Ohio Gastroenterology Group, Inc.

My review of notations made in our scheduling systems shows the following:----------------------------------------------------------------------...⇄ Patient canceled. States he is no longer having symptoms and does not need appointment.04/11/- Patient called disputing $
rescheduling fee. Advised patient appointment needed to be canceled on 3/30/2016. Patient stated he could not have made the appointment due to death in family.04/12/- Supervisor reviewed the case. Noted that patient stated initially "no longer having symptoms" but changed statement to "death in family" after receiving bill for $Called patient and left message.04/12/- Patient returned the call. Informed patient the rescheduling fee will not be waived. Patient upset. States he will not pay the fee. He will not reschedule as it took over a month to obtain the appointment and that he will report to the Revdex.com and will not recommend OGGI to anyone. I advised the patient that this will be noted in the account.------------------------------------------------------------------------...⇄ reviewing our cancelation and no show rate mid-I noted that it was approaching 10% of our capacity. We do not overbook patient office slots. The patient is correct in terms of wait times for appointments. Although we have gastroenterologists office appointments can often be out to weeks depending upon the physician. A common problem in GI is that patients no longer have symptoms and just don't show up. This lost capacity further stretches out our appointment times and 10% of our office slots were being taken by patients who had already been given an appointment and did not show up.We actually patterned our cancelation and no show policy on the policy used by one of the largest medical groups in town, a practice I actually go to and I have received, and paid two bills for situations where I was unable due to work requirements or family emergencies. Since implementing the policy our cancelation and no show rate has dropped from nearly 10% to 6%.Our policy is consistent with other such policies in the medical community in Central Ohio and it will not be waived

I made an appointment for my husband to have a colonoscopyHe has had a stroke and as his p.o.ahe relies on me heavily for assistancemy schedule at work was changed and I was unable to drive and assist him My husbands apptwas on 7/at 10amwe were to arrive at 9amhr prior to procedurewhen I called to cancel ( I did not get a name) the receptionist told me I would be charged because I did not cancel days priorAs soon as I was aware of my schedule change I did try to call that evening{ I work afternoon hrs.} on 7/at 9:59pm thinking I could leave a msg
but was unable to due to their systOn 7/ I got up early and called at 8:a.mthat is more than hrs.{days} prior to the apptWhen I spoke with the young lady she said there will be a cancel fee because I did not call days prior and my reply was that was the reason I am calling today{ this was a thursday and the appointment was for the following Monday} Her response was I should have

I had a colonoscopy on September 28, at Ohio Gastro on Olentangy Great staff, clean facility and punctualI was lightly sedated and awake enough to actually watch some of the procedure on the monitor and felt no pain Great experience since being totally put under with anesthesia is so scaryIf you are afraid of anesthesia or of having a colonoscopy, don't be, go here!

Colonoscopy service that should have been covered by my insurance, but wasn't due to diagnostic codeI asked the receptionist, at the time of the colonoscopy, why the my paper work called the procedure surveillance and not screening, which is the insurance code that I believed my procedure should have been She responded to my concern by saying that I could mark-out surveillance and wriscreeningSo I did that
Later, I received billing statements of $and $= $I called Ohio Gastroentrology Group and talked to Joanne about a coding mistake as being the reason my insurance didn't pay the full amountJoanne said there was no coding mistake and that due to my family history and an earlier colonoscopy that indicated that a polyp was found and removed, that I was under surveillance for colon cancerI asked Joanne to connect me with a supervisor about my concern, at which time she connected me to the voice mail for LoganLogan never responded to me, but I di

It should be understood that the intent by the Revdex.com is not to solve issues but to feed their postings on their web site to draw in additional readers. It is of note that the Revdex.com reserves the right to edit the response in any way they wish so that this response may or may not represent that is
stated in a factual manner and therefore cannot be trusted for its accuracy. that is the only statement I have

I was contacted by this company's collection agency in India demanding payment for a bill I had never receivedI asked the Indians for documentation and they refused.) I called the health provider and asked for documentation and was promised a copy (Turned out that they had billed an incorrect address.) None came
I called repeatedly, then e-mailed and even faxed, all to no avail Finally after months I sent a letter and received a response that my account was in collection and they would not work with me They then filed a complaint against my credit rating

I had an appointment Monday, April 4th at 9amThey have a cancellation policy of two business days prior to not be charged for cancelling I called them on March 31st, at 810am to cancel my appointment due to a death in the family and a funeral on Monday, April 4th over two hours away They informed me that the day you call doesn't count as a business day even though I called min after they opened They refused to let me reschedule or cancel without a fee stating that it wasn't two business days What I don't understand is, how can it be ok to cancel on Wednesday min before closing and not OK minutes after they open on next day which is two business days from Monday There is no way they would have filled my appt before opening the day I called I work nights and it did not specify in the instructions that the day you call is not counted Especially, min after opening and being a true hours from my appt time I attempted to call two different supervisors in which

