Overlake Hospital Medical Center

Resolution not provided yet

Revdex.com:I have reviewed the response made by the business in reference to complaint ID [redacted] , and find that this resolution is satisfactory to me I spoke to the billing department on August 3rd and they agreed to allow me to make my payment in full directly to the hospital so I could avoid having my account turned over to collections Thank you for your quick response

We have received the original Revdex.com complaint today and this subsequent information we are investigating and will respond within the time frame

Complaint: [redacted] I am rejecting this response because: When I arrived to the clinic that day, I stated that I thought my appointment was at 8:amI do not have an appointment preference as I typically schedule appointments on off daysOnly recently have I been provided a business card and I do not receive an after visit summary with written appointment informationI do not recall receiving a reminder phone callWhen creating a response, please ensure that you (Overlake) are providing correct and objective informationThe only reason I did not fully address the issue at the time is due to fear and prior negative documentation that has been placed in my chart in regards to expressed concernsI do not care what other patients due in regards to their personal preference for remembering appointmentsThe following aforementioned statement has nothing to do with the fact that I am owed a refund for an unfairly charged appointment cancellationAdditionally, Overlake needs to change their ridiculous policyAs a Nurse Practitioner, I understand the purpose of having an appointment cancellation policy, but the policy utilized by Overlake Outpatient Psychiatry is unrealistic and a way to suck money out of peopleAll in all, a refund should be issued to me immediatelyOtherwise, I will continue to address the issue and follow the proper chain of command until I am satisfied with the rectification

Hi *** ***, thank you for letting me knowI had provided the account number in the original complaint which could have been used for identifying the account in questionThe account is in my wife's name and I was following up with Overlake on her behalf in all previous correspondences with
themI thought I already provided with my wife's name in the origninal complaint but looks like I may not haveLet me know if it is ok to provide the name and any other details in the response and I will reply with name/DOBI am asking for this as I am being reminded not to provide any personally identifiable information in responses
Thanks
***

Overlake Hospital's justification for their overbilling and billing for services not provided is an absurd. The hospital's general descriptor for "Operating Room Services - Minor Surgery" did not apply in my case.I did not have any surgery, not even a minor surgery. I WAS NEVER IN THE OPERATING ROOM! I was in a tiny examination room where my privacy was constantly violated by a third party hospital employees as explained in my original complaint. The pathologist put a needle inside a 1cm cyst and drew a fluid out. It took him two minutes to do it. No anesthetic was used. No operating room related services were provided such as pand poservices which are standard and would indicate use of the operating room. Operating rooms are on a different floor at Overlake Hospital. The original text of my complaint has all the details.FRAUDULENT MEDICAL BILLINGCLAIMS ACT.Overlake Hospital cannot justify grossly overbilling patients by automatically assigning charge codes that cover use of operating rooms and operating room services, if the operating rooms WERE NEITHER PROVIDED NOR USED.If the procedure is provided in a small examination room instead of an operating room, the charges must accurately reflect that.Medical providers who bill for services never provided or bill at higher level than the actual services provided are liable under Claims Act.My claims of medical billing fraud, insurance fraud, extortion of funds, invasion of privacy stand, are valid and are reinforced by the Overlake Hospitals attempts to justifying fraud as their standard practice.I have a witness who was present during my entire visit. I intend to file a lawsuit against the hospital to protect my legal rights. I will also file complaints to the relevant State and Federal oversight agencies

Revdex.com:I have reviewed the response made by the business in reference to complaint ID ***, and find that this resolution is satisfactory to me
And thanks for helping this long pending issue to be resolved!

This complaint has been thoroughly investigated and the charges have been determined to be appropriate for the services
provided in a hospital outpatient setting While the complainant makes allegations of fraud and states that the usual charges would be $ 350.00, our investigation would not support that Had this procedure been performed in a private physician's office, it is likely that it would have been less, however, would have still included professional fees by the pathologist The cost and fee structure for hospital based services are typically higher.In order to capture appropriate charges for the services provided, the hospital utilizes industry wide charge codes, which include a general descriptor In many instances the code used broadly applies to multiple procedures and the detail is not always reflected in what appears on either the bill or on the Explanation of Benefits, which is provided by the insurance company to their subscribers In this instance, the charge code associated with CPT is generally described as "Operating Room Services - Minor Surgery." The more detailed description which is reflected in the itemized charges reflect "HC FNA(Fine Needle Aspiration)without imaging guidance."Finally, in addressing the complainant's specific allegations of fraud and extortion, we are again, unable to substantiate those claims, and would in fact, refute themThe hospital charges submitted to the complainant's insurance carrier, Regence, reflect total charges of $ 1, Regence allowed $ 1, The breakdown of that reimbursement are as follows: Code $ 142.69; $ 142.69; $and $Regence paid a total of $ 506.32, leaving a balance of $ which reflects the patient obligation (this is typically a combination of deductible and maximum out of pocket obligations set forth in the particular insurance coverage that a person has). Although we understand that the system of billed charges versus allowed charges is complex, and becomes even more so when combined with an insured's obligation as set forth in their insurance policy, it is the system in which all health care facilities must operate We certainly could have done a better job of providing a more detailed explanation in response to the complaint and for that please accept my apology I hope this provides the clarification necessary for resolution of this matter

Revdex.com:I have reviewed the response made by the business in reference to complaint ID [redacted], and find that this resolution is satisfactory to me.
I spoke to the billing department on August 3rd and they agreed to allow me to make my payment in full directly to the hospital so I could avoid having my account turned over to collections. 
Thank you for your quick response.

