Pediatric Alliance Southwestern Division

RE: [redacted] Complaint ID# [redacted] Dear Madam or Sir:We are in receipt of your letter dated September 2, regarding complaint ID# [redacted] This family, (including children *** and [redacted] ), was treated at a Pediatric Alliance office and was eventually discharged from the practice on April 19, for non-payment of services[redacted] had four (4) outstanding claims that totaled $ [redacted] which was applied to the deductible, with a breakdown as follows:• 03/04/$***• 03/28/$ [redacted] includes $ [redacted] for deductible plus a $ [redacted] late fee• 05/03/$***• 12/30/$ [redacted] had two (2) outstanding claims that totaled $ [redacted] which was applied to the deductible, with a breakdown as follows:¦ 03/09/$***¦ 01/20/$***We tried on multiple occasions between May and March via telephone (see attached documentation), to reach the guarantor, [redacted] , to resolve the outstanding balance of $***At no time did Mrs [redacted] inform us of any type of domestic distress or financial inability to resolve the matter.On March 17, we mailed a letter (see attached documentation), to Mrs [redacted] at [redacted] *** explaining that we had attempted several times to contact her and if the balance was not resolved within days her children could be discharged from the practice.On April 19, we discharged the patient from the practiceWe mailed her a certified letter (see attached documentation) informing her of this decision and asked that she choose another physician not affiliated with Pediatric AllianceOn May 10, her account was sent to the Collection Agency.This was the second discharge for non-payment for this family, with the original discharge taking place on October 7, 2013.It has been the longstanding policy and practice of Pediatric Alliance to work with our patients in resolving past due balancesBetween the individual Pediatric Alliance office and the Billing Department, we strive to satisfy patients without any interruption in patient care, while also maintaining company policiesWe offer Financial Hardship and Payment Plans to assist patients when they are in financial distress for exampleAs previously noted, we were not aware of the family’s inability to pay their balanceHad Mrs [redacted] made Pediatric Alliance aware of her domestic/financial situation, we would have discussed with her the options of either a Financial Hardship or Payment PlanIn addition, it is stated in our policy that if a balance is not paid in full and is greater than days old, the account will be assessed a $ [redacted] late fee.Due to the non-compliance and failure to pay her account in full within a timely manner, her account was discharged, and the individual Pediatric Alliance Office decided not to reinstate the family into the practiceIf you have any questions, please feel free to contact me at ###-###-####, Ext*** Monday through Friday 8:00am to 4:30pm.Sincerely,Tracey D [redacted] Billing Manager

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.When I called to make the appointment in August, the receptionist did not tell me I was dischargedIF I was discharged in April, why in the world would anyone entertain the idea of my kids having an appointmentBecause they wanted the money She misleaded me to call a collection agency in order to make an appointmentIf this was clear to Pediatric Alliance that I was discharged, they should have told me when I called to make the appointmentInstead the woman tricked me as I was desperate for them to be seen to get what they needed for schoolI went and paid the balance because I thought appointments were going to be madeI BEGGED and PLEADED with the office manager to make an exceptionShe told me NO! she told me that this was a habit and she had the final word and that was that Had I been aware of my standing or known that my kids were in jeopardy of being discharged, I would have disclosed the problems I was having prior to being dischargedAgain, they used this as a ploy to get moneyI paid what was owed and then turned their story aroundStill unacceptable Regards, [redacted]

