River City Medical Group, Inc.

Dear Mr. [redacted],I am [redacted], the Director of Compliance with River City Medical Group.  I would like to thank you for providing us this opportunity to response to Complaint ID [redacted], which was made to Revdex.com on behalf of one of our members. This is to inform you that one of our...

Utilization Management nurse practitioners contacted the member today by phone to discuss the items referenced in member's Statement of the Problem. We were able to obtain additional information regarding her condition, and assist her with possibly receiving the services and treatment she is requesting. We also assisted her with making direct contact with her managed care plan if she wished to discuss any of her concerns in more detail, or file a grievance. Please note that River City Medical Group is is not the member's insurance or health care service plan.  River City Medical Group is an Independent Physicians Association that provides services on behalf of health care service plans on a negotiated per capita rate.  As such, River City Medical Group is not authorized to handle member grievances, and instead forwards any member grievance or appeal directly to member's health care service plan, as required under the [redacted] Service Act of 1975. A detailed and exhaustive search of our records does not indicate we ever received a call, correspondence, or grievance from this member concerning any of the issues she mentioned her statement. Nonetheless, we believe the connection made with the member today has resolved her issues, concerns, and questions. If you would like to discuss this complaint in more detail, or have any additional questions or comments, please do not hesitate to contact me.Again, thank you for providing this opportunity to respond, and bringing this member's concerns to our addition.Sincerely, [redacted]

Review: I am on 24 hours a day oxygen as well as a [redacted] machine, nebulizer, incontinence supplies, I am A fall risk. I cannot breathe, I can't walk. My insurance River City refused the medical equipment I need for my life, the oxygen machine, nebulizer, wheelchair, incontinence supplies, hospital bed, [redacted], all of them. When I called the medical group to file a grievance the operator told me he consulted with his supervisor and they both agreed that I should seek a different health insurance as soon as possible if I need these items.Desired Settlement: I need them to approve the supplies that I need for my Life. That's all I want. Thank you.

Business

Response:

Dear Mr. [redacted],

During my first visit to this establishment, my initial impression was that of a standard medical building. The receptionist was as I expected, nothing out of the ordinary. I arrived 30 minutes early so I expected some wait time. I was finally seen by the triage nurse after an hour wait... 30 minutes after my appointment time. He explained that there was another patient with a more pressing matter and asked if I'd be okay waiting another 10 minutes to see the doctor; I agreed. Another 45 minutes later, I was finally admitted to a room. 15 minutes later, the P.A. finally made it to the room. She asked my reasons for coming, I stated all I needed was a stronger version of the OTC medicine I was taking. She asked if I had taken the medicine for it's designed reason, I explained my family and personal history usually took this medicine. She submitted the paperwork electronically, spent maybe 5 minutes with her. So, after 2 hours for what would have been a 15 min visit, I got my bill... $500.00. I asked how the felt a 15 minute visit was worth that much, they looked at me and said it was my insurance. So, even with all the time I waited, the little service I was provided, they felt justified with the price I was charged. My rating is on their poor service time and outrageous cost for a routine visit. I could have gone to the E.R., received the same service, and spent less.