In checking with our billing office, it was discovered that the payment was credited to the wrong account.  It is unclear why upon his contacting our billing office that it was not corrected, as the person with whom he spoke is no longer employed.  The payment has been appropriately credited and collection activity stopped.  Our apologies for this error.  We appreciate this having been brought to our attention.

This no-show complaint is related to this patient's appointment on 12/15/15 at 8:00am.   They arrived late as stated in the record and the front office and physician, both document interactions at the point of the person’s late arrival.  There is no mention at the point of this...

documentation that the patient claimed her appointment was scheduled for the wrong time.  Rather they were offered and accepted a later appointment that day.
The appointment for 12/15/15 was set with the patient after a follow up appointment on 11/17/15.  She has a pattern and prefers to schedule 8 am appointments prior to work.  If she is unable to schedule an 8 am or an earlier appointment she schedules mid-day and more recently early afternoon due to availability.  When setting appointments the front office has her write the date/time on her After Visit Summary or provides a business card with the information on it. Some patients prefer to put their appointment information in their phone calendar and the front office states this patient prefers to place the information in her phone.
This patient initiated treatment at the clinic on 10/20/15 and was provided a copy of the no-show policy.  I have included a signed copy of this notification.  Additionally, as a courtesy, the clinic utilizes the Televox reminder call system the provides notification of appointment date and time 2 days prior to the appointment.  Finally, this patient has an active OneChart (online electronic health record accessible by the patient) account as of Nov 2015 where she can see her appointments in advance.  Patients are instructed to arrive 15 minutes prior to the start time for the appointment if scheduled as a follow up and 30 minutes prior to appointment for an initial evaluation to ensure all paperwork is completed prior to the appointment start time.
This patient has demonstrated the ability to cancel and reschedule appointments outside the 24 hour no-show cancellation policy both prior to and following this no-show.   The no-show cancellation charge is applied to all no-shows.

We have received the original Revdex.com complaint today and this subsequent information.  we are investigating and will respond within the time frame.

Revdex.com:I have reviewed the response made by the business in reference to complaint ID [redacted], and find that this resolution is satisfactory to me. Sincerely, [redacted]

Complaint: [redacted]I am rejecting this response because:
When I arrived to the clinic that day, I stated that I thought my appointment was at 8:30 am. I do not have an appointment preference as I typically schedule appointments on off days. Only recently have I been provided a business card and I do not receive an after visit summary with written appointment information. I do not recall receiving a reminder phone call. When creating a response, please ensure that you (Overlake) are providing correct and objective information. The only reason I did not fully address the issue at the time  is due to fear and  prior negative documentation that has been placed in my chart in regards to expressed concerns. I do not care what other patients due in regards to their personal preference for remembering appointments. The following aforementioned statement has nothing to do with the fact that I am owed a refund for an unfairly charged appointment cancellation. Additionally, Overlake needs to change their ridiculous policy. As a Nurse Practitioner, I understand the purpose of having an appointment cancellation policy, but the policy utilized by Overlake Outpatient Psychiatry is unrealistic and a way to suck money out of people. All in all, a refund should be issued to me immediately. Otherwise, I will continue to address the issue and follow the proper chain of command until I am satisfied with the rectification.

Our investigation would indicate that the patient did not follow the instructions contained on the statements mailed instructing her to contact our billing department to arrange a payment plan if the balance could not be paid in full.
As of today this account has been removed from [redacted]...

Collections. The 40.00 payment was posted to this account on 05/04/2016 and applied to this balance on 08/02/16.
The patient is correct stating she made payments each month: 01/22/16 100.00, 05/02/2016 63.00,05/04/2016 40.00, 06/13/2016 100.00, 07/06/2016 100.00 and 08/03/2016 1227.11.
The patient was sent four statements dated 03/22/2016, 04/21/2016, 05/21/2016 and 06/20/2016.
The first statement shows: [redacted] Your responsibility is 1530.11.
[redacted] balances 101.00 and 99.00 for a total balance of 1730.11 owed from the patient.
Verbiage on the statement:
[redacted]
Your balance is currently past due. Please submit payment of $1,730.11 by April 19, 2016 to avoid collections or call us at [redacted] if you would like to make payment arrangements.
 
Each statement reflects a news balance and repeats the message above.
 
[redacted]What has happened is the patient continued to make payments without setting up a payment plan.
When a balance is not paid if full and a payment plan is not set up the balance continues to age. And in this case the account went to collections on 07/22/16.
 
From the account history:
 
06/15/2016 Patient was contacted by [redacted] : Called patient in pre-collections. LM with request for return call to our department.
 08/02/2016 Husband called and spoke to [redacted]. She was unable to discuss details on the account because we did not have permission from the patient..

Resolution not provided yet.