PennState Health St. Joseph

[To assist us in bringing this matter to a close, you must give us a reason why you are rejecting the responseIf no reason is received your complaint will be closed as Answered] Complaint: [redacted] I am rejecting this response because: MsW [redacted] is incorrect in her statement that the first invoice has been resolvedThis is an assumption, based on the fact that the bill was paidThe only reason we paid the bill was because we were getting collection noticesAll of these charges: the physician's charge, the DME (sling), the tetanus injection & the tetanus serum all should be considered as part of the Urgent Care visitThis charge is subject to a $Specialist Visit Co-Pay In reality, we are over paid by $In her letter MsW [redacted] , indicates that the admission source had to be updated to "Urgent" & [redacted] re-billedShe is speaking only of the X-Ray chargesAll of the charges listed above (the physician's charge, the DME (sling), the tetanus injection & the tetanus serum) need to be updated to "Urgent" & [redacted] re-billed, since the charges resulted from the Urgent Care Visit Any service that was done on January 29th at the Muhlenberg Urgent Care need to be bundled and billed as an Urgent Care visitTo date we are still waiting for [redacted] to reprocess the X-ray bills, StJoseph to re-bill the other services as Urgent Care treatment and be reimbursed for the over payment of $ Regards, [redacted] ***

To whom it may Concernl am responding to complaint ID #: [redacted]. l apologize for the delayed response. Our billing of?ces have been working with the [redacted] regarding his concerns with his bill. He has two separate bills he has been inquiring about.The first bill for the Urgent Care...

Visit has been resolved;Total charges: $231.00Total insurance payment: $78.11 Total insurance adjustments: $60.56Patient owes: $92.33 (Pt paid $26.00 at time of service = $66.33 remaining balance)            $92.33 = $33.00 copay                          $8.92 deductible                           $23.00 deductible                          $22.41 deductible                          $92.33 - $25.00 paid at time of service = $66.33 paid by patientThe second bill is for Outpatient X-rays he had during his Urgent Care Visit, the billing office is still working with the Insurance Company and the [redacted] on this amount. Update from billing office: The Outpatient X-ray balance on this account is still pending with ** and we are touching base with them on a regular basis. We had to have the admission source updated to Urgent and **rebilled to see if the out of pocket for [redacted] would change. Since the charges resulted from the Urgent Care visit. The charge we are billing is for the two x rays. We continue to work with the patient and the insurance company regarding his concern and bill. if you need any additional information please let me know.Thank you and again sorry for the delayed response.Sincerely,Debra W.Director of Ambulatory SitesManager of Urgent Care and WorkCare Services

[To assist us in bringing this matter to a close, you must give us a reason why you are rejecting the response. If no reason is received your complaint will be closed as Answered]
 Complaint: [redacted]
I am rejecting this response because:
Ms. W[redacted] is incorrect in her statement that the first invoice has been resolved. This is an assumption, based on the fact that the bill was paid. The only reason we paid the bill was because we were getting collection notices. All of these charges: the physician's charge, the DME (sling), the tetanus injection & the tetanus serum all should be considered as part of the Urgent Care visit. This charge is subject to a $38.00 Specialist Visit Co-Pay.  In reality, we are over paid by $54.33. In her letter Ms. W[redacted], indicates that the admission source had to be updated to "Urgent" & ** re-billed. She is speaking only of the X-Ray charges. All of the charges listed above (the physician's charge, the DME (sling), the tetanus injection & the tetanus serum) need to be updated to "Urgent" & ** re-billed, since the charges resulted from the Urgent Care Visit.  Any service that was done on January 29th at the Muhlenberg Urgent Care need to be bundled and billed as an Urgent Care visit. To date we are still waiting for [redacted] to reprocess the X-ray bills, St. Joseph to re-bill the other services as Urgent Care treatment and be reimbursed for the over payment of $54.33.  
Regards,
[redacted]

November 6, 2017To whom it may ConcernI am responding to the rejection of the previous letter sent regarding complaint ID #: [redacted].Our billing offices have continued to work on the [redacted]s concerns regarding these bills. There were two separate bills they were continuing to work on with the insurance company.The first bill was for the Urgent Care visit. There seems to some confusion on how Urgent Care services are billed to the insurance.  In their rejection they refer to all services being billed under an Urgent Care visit. If additional services are performed above the office visit those items are billed as separate items. They are not bundled under an Urgent Care office visit. I reviewed their Urgent Care visit again and on 10/13/17 a refund amount of $45.41 was requested from the billing office to go back to the patient. The billing office had continued to work with the insurance company and the over payment of $45.41 was the result. It takes 4 - 6 weeks for a refund to be processed so the [redacted]s should be receiving this refund shortly.The second bill was for Outpatient X-rays he had during his Urgent Care Visit. I reviewed this account as well and on 10/26/17 payment was posted from the insurance company and the patient balance is zero.If you need any additional information please let me know.Thank you and I apologize for any inconvenience with the billing process.Sincerely,Debra W.Director of Ambulatory SitesManager of Urgent Care and WorkCare Services