Salem Gastroenterology Consultants,PC

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Revdex.com PO Box DuPont, WA 98327Re: Complaint *** To Whom It May Concern: To clarify some confusion in the patient's response. Patient was seen in the office prior to his procedure, not for a diabetic consultationPatient was seen for a new patient office visit presenting problems of moderate to high severityThe decision to bring the patient in for an office visit is due to the four diagnoses received from the patient's referring physician and need for adjustment to multiple medicationsA patient with a medical history of this level is required to be seen for safety during their procedure.In regards to the patient stating he had completed a previous medical history form, it has been over six years.In regards to patient stating his insurance company stated they would pay 100% if coded due to a screening colonoscopy, needs further clarificationHis insurance company provided a statement of benefits, however they are not reviewing diagnosis, patient's chart, medical history or the actual claim when quoting benefitsI spoke to Moda, who stated they spoke with the patient on 8/3/and was quoted benefits of his plan with no review of the claim.Patients do have the right to request an appeal through their insurance who will in turn request chart documentation for review of accuracy and coding compliance. Sincerely, Bookkeeping Manager

Complaint: ***I am rejecting this response because:The coding used was for a Diabetic ConsultationAs stated earlier telling me to reduce my diabetic related medication by half and stop using any blood thinners one week prior tp my procedure was information I already knewAccording to Salem Gastro's last bill it claims:a comprehensive history(which was a form I had previously completed), a comprehensive examination (a medical assistant took my blood pressure and pulse) and a medical decision of moderate complexityI never saw an MD, only a PA, and that was for less than minutesThe doctors that work at Salem Gastro own itThere is definitely a profit motive for them to tell there Coders to always "Code" for what brings in the most moneyAccording to the Affordable Care Act certain preventative, screening procedures are suppose to be covered by insurance at %My insurance company said they would pay % if the coding was related to the colonoscopy,not the Diabetic Consultation they coded forThey are not endocrinologist and besides saying to reduce my meds (which I already knew) there was not any further discussion of my diabetes.Sincerely,*** ***

Complaint: ***I am rejecting this response because: I have initiated an appeal of *** EOB. The next step is at the state level. According to what I have read about coding for a screening colonoscopy the coding and payment includes any pre or post procedural visitsI did not claim to have completed the health questionnaire years priorIt had been mailed to me prior to my appointment and brought in with meI have no family history of colon/ rectal cancer nor a history of polyps, both of which are required to change a screening colonoscopy to a surgeryIf they had found something during the colonoscopy that required further procedures then they can change the codesWhen I initially asked why I had to come in for a consultation I was told that all patients that had not been seen in the past three years were required to have the "consultation". ACA states that the screening colonoscopy is suppose to be paid by insurance at 100%I feel like I went to a mechanic to get a tune up and now I'm being charged to rebuild my transmissionTo claim that I am trying to benefit myself by not having to pay my co-pay is ridiculousI would have had to have "benefited from an MA taking my temperature and blood pressure and a PA telling me something I already knewMy health insurance just increased by $per month and they say we need to be more efficient in our use of our coverage, but what good does that do if providers are allowed to code at will and leave the patient in the dark$won't kill me but I would much rather give it to a charity where it will do more good than putting more Italian leather boots on the feet of Salem Gastro.Sincerely,*** ***

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September 1,2015 Revdex.com PO Box DuPont, WA 98327Re: Complaint ***To Whom It May Concern:I have reviewed the patient's chart for accuracy and appropriate coding upon learning of his Revdex.com complaint.The patient's
office visit prior to the screening colonoscopy was done to review his medical status and adjust medications as necessary to assure his safety during the procedure.The office visit was coded appropriately and sent to the patient's insurance carrier for processingThe insurance carrier processed the claim and applied benefits based on the contracted plan that he is enrolled in.For Salem Gastro to change the coding on this claim for the sole purpose of providing financial benefit to the patient, would falsely represent the visit and be considered fraudulent billing to the insurance carrier.Thank you for your attention to this complaint and bringing it to our attention.Sincerely,Bookkeeping Manager