Primary Pediatrics

I am in receipt of your letter dated December 22, voicing a complaint from one of our parentsHer phone call on December 19, was in regards to a laboratory bill [redacted] from March 29, I am in receipt of your letter dated December 22, voicing a complaint from one of our parentsHer phone call on December 19, was in regards to a laboratory bill from [redacted] from March 29, The parent called regarding the bill on March 29, and spoke to one of my nursing staff who forwarded the call to meApparently, her insurance suggests that she use [redacted] rather than [redacted] ***I spoke with the Mom and explained to her that the bill was between her, her insurance and [redacted] ***We do not have anything to do with [redacted] ***billingI apologized for the error on our part but explained that there was nothing we could do now about the error at this pointI suggested that she call her insurance company and ask about an out of network benefit for the billShe became angry and said that she would be leaving the practiceShe did not leave the practice and in fact, her son, was seen here in the office on October 17, for a well checkupNo mention of the bill was made at that time.Our office takes many insurance plans and we cannot possibly know each and every patient's preferred laboratoryOn investigation, I see that a note was only made to the patient's electronic medical record chart on March 29, that Quest was the preferred laboratoryOn December 19th, I took the phone call from the Mom after she asked to speak with meI again reiterated that at this time I could not help her with the bill and asked if she had spoken with her insurance company as I suggestedShe said no that she had notI apologized again for our error and told her that I didn't know how I could help her as this point in timeI again suggested several times that she call her insurance company and see what they could do for herAt this point she became angry and asked to speak to a supervisorI explained that one of the managing partners was my supervisor and that they were seeing patients and could not come to the phone at this time but I would have one of them call herShe became angry and repeatedly kept saying "get someone on the phone right now!" Rather than keep repeating myself, I told her that one of the doctors would call her back and I was hanging up now, which I didI referred her complaint to one of our managing partnersThe doctor had an administrative assistant call the Mom backA message was left for the Mom to provide us with a copy of her bill and a copy of the explanation of benefits from her insurance companyAs of today, this has not been providedI suspect that the insurance company paid all but $of the billThis amount may be co-insurance on the member's partWhen the information we requested is provided, one of our managing partners will assess the situationSince it has been almost a year since the original date of service at [redacted] ***., I am assuming that her bill is being sent to collections and thus her frustration I have been with this practice for years and have never had anyone complain that I was rudeI am the most friendly, customer service oriented staff member here but I will not be spoken to in a demanding or abusive mannerSince your letter to me states that you do not personally identify the customer, I have not used any names in this letter and I would assume that my name would not be listed on your website with the original complaintIf this is not the case, I would like to be notified of thisI would like a determination letter regarding this matterThank you, Linda S***, RN

I am in receipt of your letter dated December 22, 2014 voicing a complaint from one of our parents. Her phone call on December 19, 2014 was in regards to a laboratory bill [redacted] from March 29, 2014.
I am in receipt of your letter dated December 22, 2014 voicing a complaint...

from one of our parents. Her phone call on December 19, 2014 was in regards to a laboratory bill from [redacted] from March 29, 2014. The parent called regarding the bill on March 29, 2014 and spoke to one of my nursing staff who forwarded the call to me. Apparently, her insurance suggests that she use [redacted] rather than [redacted]. I spoke with the Mom and explained to her that the bill was between her, her insurance and [redacted]. We do not have anything to do with [redacted]. billing. I apologized for the error on our part but explained that there was nothing we could do now about the error at this point. I suggested that she call her insurance company and ask about an out of network benefit for the bill. She became angry and said that she would be leaving the practice. She did not leave the practice and in fact, her son, was seen here in the office on October 17, 2014 for a well checkup. No mention of the bill was made at that time.Our office takes many insurance plans and we cannot possibly know each and every patient's preferred laboratory. On investigation, I see that a note was only made to the patient's electronic medical record chart on March 29, 2014 that Quest was the preferred laboratory. On December 19th, I took the phone call from the Mom after she asked to speak with me. I again reiterated that at this time I could not help her with the bill and asked if she had spoken with her insurance company as I suggested. She said no that she had not. I apologized again for our error and told her that I didn't know how I could help her as this point in time. I again suggested several times that she call her insurance company and see what they could do for her. At this point she became angry and asked to speak to a supervisor. I explained that one of the managing partners was my supervisor and that they were seeing patients and could not come to the phone at this time but I would have one of them call her. She became angry and repeatedly kept saying "get someone on the phone right now!" Rather than keep repeating myself, I told her that one of the doctors would call her back and I was hanging up now, which I did. I referred her complaint to one of our managing partners. The doctor had an administrative assistant call the Mom back. A message was left for the Mom to provide us with a copy of her bill and a copy of the explanation of benefits from her insurance company. As of today, this has not been provided. I suspect that the insurance company paid all but $29.00 of the bill. This amount may be co-insurance on the member's part. When the information we requested is provided, one of our managing partners will assess the situation. Since it has been almost a year since the original date of service at [redacted]., I am assuming that her bill is being sent to collections and thus her frustration I have been with this practice for 22 years and have never had anyone complain that I was rude. I am the most friendly, customer service oriented staff member here but I will not be spoken to in a demanding or abusive manner. Since your letter to me states that you do not personally identify the customer, I have not used any names in this letter and I would assume that my name would not be listed on your website with the original complaint. If this is not the case, I would like to be notified of this.
I would like a determination letter regarding this matter.
Thank you,
Linda S[redacted], RN

Review: In July 2013 I called to schedule physicals for both of my children & at that time I was informed we had an outstanding balance that had to be paid prior to scheduling any appointments. My children are covered under Maryland Medicaid & have been for many years so I was surprised I had a bill that wasn't paid. When I tried to speak to someone in the billing office she stated all she knew is that it was a balance from a visit in 2009 but couldn't provide me any details since it was old. I asked why in the many times I had been in the office since 2009 I was never informed of this or never received any statements she could not provide an explanation for that. At that point I faxed an inquiry to the Office Manager requesting clarification and explanation of why the charges were $160 for one office visit, which I found excessive. I had no response so I sent anther request also stating I didn't believe this was Fair Billing Practices to bill someone 4 years later without any prior notification even though we had been in the office many since in those 4 years. I stated I would like a response/explanation within 30 days....which I never received. I have not received any response from the office such as a phone call, letter or even a bill regarding this account. My children have not been able to get physicals or go into the office for sick visits since this issue arose. Again I feel this is Unfair Billing Practices and unprofessional of the office to not even acknowledge my inquiry. Again my children have been covered by Maryland Medicaid for many years so I am surprised they did not pay for something. I have also been informed by the insurance carrier that they are supposed to verify coverage prior to a member receiving treatment so if for some reason there is a problem with coverage the provider knows in advance and can inform the member they are not covered. If they do not follow protocol it is not the members responsibility. I have been bringing my children to this office for over 10 years and have never had an issue with the care received or the office staff prior to this. Its a shame this could not be resolved before this point.