Sanford Health

Initial Business Response /* (1000, 8, 2015/12/04) */
Dear [redacted]:
I am in receipt of your letter of consumer complaint filed by Mr. [redacted] against Sanford Health. Thank you for allowing me the opportunity to share with you additional history surrounding our attempts to help resolve...

these outstanding unpaid balances for services rendered to Mr. [redacted]'s son, [redacted].
When Mr. [redacted] presented his son for treatment at the Sanford Medical Center Fargo Emergency Department on July 22, 2013, he did not have the proper insurance information available for billing of the charges for that visit. As indicated in his letter, he did present that information to Sanford Health at a later date. The insurance was added and the claim was file to California Medicaid on August 16, 2013. Sanford did finally receive a response from California Medicaid on December 6, 2013 with a denial. Upon follow up with California Medicaid to inquire on the denial reason, the California Medicaid representative indicated the denial reason of "Patient does not have coverage and charges are not seen as emergency charges." Based upon this denial and based upon the Statement of Financial Responsibility form signed by Mr. [redacted], the unpaid balance was moved to his responsibility. Sanford requested payment from Mr. [redacted] with our billing statements dated April 15, 2014, May 14, 2014, June 12, 2014, July 14, 2014, August 12, 2014, and again on September 10, 2014. All statements were sent to the address of record for the account at that time. This address remains the address on file.
With no response for payment from Mr. [redacted], the balances were sourced to a collection agency for payment of the outstanding amount on September 26, 2014. The collection agency would have worked with [redacted] Law Office in Bismarck, ND in order to pursue Mr. [redacted] for payment on this unpaid balance.
On October 23, 2014, Mr. [redacted] had a conversation with Tricia from Sanford and indicated that he was working with a Vanessa from California Medicaid and he was going to have her contact Sanford on this balance. Unfortunately, no contact was ever received from Vanessa. The next contact received was on October 13, 2015. At this time, due to the time that has elapsed, the only remaining option for resolution of the balance is either payment from Mr. [redacted] or completion of the Financial Assistance application. We have currently sent Mr. [redacted] two applications on October 15, 2015 and December 3, 2015, respectively. Based upon his financial situation, he may qualify for a reduction in the amount owed, up to complete forgiveness of the outstanding balance. As we await the completed application from Mr. [redacted], we have contacted the collection agency to place the account on hold. The account was originally placed on a 60 day hold on October 15, 2015 and we have requested a 30 day extension due to the request for the second application on December 3, 2015.
I certainly understand Mr. [redacted]'s frustration at the denial of coverage by California Medicaid for his son's medical services provided. Unfortunately, denial of healthcare services provided occurs all too frequently. When those denials are received, our main communication with our patients is through our billing statements. If Mr. [redacted] ever has questions related to charges on his billing statement, he can call our customer service center at[redacted] or toll free at[redacted]. Our customer service specialists are trained to assist our patients with any of their billing questions.