S & S Contractors

This complaint is directed to Billing Department Sutter Health Medical Foundation at Capitol Ave, Sacramento, CA April 9, Patient name: [redacted] Patient account number: [redacted] Date of Service: Sept 1, 2015, Sept 25, Physician: Dr [redacted] MD This is with regards to the charges on the accountMedical Report from patient's physician, Dr [redacted] , [redacted] Hospital CD from the [redacted] hospital containing [redacted] X-Ray When we made the appointment over the phone, we had asked if there was any way to forward a medical report and CD from patient's doctor in advance to Dr [redacted] so he can preview them prior to our visitPerson on the phone said it was not necessary and we were to show it to him when we meet with himWhen [redacted] met with Dr [redacted] , we showed the attached documents to the front desk when we checked inWe specifically gave instructions that it is of paramount importance that the report be presented to the doctorThe front desk personnel took the report and CD and said she will send this to the doctor About mins later, we were surprised that [redacted] was told to go into the X-Ray room to have X-ray takenWe explained that Dr [redacted] report stated that the patient do not need further X-Ray and showed a second copy I had in my handFront desk personnel refused to listen nor look at the documentsWhen asked why was the X-Ray mandatory for the visit with the doctor, the staff insisted [redacted] to take a new X-Ray and the only explanation was"without which the doctor will not see your son"She made it sound like the doctor had already reviewed the documentsWe had no alternate optionWe expressed that we would not be responsible for the charges as a second X-ray was unnecessary as stated on the doctor's notesWhen we met with Dr [redacted] , he started reading the report in our presence when he opened [redacted] file Apparently, the report and CD with the X-Ray were never presented to the doctorHad the doctor a chance to look at the report and X-ray, [redacted] would not have to be forced to suffer rounds of radiation unnecessarilyWe are disputing the charges, which should not be born by us as the mistake lie with communications between the doctor and the front desk personnel who refused to listen and failed to present the important documents to the doctor at a timely mannerThis violate line and of Patients' Rights and Responsibilities as stated by Sutter Health HospitalWe called on Feb 16, 2016, spoke with ***, [redacted] Billing Department and again on April 8, with [redacted] at Billing to follow upOn the first occasion, we were told to wait a few weeks while the review team looked at our caseWe did not hear back from anyone Instead, we received notification from the Collections agency I have reviewed the patients chart as this is from and only have our notes to go off ofUnfortunately I do not see any documentation on the patient bring in their report or CD nothing was noted on their intake sheet or the visit, there are a few things that will lead to us needing additional x-rays but without the documentation I can’t give a clear reason why, I’m very sorry the patient and patients were either mis informed or per their complaint the imaging wasn’t giving to the MD? The clinician needs to view the imaging (films) to treat the patient a report isn’t enough For fractures imaging needs to be less than a week old due to healing, changes and possible movement (the date of injury was 8/27/per their intake sheet, their original appt was 9/prompting the need of new x-rays, but their appt was moved to 9/1st) The original imaging was done out of the country, not sure if the CD was compatible, if not then we would need to send patient for additional imaging but per the patient complete that was not told to them nor is there any documentation

hello, I have reviewed all your accountsI read the notes on the account that you requested we debit your Health savings Account for $on 12/31/I have read the account notes that state your account had not been billed so we could not tell you what your out of pocket was at the time of the callYou also stated that you wanted to use your HSA before year endWe complied to your requestWhen your insurance paid it left a credit of $In our financial reconcilation we had discovered you had an out standing patient balance of $on another account this left a balance of $still owing.Since we process HSA's the same as we do any credit or debit card payment we can refund the overage back you your HSA we will not process this as an out of pocket refund As an FYI once that tranaction is completed you will owe the $for your patient responsibility listed by your your insurance company for services provided on a date of service in

To whom it may concern,On 11/09/15, we appealed this claim to your insurance carrier It is currently in appeals process Our claim which we submitted to Blue Cross, indicates "Sutter Roseville Urgent Care" and our appeal indicates to make a note of this when reprocessing the claim.Thank you.Sutter Medical Foundation

