Orthopedic & Sports Institute of the Fox Valley

Revdex.com: 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 The attachment provided does not indicate the charges for the surgeon, anesthesiologist, facility fees, etc It only shows a breakdown of what my insurance gave them This I did receive Regards, [redacted]

Revdex.com: 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 do have a sheet indicating that I would receive claims from multiple providers I just never knew was aware of a 'Facility Fee'.With that said, I still should not have been charged separate 'Facility Fees' My statements from the surgeon only indicate procedures being performed and the breakdown with codes only indicates codes ( [redacted] ***) that was submitted to my insurance company So, there should have been only 'Facility Fees' I am being over charged as is my health insurance which has now caused me to have an additional bill Regards, [redacted]

The Orthopedic Sports Institute of the Fox Valley (OSI) has been in existence for nearly years To my understanding we have never had a complaint submitted to the Revdex.com of Wisconsin We pride ourselves in being patient focused and cost effective in health care Our physician owners opened OSI in to provide better service to patients and families, and to reduce health care costs Our in-patient and outpatient fees are consistently 10% - 30% less than hospitals We understand that medical bills are complex and work hard to make the billing process less confusingMs [redacted] received a letter in July, explaining the bills she could expect to receive for her scheduled August 6, surgery Those fees included the Surgeon for his services, Anesthesiologist services and facility fees for the Orthopedic Sports Institute Surgery Center Facility fees are not “mystery fees” but are charged by all hospitals and Ambulatory Surgery Centers OSI is an Ambulatory Surgery CenterBesides paying for the facility which includes the waiting room, surgical prep room, the operating room, the post-operative space and special equipment; it pays for nurses, surgical techs & aids that provided services to her before, during and after surgery It also includes all drugs, medications, surgical supplies and dressings provided to her during surgery In addition, this fee covers sterile processing of all instruments, garments and other materials used in surgery The fee paid for each procedure is determined by each individual insurance company, not OSI The payment by the insurance company to OSI, or any hospital, is where it gets complicated and confusing Although one may think if you had a procedure done in the operating room there would be one charge However, insurance companies break out every procedure by several codes Since there were three charges exactly the same Ms [redacted] ’ understanding was the insurance company was charged three times for the same procedure In reality the insurance company has negotiated rates for every procedure that is broken out by codes In this case the codes were submitted to the insurance company for three different procedures done by the surgeon Even though the fee is the same the codes were differentWhat’s more confusing is that the insurance company does not pay the full charges, but only a portion In Ms [redacted] ’ surgery it appears her insurance company will pay our charges of $8,for the facility fee, but instead they will pay only a percentage and OSI will receive $1,from insurance and $from Ms [redacted] for a total allowable charge of $2, OSI has an impeccable record for service, cost and value I understand Ms [redacted] confusion about her bill and we would have been happy to explain this to her in person She still has an outstanding bill to OSI for $for her surgery provided on August 6,

Revdex.com: 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.The attachment provided does not indicate the charges for the surgeon, anesthesiologist, facility fees, etc It only shows a breakdown of what my insurance gave them This I did receive Regards, [redacted]

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID ***, and have determined that this does not resolve my complaint. For your reference, details of the offer I reviewed appear belowI do have a sheet indicating that I would receive claims from multiple providers I just never knew was aware of a 'Facility Fee'With that said, I still should not have been charged separate 'Facility Fees' My statements from the surgeon only indicate procedures being performed and the breakdown with codes only indicates codes (*** * ***) that was submitted to my insurance company So, there should have been only 'Facility Fees' I am being over charged as is my health insurance which has now caused me to have an additional bill
Regards,
*** ***

Revdex.com:
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.The attachment provided does not indicate the charges for the surgeon, anesthesiologist, facility fees, etc.  It only shows a breakdown of what my insurance gave them.  This I did receive.  
Regards,
[redacted]

Revdex.com:
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 do have a sheet indicating that I would receive claims from multiple providers.  I just never knew was aware of a 'Facility Fee'.With that said, I still should not have been charged 3 separate 'Facility Fees'.  My statements from the surgeon only indicate 2 procedures being performed and the breakdown with codes only indicates 2 codes ([redacted]) that was submitted to my insurance company..  So, there should have been only 2 'Facility Fees'.  I am being over charged as is my health insurance which has now caused me to have an additional bill.
Regards,
[redacted]

The Orthopedic Sports Institute of the Fox Valley (OSI) has been in existence for nearly 10 years.  To my understanding we have never had a complaint submitted to the Revdex.com of Wisconsin.  We pride ourselves in being patient focused and cost effective in health care. ...

