Oak Valley Hospital

Message:Re: Complaint ID # [redacted] Dear [redacted] ,I apologize for the delay in a timely response to complaint ID # [redacted] as we were unable to access the complaint from the website I am responding in the absence of our President and C.E.O.I spoke with our ambulance manager who states he did attempt to contact this patient to resolve his issues and was unable to get in touch with him No other departments, such as the office of our President and C.E.Oor the Quality & Risk Management Department have received a message regarding this incidentChart review does not support the claims made against the hospital and, in fact, support that the treatments the complainant claims were withheld were in fact supplied to the patient I will, however, have the Quality & Risk Management Department reach out to patient as I see he is requesting complaint forms from the hospital.Feel free to contact me should you have any questions or need any assistance.Sincerely, [redacted] ***Vice President of Nursing Services

Message:
Re: Complaint ID # ***
"">Dear *** ***,
I apologize for the delay in a timely response to complaint ID #*** as we were unable to access the complaint from the website. I am responding in the absence of our President and C.E.OI spoke with our ambulance manager who states he did attempt to contact this patient to resolve his issues and was unable to get in touch with him. No other departments, such as the office of our President and C.E.Oor the Quality & Risk Management Department have received a message regarding this incident.
Chart review does not support the claims made against the hospital and, in fact, support that the treatments the complainant claims were withheld were in fact supplied to the patient. I will, however, have the Quality & Risk Management Department reach out to patient as I see he is requesting complaint forms from the hospitalFeel free to contact me should you have any questions or need any assistanceSincerely,
*** *** ***
Vice President of Nursing Services

I accept the business responseI received the form as promised by the businessComplaint is closed to my satisfaction

Message:Re: Complaint ID # [redacted]Dear [redacted],I apologize for the delay in a timely response to complaint ID #[redacted] as we were unable to access the complaint from the website.  I am responding in the absence of our President and C.E.O.I spoke with our ambulance manager who states he did...

attempt to contact this patient to resolve his issues and was unable to get in touch with him.  No other departments, such as the office of our President and C.E.O. or the Quality & Risk Management Department have received a message regarding this incident. Chart review does not support the claims made against the hospital and, in fact, support that the treatments the complainant claims were withheld were in fact supplied to the patient.  I will, however, have the Quality & Risk Management Department reach out to patient as I see he is requesting complaint forms from the hospital.Feel free to contact me should you have any questions or need any assistance.Sincerely,[redacted]Vice President of Nursing Services

Review: Charges to the V.A. were requested many times to be corrected and resubmitted. Have been resubmitted without changes. Now I am in collections.

Account# [redacted] Service date 10/21/12 to 10/22/12. Emergency room services to be checked for blood clots in legs. Bill Total $6489.14 I had an 80% blockage behind the right knee. Charges were submitted to the Veterans Health Care System several times. The VA requested that they need to correct the TC modifier on line 10 (HCPCS code 93970) of the claim. Oak Valley keeps submitting the claim without any changes. Now they are going after me and I am in collections and my credit rating is in jeopardy. I have been back and forth between the VA all year trying to get this taken care of. At one point I got the billing office to speak directly with the VA Non-VA Medical Care office and was told that an agreement was made and a payment should follow soon. It all depends on the ability of Oak Valley to respond and make then necessary changes. It is almost like Oak Valley office is run by an automated machine and it can't make changes on its own. This should not be this difficult and frustrating.Desired Settlement: I just want them to do their job professionally and stop harassing me. Make the requested changes on the claim they need to send to the V.A. and get the claim paid and leave me alone and get me out of collections so I can have a Merry Christmas.

Business

Response:

This is in response to a letter we received from the Revdex.com on January 9, 2014. This is in reference to Case [redacted]: [redacted]. I tried to respond to you on the Online Complaint tools and could not get them to work. Mr. [redacted]'s complaint states that V.A. has requested several times that the modifier needs to be corrected and resubmitted on his service in the emergency room on 10/21/12 to 10/22/12. Here are the following timelines that Oak Valley Hospital has followed to get the claim paid. On 11/08/12 the business office billed the claim to VA with emergency room notes. On 12/06/12 we received a request from VA for a modifier for code 93970. We forwarded this request to our Medical Records Department and they stated the there was no modifier according to the Encoder they could attach to the 93970 code. We spoke to the Medicare biller and she suggested the modifier 59 so we rebilled with the modifier on 02/01/13. On 03/05/2013 we received a denial from VA that the 59 modifier was not valid, we called an left a voice message with VA to see if they could assist in what modifier to use. We followed up for several months with no calls back from VA. On 06/28/13 we received a denial from VA that the claim did not meet medical necessity. We turned this to patient responsibility at that time. On 08/20/13 spoke to the patient he was upset that this was being billed to him and asked that we resubmit the claim to VA. We rebilled to VA on 08/20/13 and advised the patient the claim was denied for not medically necessary. We received another call from the patient on 12/03/13 because the account was turned to pre collections for no response from VA or the patient. On 12/13/13 the patient called and state he is still working with VA to get the claim paid. After receiving the correspondence from Revdex.com and seeing the statement from the patient being advised by VA to rebill with the TC modifier I advised my staff to rebill VA again and attach the TC modifier on code 93970 per their request on 01/15/14.

I have attached the denials from VA. I know it is going to take months before we get a response from VA on the resubmitted claim. We have stopped the pre collection process and would ask that the patient keep in contact with us as to the status if he receives anything from VA. We will continue to do the same.

Consumer

Response:

in reference to complaint ID [redacted].

In truth I cannot accept or deny the response since I really have to know that they physically followed through with what they said they would do.

I did also contact the Veterans Administration in Palo Alto and they told me the following this morning. I am not sure why a claim mailed on the

15th of the month has not arrived yet but this is what they said.

So far the VA has not received an updated claim yet, however I have gone ahead requested for the claims processing team to reopen the claim for review.

It is currently back in processing. Once processing has been completed, both you and the provider will received notices on the result of their findings.

Provider Relations-[redacted]

Thanks for your assistance and I will let you know when I get a confirmation from the VA that the claim has been received, accepted and processed.

Sincerely,

Review: I would like to complain a bought the way oak valley ambulance treated me lack services lack of equipment lack of experience and professionalism demined me live saving services drug me threw ditch slam in hot ambulance shut the door stared yells at me don't need oxygen these actions and procedures cost me my life I died in the ambulance after my internal defibrillator went off still deny me oxygen and backboard to get me out ditch the [redacted] police witnessed incident and Mention to me their unprofessionalism . a week latter still suffering from this I have left messages for ambulance manager and hospital manger to call back sill noting 9/16/15 will seek professional help soon.Desired Settlement: call back and complaint forms

Business

Response:

Message:Re: Complaint ID # [redacted]Dear [redacted],I apologize for the delay in a timely response to complaint ID #[redacted] as we were unable to access the complaint from the website. I am responding in the absence of our President and C.E.O.I spoke with our ambulance manager who states he did attempt to contact this patient to resolve his issues and was unable to get in touch with him. No other departments, such as the office of our President and C.E.O. or the Quality & Risk Management Department have received a message regarding this incident. Chart review does not support the claims made against the hospital and, in fact, support that the treatments the complainant claims were withheld were in fact supplied to the patient. I will, however, have the Quality & Risk Management Department reach out to patient as I see he is requesting complaint forms from the hospital.Feel free to contact me should you have any questions or need any assistance.Sincerely,[redacted]Vice President of Nursing Services

Consumer

Response:

I accept the business response. I received the form as promised by the business. Complaint is closed to my satisfaction.