Rady Children's Hospital San Diego

Today received Revdex.com "complaint" via email from  Mom [redacted] addressingsame concerns but feeling " I have received no cooperation", last line in herCustomer Statement of the Problem to Revdex.com.    Printed and scanned Revdex.com contact topatient chart, informed them it will be...

addressed with Upper Management,(probably at our weekly meeting next week if not before.)  [redacted] for anotherhold at CBB Collection Agency. We will be in touch, hopefully next week sometime after Wednesday.  Thank you. [redacted]Patient Financial Services/Customer Services/Lead-BSBA3020 Children’s Way  MC 5002San Diego CA  92123858-966-5915858-966-7598(f)

September 24, 2015
 
[redacted]
Revdex.com of San Diego, Orange, & Imperial Counties
 
RE:  [redacted]
 
Dear Ms. [redacted],
 
This is in response to the above noted complaint regarding Rady Children's Hospitals’ billing practice for physical therapy. Let me assure...

you that we take complaints of this nature very seriously, investigate them thoroughly and respond accordingly.
 
One of the consumer’s main complaints appears to be that he wasn’t given an accurate estimate of the total cost of his daughter’s treatment before treatment began. Estimates are based on several variables such as how quickly the patient responds to treatment which can’t be determined in advance. We make a diligent attempt to answer any query a patient or guardian might have.  In this case, there are 40 different instances in the past 15 months, where multiple members of this organization spoke to the consumer or reviewed the medical documentation in question. After completing an extensive review by leadership and compliance, it has been determined that fraud was not committed and the charges were billed accurately. Additionally, our reimbursement from Medi-Cal is based on a predetermined rate and is not dependent on the amount billed. Rady Children's Hospital San Diego, follows the billing guidelines as determined by CMS, the Centers for Medicare and Medicaid Services.
 
According to the CMS definition of one-on-one (private) therapy sessions, the therapist can attend to multiple patients giving each patient specific blocks of time. However, many of our orthopedic patients are treated individually (one-on-one) and never by greater than one physical therapist to two patients. These sessions (two-on-one) are supported by a physical therapist extender to ensure patients are always engaged and supported. Additionally, we are proud to offer 60 minute sessions for all our orthopedic patients, whereas less expensive providers may offer 30 minute sessions. Comparative pricing should be consistent with the length of visit.
 
While Rady Children's Hospital Physical Therapy Department now has a nice parent viewing area, we regret that we did not have this available in 2014. Due to limited space and to accommodate the nature of orthopedic rehabilitation activities fully at that time, we had to utilize the gym area for treatment only. We have addressed this need with program relocation, so that parents and siblings can now comfortably wait and watch.
 
Our therapists and the rest of the clinical staff at Rady Children's Hospital San Diego work diligently to bring the best possible medical treatment to the patients within our care.  I apologize that the consumer feels that his child did not get the individual attention he thought she should have received. We hope that therapy she subsequently received elsewhere was helpful.

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID [redacted], and have determined that this proposed action would not resolve my complaint.  For your reference, details of the offer I reviewed appear below.
The business is proposing to review my claim but does nothing to resolve it. Until Rady Children's takes responsibility for referring me to services (stitches) my son did not need, by removing the excess charges, this claim will not be resolved.Sincerely,
[redacted]

Review: A Dr. at Rady's referred my daughter to receive physical therapy at Rady's. On the first visit, we asked what the cost of the physical therapy would be. We were told it was complicated and they did not know the cost. We could not proceed until we signed a paper that contained a large range of pricing that they could apply (gotcha). We attended one visit per week for six weeks. Our initial response to the billing of $275 for a one hour physical therapy visit was that the amount would be reduced by the insurance. My daughter who received the physical therapy let us know that the therapist was simultaneously working with up to 3 children and much of her time was spent waiting for the therapist to finish with the other children before getting her started on her next exercise. I have a high deductible medical plan and am responsible for paying the cost of the therapy that was provided. There was limited adjustment to the Rady's bill, by my insurance company, as Rady's fraudulently applied the insurance billing code for a private physical therapy session - which they were not !!!!! Rady's is deceitful in their approach to their patients. Parents are not allowed to observe the physical therapy sessions -- likely so that they do not know of the wasted time, due to the large number of patients seen by each therapist. Additionally if Rady's is going to have billing rates that are so much above market rates they should be very clear to their patients what those fees will be in advance of rendering the services. Subsequent to the disappoint experience with Rady's, my daughter received physical therapy from a reputable group in Poway for $75 for a one hour session and she really received one on one physical therapy. The service scheme, and rates, Rady's employs in physical therapy may allow high billings to Medi-cal and other State/Federal program, but they are predatory to individuals.Desired Settlement: I am willing to pay a fair market rate for the physical therapy of $100 per hour.

I want Rady's to cease and desist taking advantage of California State taxpayers with their fraudulent billing practices. I will contact the state if needed to alert them to these practices.

Business

Response:

September 24, 2015