I am rejecting this response because: as stated in my complaint, I questioned the code language in the paper work the day of the procedure and why that same code language was not in the paper work that I filled out and returned weeks before the procedureHad I known the procedure would not be covered by my insurance, I would not have elected to have the procedureTheir deception in this matter and their reluctance to discuss this with me is why I reject their response
Regards,
*** ***

I had a colonoscopy procedure on March 18, by provider John JW***, MDI received a bill the beginning of April for the amount of $which was due by April 18, The statement stated this was my part of the co-payment that our insurance company, *** Healthcare did not payI submitted a personal check #*** on April 10, in the amount of $After mailing the payment, I received an Explanation of Benefits from *** Healthcare stating that the procedure was paid on April 7th 100% to Ohio Gastroenterology GroupI phoned the billing department at ###-###-####I was told that it may be October before I received reimbursementI ask to speak to a Manager as I felt this amount of time was unacceptable to meI left repeated messages for the Manager, none of which were returned to meThe last conversation with the billing department told me it could take another days to receive reimbursementI feel this in totally unfairIf I had not made payment to them,

I am writing to let future and current patients of Ohio Gastroenterology Group aka Central Ohio Endoscopy Center, know about their billing practicesBeware of their billing practices for a screening colonoscopy versus a diagnostic colonoscopy OGG will try to billing you for a diagnostic colonoscopy, even if you do not have any cancer in prior screenings, or any symptoms that would require a diagnostic colonoscopyThis business will receive more money from a diagnostic procedure from an individual paying for this procedure versus an insurance companyOGG refused to correct my procedure from a screening to a diagnostic in my second procedure three and a half years after my first screening Even when, according to their own printed material defining a screening versus a diagnostic colonoscopy, I did not show symptoms needed for a diagnostic colonoscopyAdditionally, OGG will not inform you of your stated type of procedure prior to your appointment The only information you will receive is a notice that you are financially obligated to what this business bills you

I called the company to inquire about an appointment The company had a cancelled appointment opening for the following day I called later the same day and left a voice mail message stating I wanted to cancel the appointment Since, this was a minute appointment there was no time to cancel within the hours "required cancellation notice." I am now being billed a rescheduling office fee I did not give the business my social security number, nor did I fill out any personal paper work How can a rescheduling fee be charged, if time does not permit cancellation of This was an open spot from a previous cancelation from another person The phone system was a message system, no one called me back I did not have hours to cancel because the appoint was less than hours from the time I made the call I find this to be and unethical practice I called and was told the bill could not be removed

If the conditions to charge 25.00 are based on not canceling within 48 hours, then how can I be charged if I did not have a period of 48 hours to cancel the service? How can this hold true to their policy. There was no way to cancel the appointment 48 hours prior because the appt was less then 48 hours after I placed the call. How can those rules apply. I didnt sign any papers or even go to the location, and I did call and cancel. It was impossible for me cancel 48 prior to the appointment.

We have reviewed the complaint along with an internal investigation of the details of the statement and find them to be contrary to our own internal inbound and outbound phone system which tracks all inbound and outbound call details and information as well as identification metrics of any potential...

voice mail.The decision stands.

In an effort to reduce wait times for patient appointments we have begun to directly address those patients who fail to show up for an appointment or who cancel at the last minute in such a way that we cannot fill the appointment slot with another patient on a priority wait list.  We found that...

a key component to wait times is a cycle where patients schedule an appointment when they don't feel well and they when they feel better they just don't show up.  As we had never directly addressed this point our cancellation and no show rate had grown to nearly 10% of all appointments.  This structurally reduced our capacity by 10% and forced appointments further and further out into the future.We now charge a rescheduling fee to all those patients who fail to notify us in time to fill their appointment slot.  As you might guess if a patient is waiting three months to see their physician we also have many patients on priority waiting lists who can come in at almost a moments notice.Our wait times have begun to drop and our "first available" appoint slots have also begun to move closer in as the program has encouraged accountability with our patients.We do not waive these fees.  A fee waived once is a fee expected to be waived again and again and thus allowing patient to fall back into the habit of canceling and failing to show for an appointment as there is no consequence to their actions.

The business reply was not clear. I followed the 2 day rule and do not owe the penalty fee. I need a clear response so if I need to take further action I will.  i would prefer to end the matter but I need a  proper response from the business. 
Regards, [redacted]

I reviewed the response made by the business in reference to complaint ID [redacted], and find the resolution is satisfactory to me.  It does bother me that additional measures had to be taken in order to get a Manager to return phone calls. I realize that they have many patients. I hope this isn't their standard route for all patients. I was told yesterday by them that the bill I received would have been turned over to a collection agency in July but then they're able to hold my money until the end of October. They were paid in full by [redacted] Healthcare in April. It is difficult for me to imagine paying my bills that late. I don't know any other recourse I have but to accept their offer for payment the end of the month. Shame on them for this matter.