Our physician owners opened OSI in 2006 to provide better service to patients and families, and to reduce health care costs.  Our in-patient and outpatient fees are consistently 10% - 30% less than hospitals.  We understand that medical bills are complex and work hard to make the billing process less confusing. Ms [redacted] received a letter in July, 2015 explaining the bills she could expect to receive for her scheduled August 6, 2015 surgery.  Those fees included the Surgeon for his services, Anesthesiologist services and facility fees for the Orthopedic Sports Institute Surgery Center.  Facility fees are not “mystery fees” but are charged by all hospitals and Ambulatory Surgery Centers.  OSI is an Ambulatory Surgery Center. Besides paying for the facility which includes the waiting room, surgical prep room, the operating room, the post-operative space and special equipment; it pays for nurses, surgical techs & aids that provided services to her before, during and after surgery.  It also includes all drugs, medications, surgical supplies and dressings provided to her during surgery.  In addition, this fee covers sterile processing of all instruments, garments and other materials used in surgery.  The fee paid for each procedure is determined by each individual insurance company, not OSI.  The payment by the insurance company to OSI, or any hospital, is where it gets complicated and confusing.  Although one may think if you had a procedure done in the operating room there would be one charge.  However, insurance companies break out every procedure by several codes.   Since there were three charges exactly the same Ms. [redacted]’ understanding was the insurance company was charged three times for the same procedure.  In reality the insurance company has negotiated rates for every procedure that is broken out by codes.  In this case the codes were submitted to the insurance company for three different procedures done by the surgeon.  Even though the fee is the same the codes were different. What’s more confusing is that the insurance company does not pay the full charges, but only a portion.  In Ms. [redacted]’ surgery it appears her insurance company will pay our charges of $8,223 for the facility fee, but instead they will pay only a percentage and OSI will receive $1,344.90 from insurance and $854.85 from Ms. [redacted] for a total allowable charge of $2,199.75.  OSI has an impeccable record for service, cost and value.  I understand Ms. [redacted] confusion about her bill and we would have been happy to explain this to her in person.  She still has an outstanding bill to OSI for $854.85 for her surgery provided on August 6, 2015.

The Orthopedic Sports Institute of the Fox Valley (OSI) has been in existence for nearly 10 years.  To my understanding we have never had a complaint submitted to the Revdex.com of Wisconsin.  We pride ourselves in being patient focused and cost effective in health...

care.  Our physician owners opened OSI in 2006 to provide better service to patients and families, and to reduce health care costs.  Our in-patient and outpatient fees are consistently 10% - 30% less than hospitals.  We understand that medical bills are complex and work hard to make the billing process less confusing. Ms [redacted] received a letter in July, 2015 explaining the bills she could expect to receive for her scheduled August 6, 2015 surgery.  Those fees included the Surgeon for his services, Anesthesiologist services and facility fees for the Orthopedic Sports Institute Surgery Center.  Facility fees are not “mystery fees” but are charged by all hospitals and Ambulatory Surgery Centers.  OSI is an Ambulatory Surgery Center. Besides paying for the facility which includes the waiting room, surgical prep room, the operating room, the post-operative space and special equipment; it pays for nurses, surgical techs & aids that provided services to her before, during and after surgery.  It also includes all drugs, medications, surgical supplies and dressings provided to her during surgery.  In addition, this fee covers sterile processing of all instruments, garments and other materials used in surgery.  The fee paid for each procedure is determined by each individual insurance company, not OSI.  The payment by the insurance company to OSI, or any hospital, is where it gets complicated and confusing.  Although one may think if you had a procedure done in the operating room there would be one charge.  However, insurance companies break out every procedure by several codes.   Since there were three charges exactly the same Ms. [redacted]’ understanding was the insurance company was charged three times for the same procedure.  In reality the insurance company has negotiated rates for every procedure that is broken out by codes.  In this case the codes were submitted to the insurance company for three different procedures done by the surgeon.  Even though the fee is the same the codes were different. What’s more confusing is that the insurance company does not pay the full charges, but only a portion.  In Ms. [redacted]’ surgery it appears her insurance company will pay our charges of $8,223 for the facility fee, but instead they will pay only a percentage and OSI will receive $1,344.90 from insurance and $854.85 from Ms. [redacted] for a total allowable charge of $2,199.75.  OSI has an impeccable record for service, cost and value.  I understand Ms. [redacted] confusion about her bill and we would have been happy to explain this to her in person.  She still has an outstanding bill to OSI for $854.85 for her surgery provided on August 6, 2015.

Revdex.com:
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.
The attachment provided does not indicate the charges for the surgeon, anesthesiologist, facility fees, etc.  It only shows a breakdown of what my insurance gave them.  This I did receive.  
Regards,
[redacted]

This letter is in response to the letter we received on 12/16/15, dated December 14th related to complaint ID 10966781 submitted by [redacted].  Ms. [redacted]’ first complaint stated she was not aware of a facility fee related to her surgery on August 8th, 2015.  We believe the letter dated July 2, 2015 which outlined the different bills she could expect to receive addressed this issue.  Also stated and explained in our December 2, 2015 response, facility fees are standard fees related to surgical procedures and are not unique to our business. Ms. [redacted]’ 2nd complaint is in regards to the number of codes the insurance company was billed.  We have included the results of a medical billing coding audit from The Coding Network, a national medical billing, coding, and auditing company.  The results of the audit were consistent with the services billed to Ms. [redacted]’ insurance company.  Similar to a hospital and the surgeon’s office, the Surgery Center and the surgeon’s office are separate entities, managed and operated by completely different personnel.   The surgeon’s office omitted the 3rd code in error. We believe this addresses Ms. [redacted]’ issue. Thank you, [redacted] Finance Manager Orthopedic & Sports Surgery Center 2105 E. Enterprise Ave. Ste 101 Appleton, WI 54913 Desk-920-560-1114