To whom it may concern:We received your letter dated 01/04/regarding complaint ID# [redacted] .The patient was seen on 08/23/for a preventative visitDuring this visit, the patient also had a complaint of wartsThe physician completed the preventative visit and treated the patient's warts with HistofreezeAt the time of the service, the physician advised the patient of filling, salicylic acid, and duct tape nightlyReturn in 2-weeks for re-freeze if needed.On 09/14/2016, the patient returned for a chief complaint of a pimple in the nose and during the general inspection it revealed a plantar wartConsent was obtained and the wart was treated again with histofreezeThe procedure and risks were explained in detail.According to the American Medical Association Coding Manual CPT book, Destruction means the ablation of benign, premalignant or malignant tissues by any method, with or without curettement, including local anesthesia, and not usually requiring closureAny method includes electrosurgery, cryosurgery, laser and chemical treatment Lesions include conddyiomata, papillomata, moliuscum contagiosum, herpetic lesions, warts (ie, common, plantar, flat) milia, or other benign, premalignant (eg, actinic keratosis), or malignant lesionsHistofreeze is a chemical treatment.Pediatric Alliance has coded both dates of service, 08/23/& 09/14/appropriately.According to the Coding Guidelines we could have billed for an office visit and destruction of lesion on 09/14/16, but the office voided the visit related to the pimple in the noseTherefore she was only billed for the destruction of lesion, [redacted] ff you have any questions, please feel free to contact me at [redacted] , ExtMonday through Friday 8:00am to 4:30pmSincerely,Tracey D [redacted] Billing Manager

We received your letter dated 12/05/regarding complaint ID# [redacted] .As per federal HIPAA and privacy laws, Pediatric Alliance cannot disclose any protected health information or information regarding treatment for any of our patients without written patient consentPediatric Alliance adheres to Best Practice Guidelines for all of our patients to provide exceptional, clinically appropriate care and treatment.Physician practices do not determine which services are covered by insurance companiesService charges are determined by the market and healthcare providers submit those charges to the appropriate insurance companyThe patient's insurance plan determines the amount that they will reimburse for specific services and the amount the patient is responsible forHealthcare providers are contractually prohibited from adjusting charges for deductibles and/or co-insuranceThis information is stated in our Financial Policies which are provided to all patientsIt is ultimately the patient's/parents responsibility to comprehend what their out of pocket for services will be.If you have any questions, please feei free to contact me at ###-###-####, Ext [redacted] Monday through Friday 8:00am to 4:30pm.Sincerely,Tracey D [redacted] Billing Manager

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 below.It is evident at this time that you certainly preferred to lose a patient than to have
a sensible position before this issueI see that you prefer charging about $for a procedure
that costs $buying similar freezing spray at the pharmacy, than to keep a patient and in consequence loosing
thousands of dollars, it's your decision.
Regards,
*** ***

To whom it may concern:We received your letter dated 01/04/regarding complaint ID# ***.The patient was seen on 08/23/for a preventative visitDuring this visit, the patient also had a complaint of wartsThe physician completed the preventative visit and treated the patient's warts with HistofreezeAt the time of the service, the physician advised the patient of filling, salicylic acid, and duct tape nightlyReturn in 2-weeks for re-freeze if needed.On 09/14/2016, the patient returned for a chief complaint of a pimple in the nose and during the general inspection it revealed a plantar wartConsent was obtained and the wart was treated again with histofreezeThe procedure and risks were explained in detail.According to the American Medical Association Coding Manual CPT book, Destruction means the ablation of benign, premalignant or malignant tissues by any method, with or without curettement, including local anesthesia, and not usually requiring closureAny method includes electrosurgery, cryosurgery, laser and chemical treatment Lesions include conddyiomata, papillomata, moliuscum contagiosum, herpetic lesions, warts (ie, common, plantar, flat) milia, or other benign, premalignant (eg, actinic keratosis), or malignant lesionsHistofreeze is a chemical treatment.Pediatric Alliance has coded both dates of service, 08/23/& 09/14/appropriately.According to the Coding Guidelines we could have billed for an office visit and destruction of lesion on 09/14/16, but the office voided the visit related to the pimple in the noseTherefore she was only billed for the destruction of lesion, ***ff you have any questions, please feel free to contact me at ***, ExtMonday through Friday 8:00am to 4:30pm.Sincerely,Tracey D*** Billing Manager