I am rejecting this response because:It is not an excuse that due to the lack of your ability to obtain information, you concluded there was no report or CD.As mentioned on the complaint, Medical report from physician as well as accompanying report was presented during check in Do you have a video in your lobby? Please pull that up and you could see the CD was handed over to the front desk when patient was checked inWe requested that the two important documents be presented to Dr [redacted] prior to meeting patient.Please retrieve phone conversation for booking appointment as it will reveal during phone conversation to make appointment, we asked how to ensure doctor will first read and study the CD and report prior to meeting [redacted] Sutter Health rep advised us that Doctor will look at the info - we "just need to bring it" CD is compatible - seen ad ran through in different healthcare organisations The images on the CD were taken in a renown hospital in Davos, Switzerland, not some third world country facility The medical report stated clear instructions ADDRESSED to the next physician who would be taking over patient's case Specifically, instructions stated NO NEED for further XraysThe language used is English, a working medium used by American doctors.We had an earlier appointment but was cancelled due to Dr [redacted] having a emergency call.We are disputing the charges, which should not be born by us as the mistake lie with communications between the doctor and the front desk personnel who refused to listen and failed to present the important documents to the doctor at a timely mannerThis violate line and of Patients' Rights and Responsibilities as stated by Sutter Health Hospital

I reviewed the information that was sent and the only things received were the HIPPA Auth form and a copy of the billing statementI tried to reply however it wanted me to sign in and I do not have accessCan you please respond to the Revdex.com that we have reviewed the chart again and Medical record documentation supports what was billed and our original review stands? Also let them know that the payments were posted correctly according to the EOB from the payer and he can appeal this through his HealthplanI will add another account note so we have this on file

This has been re-reviewed and the outcome remains the sameDocumentation and past history support the diagnosis that was originally billed.Sent on: 3/3/1:08:PM

We have reviewed the account and the balance on the account is accurateWe have addressed the consumers concern verbally and in writing

Revdex.com:I have reviewed the response made by the business in reference to my concern, and find that this resolution is satisfactory to me

To Revdex.com, I had some serious difficulty in responding to this as I am not able to change
the font. Items in bolded below are the individual responses to the complaint
questions Date of service: 12/18/*** *** ** ($$USCB America
interest
incurred) Sutter: 5/21/payment voided… but was not corrected w
collection agency #collection agency medrecord ***For the above transaction, there were some billing errors made by
the physician for your Welcome to Medicare Physical. During the
correction process, the account was put in collections for a brief time, as the
charge was applied to patient deductible. Currently, this
transaction is no longer in collections and we received payment from Medicare
in June of 2014. ?2/06/** *** *** ($$USCB America) *** sent
a check on 3/7/for $Medicare is my primary coverageFor the above transaction, once payment was received from your
secondary insurer, of $22.04, this was taken out of collections, this
transaction is now a zero balance.12/12/*** *** ($PWU…APWU paid Sutter $on 1/29/
ck number #*** by APWU) Medicare coverage leaving me $co pay USBC
collection $with interest on this service shown on their June 12,
The service costs were still sent to the collection agency, in turn to bill me
with the interest costsThe above information is gathered information by
myself with multiple calls with Medicare, APWU, Sutter Foundation, and USCB
America collection agency.On the above transaction, this was never put in
collections. Your copay of $18, was applied a month later, and that
in addition to the insurance payment brought the account to a zero
balance. We are not aware of any other patients having these issues, we apologize for
the inconvenience

I received an email that Sutter had responded and I accepted their response but I contacted my insurance and they have nothing in the system showing they were contact like Sutter stated.Can you please remove that I accepted it so I can send another message/response to them please.Thank you,***

To whom it may concern,Per our legal counsel, California does not define specifically what an Urgent Care is or who/how it can be billed. The CPT codes are the same regardless of the place of service code being used. We clearly indicate on our claims that these services have been
rendered at the Roseville Urgent Care location. It is unfortunate that the patient’s insurance company is unable to process the claim as urgent care even though the claims state thisWe have also taken steps and have appealed this with the insurance. This was done as a telephone appeal, where we spoke to the insurance, explained the situation and advised that they process this as an urgent care visit since that it what appears on the claim form, "Roseville Urgent Care."Please do not hesitate to reach out to us in the future in the event the carrier continues to apply this to your deductible

Thank you so much forwarding this e-mail to me to allow me to respond. We are reviewing the customer’s complaint and working on a resolution. There is some discrepancy between the billing information and the eligibility information posted by the insurance company for the patient’s
plan. Once we can resolve the discrepancy, we will contact the customer with a resolution. There is no recording available for the conversation the customer had with our representative as that technology is not in use at the facility. Please let me know if you need any additional information or if this response is not sufficient for your needs. Thank you. *** ***Patient Access SupervisorSutter Roseville Medical Center

This complaint is for Sutter Medical Foundation, not Sutter Facilities.