We have received and reviewed the complaint you sent in regard to the billing concern you received from Ms. [redacted].I have reviewed her concerns, and listed the response below. Ms. [redacted] spouse called us on July 18th in regards his spouse’s refund, refund request was submitted to the...

department manager per this call. Ms. [redacted] has called several times since then (twice on 8/2/16 and again on 10/5/16) and has been told each time that our refund process can take up to 90 days, which is standard practice amongst medical practices.There is a note from a medical billing representative dated 8/2/16 stating patient was upset with our process and that she wanted to speak to the manager about this issue. The manager does not recall receiving a voicemail, and apologized for not returning this call.Her refund was submitted to the accounts payable department on 9/267/2016 for her check to be cut on the next check run which was 10/10/2016 it is currently pending signature when a signer is available on 10/12/2016. The billing manager spoke to Ms. [redacted] yesterday (10/10/2016) per her voicemail that was left on 10/5/2016 and explained that it is a 90 day process from the time it is submitted and we are still within that time frame. We apologized to her for the missed return call that she mentioned.The billing manager explained that we will not refund until all of the claims are processed and that the facility charge was the last claim to be paid by her insurance. Facility claim was paid in May and the refund was submitted in July once everything had been reconciled. The billing manager let the patient know that her check was cut yesterday and is now just waiting on the physician to sign. At this point the patient stated she was told by Linda, the billing representative that it could take another 90 days for the doctor to sign. The billing manager explained this is not the case, it is a 90 day process from the time that the refund is submitted for processing. The billing manager then reiterated that her refund check will be mailed out to her by the end of the week and she should receive it within the next week or so. The patient was provide the direct number for the billing manager to call with any other questions.We apologize for any confusion and for any upset Ms. [redacted] endured. We have taken steps to get this corrected and her check should be in the mail after being signed on 10/12/16.If you have any questions or concern please feel free to contact me directly.Sincerely, Megan D[redacted]Director of OperationsOhio Gastroenterology Group, Inc.Central Ohio Endoscopy, LLC

Medical groups do not make arbitrary decisions on the proper method of coding an encounter.  We are held to the requirements for care as laid down by Medicare regardless of the age or insurance of the patient.  They basically set the rules for everyone to follow.There are three issues...

here.First is the definition of a "screening" procedure. A screening colonoscopy is one where the patient has no symptoms and had had no findings in the past.  It might best be thought of as the "first" colonoscopy.  If a patient had a prior colonoscopy and the gastroenterologist removed a polyp or took a biopsy with positive findings, future colonoscopies can no longer be classed as a "screening."In this case Mr. [redacted] had a colonoscopy in 2010.  A polyp was removed and diagnosed as a tubular adenoma by a pathologist.  This is a polyp that has the potential to develop into colon cancer but was removed prior to its beginning to differentiate into more dangerous tissue.  Mr. [redacted] has a higher than average chance of developing colon cancer and needs to have periodic colonoscopies to inspect if further polyps had developed so they can be removed before they develop into a tumor.  The common term in GI for this kind of repeated colonoscopy is  "surveillance" as the gastroenterologist is inspecting for those returned polyps.Second is the coverage of insurance.  We have no control over a patient's benefits.  It is fairly common for a patient not to understand the nuances of coverage until after an event when the patient believes they have an idea of their coverage but their insurance company states something different.  I know that is frustrating as it has happened to my wife who is on my own insurance.  The insurance company is the only party that can explain coverage as we don't have a copy of the individual policy.  I will say from experience that the insurance company will typically state that it was the patient's "choice" of benefits when they purchased or selected the policy at their work.Third is the request to change how an event is coded or classified so that the patient's insurance might pay more to the patient.  As I mentioned above we have to apply those rules as established by Medicare as they set the universal rules in all aspects of health care.  Basically is has two layers.  Medicare sets the rules on how care is classified and coded and then the insurance company decides what they are going to cover in a specific policy based on those rules.  To change how an event is billed so that it pays more is specifically determined as "enticement for care" which is classified specifically as fraud.  Its not just  breaking the rules, its breaking the law. So the bottom line is that we can't change how an event is classed or coded.  Mr. [redacted]'s bill was coded appropriately and was denied for some reason by his insurance coverage.  There is nothing we can do.

Yes I did initially call because of not showing symptoms on Thursday And it wasn't until later that day I found out that my cousins funeral would be on that day over two hours drive from Columbus.  So regardless of not showing symptoms I couldn't have came anyways and they were given ample time to reschedule. I called them at 810am on that day practically two full business days. In their letter.no where does it say two business days aren't counting the day you call especially when I called as soon as they opened. There is no difference if I would have callef.Wednesday at closing time or first thing Thursday.  If.you are gonna say the day you call doesn't count.you need to say that in your instructions. You all had plenty of time and there is zero difference between opening time on Thursday and closing time Wednesday.. there is no way you would have done anything at closing. All you are doing is being picky trying to charge a senseless fee. Greedy company... plain and simple.. also I called two different managers twice and left voice-mail and you can't respond but yet you type away on this computer. Unprofessional. 
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