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 below
In response to the letter sent by Tracey D*** Billing Manager for Pediatric Alliance: I signed a release form with Revdex.com so you could disclose any necessary medical information related to the claim in question. I AM NOT QUESTIONING THE COVERAGE BY THE INSURANCE. I received the answer from Pediatric AllianceI went to the Revdex.com complaint website and started to respond but I couldn't say all I wanted.How can I finish my answer? I tried to edit it but I didn't find the way. Here is the rest of my answer. What I am questioning is how the procedure was coded and therefore billed to the insurance.The code used is *** Destruction of a LesionThis code implies like it says the 'destruction' or 'removal'.Here is a explanation of should occur in order to remove the lesion, according to the Medical Disability Guidelines: “The procedure typically will be performed in a medical office on an outpatient basisThe area where the plantar warts are found will be cleaned, followed by possible cutting or shaving of some of the dead skin surrounding the area (debridement)Various procedures for removing the warts may be used alone or in combination with others.When chemical cauterization is used, acid may be placed on the warts either through direct application or through a plaster-like substance containing the acid that is cut in the shape of the wart and held onto the site by tapeSeveral applications left on the foot about eight hours daily may be required before the plantar warts and surrounding dead skin are ready to be filed or cut awayA doughnut-shaped pad may need to be worn over the wart during this form of treatment.Cryotherapy or cryocauterization involves use of cotton swabs or other applicators such as sprays to place a freezing agent, typically liquid nitrogen, directly on the affected site to destroy the wartsAdditional applications may be needed at intervals of days or weeksThe warts should turn black and fall off when they are completely destroyed.Deeper or multiple plantar warts may need to be excised by curettage, which involves anesthetizing the involved area, identifying and marking appropriate margins, and scooping out the warts with a specialized instrument (dermal curette) possibly in combination with acid application.With procedures called electrocauterization or electrodissection, an electric needle is used to burn and remove the wartsSeveral treatments may be required before the warts are completely removed.Various laser treatments are being explored for removal of plantar wartsA local anesthetic may be injected to numb the area prior to treatmentWith a CO2 laser, the light beam both cuts and vaporizes the plantar wartsAnother method uses a pulsed dye laser to selectively destroy the wartLaser treatments typically are not used because of the expense of the procedure.” Medical Disability Guidelines What I question is that Pediatric Alliance coded a simple application of freezing spray as a much more complicated, involved and longer procedure corresponding to the code applied. The problem is not how the insurance charged, the problem is how Pediatric Alliance billed the insuranceThey upcoded what was done, they charged excessively for something very simple. For all those reasons, I consider that they should refund what we have paid, the dollars! Thanks. Happy New Year!!!
Regards,
*** ***

We received your letter dated 12/05/regarding complaint ID# ***.As per federal HIPAA and privacy laws, Pediatric Alliance cannot disclose any protected health information or information regarding treatment for any of our patients without written patient consentPediatric
Alliance adheres to Best Practice Guidelines for all of our patients to provide exceptional, clinically appropriate care and treatment.Physician practices do not determine which services are covered by insurance companiesService charges are determined by the market and healthcare providers submit those charges to the appropriate insurance companyThe patient's insurance plan determines the amount that they will reimburse for specific services and the amount the patient is responsible forHealthcare providers are contractually prohibited from adjusting charges for deductibles and/or co-insuranceThis information is stated in our Financial Policies which are provided to all patientsIt is ultimately the patient's/parents responsibility to comprehend what their out of pocket for services will be.If you have any questions, please feei free to contact me at ###-###-####, Ext*** Monday through Friday 8:00am to 4:30pm.Sincerely,Tracey D***
Billing Manager