I am rejecting this response because: It is not acceptable I will not pay for there miss billing of my account it will sit on my credit for years without being paid until they fix this issue, I asked four times before I left the doctors office to make sure I would not be billed as a diagnoses before I showed up to the appointment and I was assure that it would not be diagnosed as such. I went to the appointment only seeking to get a routine check up, change the billing or never be paid for the services. THIS IS MY FINAL OFFER

I just spoke with [redacted] to advise what document was needed for us to review once again for High Cost Charity Care.  She told me that she would mail the document needed.  Ms. [redacted] had stated that she never received our charity determination letter that was mailed to her...

on 11/28/16 stating charity was denied due to “over income”.  Verified her address that we have on file which was correct.  I told her that I would notify the bad debt vendor to put a 30 day hold on the account and that there has been no negative credit reporting listed on her credit file which she was glad to hear.    I had also received a Ticket ([redacted]) as well which has now been closed.  Thanks,

Revdex.com:
I have reviewed the response made by the business in reference to my concern, and find that this resolution is satisfactory to me.

I am rejecting this response because:Please note that service costs charges that were later addressed were still sent to the collection agency, in turn to billed to me with the interest costs. See enclosed document by UCSB contracted under Sutter Health.The above information is gathered information by myself with multiple calls with Medicare, APWU, Sutter Foundation, and USCB America collection agency.Sutter Foundations made adjustments within their own system BUT failed to send this information on to USCB (refer to time period to make adjustments).The original billing of $823.40 ballooned to well over $1,339 plus due to accrued interests by USCB collection agency. The given figures were submitted to me and paid by me to UCSB before uncovering the errors made by Sutter Health Billing, even though corrections and adjustments were made to SUTTER HEALTH. SUTTER HEALTH did not alert the collection agency of these changes spanning over 3 years…leaving me with the cost. (Please note date of UCSB billing).I am asking for your attention and full repayment of over billing (interest incurred through USCB as well as financial loss, and stress that has been plced onto our family).Your timely response would be appreciated in this matter.These errors have us concerned with the handling of pior billings and billings sent to collections, that were not retracted but leaving the consumer with unwarranted expenses.[redacted]

I reviewed the information that was sent and the only things
received were the HIPPA Auth form and a copy of the billing statement. I tried
to reply however it wanted me to sign in and I do not have access. Can you
please respond to the Revdex.com that we have reviewed the chart again and Medical
record documentation supports what was billed and our original review stands?
Also let them know that the payments were posted correctly according to the EOB
from the payer and he can appeal this through his Healthplan. I will add
another account note so we have this on file.

I am rejecting this response because:I have sent in all supporting documents that Sutter Health asked for frim the beginning. It clearly shows that I certainly qualify for the charity care program.I'am asking that this matter gets resolved in its entirety once, and for allI expect this to be resolved immediately Regards[redacted] .

hello, I have reviewed all your accounts. I read the notes on the account that you requested we debit your Health savings Account for $2070.84 on 12/31/14. I have read the account notes that state your account had not been billed so we could not tell you what your out of pocket was at...

the time of the call. You also stated that you wanted to use your HSA before year end. We complied to your request. When your insurance paid it left a credit of $1470.84. In our financial reconcilation we had discovered you had an out standing patient balance of $2815.15 on another account this left a balance of $1344.31 still owing.Since we process HSA's the same as we do any credit or debit card payment we can refund the overage back you your HSA we will not process this as an out of pocket refund.  As an FYI once that tranaction is completed you will owe the $2815.15 for your patient responsibility listed by your your insurance company for services provided on a date of service in 2015. .