: [redacted]Mediator: [redacted]This letter is in response to the aforementioned complaint ID [redacted], detailing our communication with the customer and our resolution.On March [redacted] we received a call from [redacted] inquiring the balance on his account to which was confirmed. The second call received from customer was on March [redacted] expressing his dissatisfaction regarding the amount charged to his insurance carrier and his out of pocket responsibility for services rendered to him at the [redacted] Imaging Center. [redacted] received services rendered on 2/**/2015 by an In-Network Facility and Provider and charges were submitted to his insurance carrier on his behalf, to which the charges were processed based upon the In-Network Contractual Rate [redacted] Imaging has with his carrier. His responsibility is not based upon the charges submitted but upon the in-network contractual rate. A portion of the allowed amount was applied towards his deductible and co-insurance.We endeavor to provide excellent customer care and to resolve any disputes to the best of our ability.If you require additional information regarding this matter, please do not hesitate to contact me at the above address or by telephone at ###-###-####.Sincerely,[redacted]