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 belowIn response to the letter sent by Tracey D*** Billing Manager for Pediatric Alliance:
I signed a release form with Revdex.com so you could disclose any necessary medical information related to the claim in question
I AM NOT QUESTIONING THE COVERAGE BY THE INSURANCE.
I received the answer from Pediatric AllianceI went to the Revdex.com complaint website and started to respond but I couldn't say all I wantedHow can I finish my answer? I tried to edit it but I didn't find the way
Here is the rest of my answer
What I am questioning is how the procedure was coded and therefore billed to the insuranceThe code used is *** Destruction of a LesionThis code implies like it says the 'destruction' or 'removal'Here is a explanation of should occur in order to remove the lesion, according to the Medical Disability Guidelines:
“The procedure typically will be performed in a medical office on an outpatient basisThe area where the plantar warts are found will be cleaned, followed by possible cutting or shaving of some of the dead skin surrounding the area (debridement)Various procedures for removing the warts may be used alone or in combination with others.When chemical cauterization is used, acid may be placed on the warts either through direct application or through a plaster-like substance containing the acid that is cut in the shape of the wart and held onto the site by tapeSeveral applications left on the foot about eight hours daily may be required before the plantar warts and surrounding dead skin are ready to be filed or cut awayA doughnut-shaped pad may need to be worn over the wart during this form of treatment.Cryotherapy or cryocauterization involves use of cotton swabs or other applicators such as sprays to place a freezing agent, typically liquid nitrogen, directly on the affected site to destroy the wartsAdditional applications may be needed at intervals of days or weeksThe warts should turn black and fall off when they are completely destroyed.Deeper or multiple plantar warts may need to be excised by curettage, which involves anesthetizing the involved area, identifying and marking appropriate margins, and scooping out the warts with a specialized instrument (dermal curette) possibly in combination with acid application.With procedures called electrocauterization or electrodissection, an electric needle is used to burn and remove the wartsSeveral treatments may be required before the warts are completely removed.Various laser treatments are being explored for removal of plantar wartsA local anesthetic may be injected to numb the area prior to treatmentWith a CO2 laser, the light beam both cuts and vaporizes the plantar wartsAnother method uses a pulsed dye laser to selectively destroy the wartLaser treatments typically are not used because of the expense of the procedure.” Medical Disability Guidelines
What I question is that Pediatric Alliance coded a simple application of freezing spray as a much more complicated, involved and longer procedure corresponding to the code applied
The problem is not how the insurance charged, the problem is how Pediatric Alliance billed the insuranceThey upcoded what was done, they charged excessively for something very simple
For all those reasons, I consider that they should refund what we have paid, the dollars!
Thanks
Happy New Year!!!
Regards,
*** ***

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 below
It is evident at this time that you certainly preferred to lose a patient than to havea sensible position before this issueI see that you prefer charging about $for a procedurethat costs $buying similar freezing spray at the pharmacy, than to keep a patient and in consequence loosingthousands of dollars, it's your decision.
Regards,
*** ***

RE: [redacted]Complaint ID# [redacted]Dear Madam or Sir:We are in receipt of your letter dated September 2, 2017 regarding complaint ID#[redacted]. This family, (including children [redacted] and [redacted]), was treated at a Pediatric Alliance office and was eventually discharged from the...

practice on April 19, 2017 for non-payment of services.[redacted] had four (4) outstanding claims that totaled $[redacted] which was applied to the deductible, with a breakdown as follows:• 03/04/16 $[redacted]• 03/28/16 $[redacted] includes $[redacted] for deductible plus a $** late fee• 05/03/16 $[redacted]• 12/30/16 $[redacted] had two (2) outstanding claims that totaled $[redacted] which was applied to the deductible, with a breakdown as follows:¦ 03/09/16 $[redacted]¦ 01/20/17 $[redacted]We tried on multiple occasions between May 2016 and March 2017 via telephone (see attached documentation), to reach the guarantor, [redacted], to resolve the outstanding balance of $[redacted]. At no time did Mrs. [redacted] inform us of any type of domestic distress or financial inability to resolve the matter.On March 17, 2017 we mailed a letter (see attached documentation), to Mrs. [redacted] at [redacted] explaining that we had attempted several times to contact her and if the balance was not resolved within 30 days her children could be discharged from the practice.On April 19, 2017 we discharged the patient from the practice. We mailed her a certified letter (see attached documentation) informing her of this decision and asked that she choose another physician not affiliated with Pediatric Alliance. On May 10, 2017 her account was sent to the Collection Agency.This was the second discharge for non-payment for this family, with the original discharge taking place on October 7, 2013.It has been the longstanding policy and practice of Pediatric Alliance to work with our patients in resolving past due balances. Between the individual Pediatric Alliance office and the Billing Department, we strive to satisfy patients without any interruption in patient care, while also maintaining company policies. We offer Financial Hardship and Payment Plans to assist patients when they are in financial distress for example. As previously noted, we were not aware of the family’s inability to pay their balance. Had Mrs. [redacted] made Pediatric Alliance aware of her domestic/financial situation, we would have discussed with her the options of either a Financial Hardship or Payment Plan. In addition, it is stated in our policy that if a balance is not paid in full and is greater than 90 days old, the account will be assessed a $** late fee.Due to the non-compliance and failure to pay her account in full within a timely manner, her account was discharged, and the individual Pediatric Alliance Office decided not to reinstate the family into the practice. If you have any questions, please feel free to contact me at ###-###-####, Ext. [redacted] Monday through Friday 8:00am to 4:30pm.Sincerely,Tracey D[redacted] Billing Manager

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.When I called to make the appointment in August, the receptionist did not tell me I was discharged. IF I was discharged in April, why in the world would anyone entertain the idea of my kids having an appointment. Because they wanted the money.  She misleaded me to call a collection agency in order to make an appointment. If this was clear to Pediatric Alliance that I was discharged, they should have told me when I called to make the appointment. Instead the woman tricked me as I was desperate for them to be seen to get what they needed for school. I went and paid the balance because I thought appointments were going to be made. I BEGGED and PLEADED with the office manager to make an exception. She told me NO! she told me that this was a habit and she had the final word and that was that.  Had I been aware of my standing or known that my kids were in jeopardy of being discharged, I would have disclosed the problems I was having prior to being discharged. Again, they used this as a ploy to get money. I paid what was owed and then turned their story around. Still unacceptable.
Regards,
[redacted]

We received your letter dated 12/05/16 regarding complaint ID# [redacted].As per federal HIPAA and privacy laws, Pediatric Alliance cannot disclose any protected health information or information regarding treatment for any of our patients without written patient consent. Pediatric Alliance adheres to...

Best Practice Guidelines for all of our patients to provide exceptional, clinically appropriate care and treatment.Physician practices do not determine which services are covered by insurance companies. Service charges are determined by the market and healthcare providers submit those charges to the appropriate insurance company. The patient's insurance plan determines the amount that they will reimburse for specific services and the amount the patient is responsible for. Healthcare providers are contractually prohibited from adjusting charges for deductibles and/or co-insurance. This information is stated in our Financial Policies which are provided to all patients. It is ultimately the patient's/parents responsibility to comprehend what their out of pocket for services will be.If you have any questions, please feei free to contact me at ###-###-####, Ext. [redacted] Monday through Friday 8:00am to 4:30pm.Sincerely,Tracey D[redacted] Billing Manager

To whom it may concern:We received your letter dated 01/04/2017 regarding complaint ID# [redacted].The patient was seen on 08/23/2016 for a preventative visit. During this visit, the patient also had a complaint of warts. The physician completed the preventative visit and treated the patient's warts with Histofreeze. At the time of the service, the physician advised the patient of filling, salicylic acid, and duct tape nightly. Return in 2-3 weeks for re-freeze if needed.On 09/14/2016, the patient returned for a chief complaint of a pimple in the nose and during the general inspection it revealed a plantar wart. Consent was obtained and the wart was treated again with histofreeze. The procedure and risks were explained in detail.According to the American Medical Association Coding Manual CPT book, Destruction means the ablation of benign, premalignant or malignant tissues by any method, with or without curettement, including local anesthesia, and not usually requiring closure. Any method includes electrosurgery, cryosurgery, laser and chemical treatment Lesions include conddyiomata, papillomata, moliuscum contagiosum, herpetic lesions, warts (ie, common, plantar, flat) milia, or other benign, premalignant (eg, actinic keratosis), or malignant lesions. Histofreeze is a chemical treatment.Pediatric Alliance has coded both dates of service, 08/23/16 & 09/14/16 appropriately.According to the Coding Guidelines we could have billed for an office visit and destruction of lesion on 09/14/16, but the office voided the visit related to the pimple in the nose. Therefore she was only billed for the destruction of lesion, [redacted]ff you have any questions, please feel free to contact me at [redacted], Ext. 130 Monday through Friday 8:00am to 4:30pm.
Sincerely,Tracey D[redacted]
Billing Manager