Schick Shadel Hospital

Enclosed consent formPlease forward to the person(s) involved with complaint # [redacted] to fill out the highlighted sectionIn order to verify the identity the signer must be the patient and the document must be notarizedRespectfully, Jerry Z [redacted]

Attached is the notorized Schick Release formI had very hard time finding a notory that would notorize thisAs you can see, they hand wrote "*Doc must be notorized" however, notories need verbage to notorize and since I wasn't checking any of the boxes-Consent to disclose patients presence- they wouldn't notorize itAs in my rejection to company, I stated this release did not pertain to my situation. A professional company would Have a general release to fill in the information needing releasedCustomize a release document for individual situationsI find it hard to believe that this company doesn't have a release for financials only I finally found a notory that would notorize but he had to do it on seperate paper, see page 2, if you print the pages his stamp will match showing the doc was notorized, I guess? Contact me if you need any other information Sincerely, *** *** Please see attached

Enclosed consent form. Please forward to the person(s) involved with complaint #[redacted] to fill out the highlighted section. In order to verify the identity the signer must be the patient and the document must be notarized. Respectfully, Jerry Z[redacted]

To whom it may concern:The prices in effect as of October 2013 were as follows:Detoxification Services Alcohol= $1000.00 per DiemTreatment Services Alcohol= $1567.00 per Diem• A typical stay for detoxification services for alcohol is 3 days.• A typical stay for treatment is 10 days.• The length of stay can vary greatly depending on medical necessity. This is especially the casewith detoxification services.• Per Diem charges are billed when a patient occupies a bed at 12 am.Prior to admission we estimate the costs of service based on three days of detox and 10 days oftreatment. There is no charge for the day of discharge.Additional detox or treatment days are billed to the patient within 30 days of discharge.There are three notifications we provide the patient during their stay which advises them the balancedcollected is only an estimate and additional charges may apply. In addition in 2013 we provided financialcounseling to review costs and billing procedures.I have enclosed three documents that we asked each patient to review and sign. I reviewed the chartand confirmed that this admit signed all three forms. Copies of the signed documents along with anitemized statement have been sent to the address supplied on the complaint form.In addition I spoke with this admit on April 1st and May 13th 2014 in regard to the balance. During bothof these conversations if I understood her concerns correctly she suggested that she did not have fourdays of detox services. I went through the billing procedures with her and verified the physician's ordersregarding her length of stay in detox. My notes suggest I sent the admit copies of the supportingdocuments at her request. We subsequently delayed assignment an additional90 days pending aresponse before preparing the account for assignment to the collection agency.Below please find the contact information for the agency where this account is assigned. I would suggestyou contact them directly to discuss the current balance and their credit reporting procedures.Respectfully,Jerry Z[redacted]

Complaint: [redacted] I am rejecting...

this response because:1)There is no written response from the business regarding my complaint. 2) Instead, the Schick Shadel attached a "Consent for release of Alcohol or Drug Abuse Patient Information" (I've attached a copy for your review) stating that I would authorize Schick and/or its employees to release information obtained during my assessment, diagnosis and treatment for alcohol and/or drug abuse. The header of this release is typed, 'Alcohol or Drug Abuse'. But, the information Schick is asking me to authorize release of (see underlined sentence above) which, not only doesn't pertain to my complaint, but in the authorizing paragraph after I would print my name and authorize info. (underlined above) it states, " alcohol and/or drug abuse" This release in totality has a 'header' release of 'or'  but an authorize release of 'and/or'. Schick also stated to that the release must be notarized (my guess is to ascertain my actual identity, see certifying as such below. In addition to 99% of the upper 1/2 of release not pertaining to my complaint, it the continues on the lower 1/2 with even more impertinent release of info. It has 4 columns. Column #1 "Release of information to": typed, "Attorney, Parole Court Officer"...hand written-Revdex.com & address. Column #2 "Purpose": typed, "To assist in legal matters"...hand written-Complaint [redacted]. Column #3 "Type of information": typed, "Medical, psychological, treatment plan, continuing care plan, and course"...handwritten-Financial. My Revdex.com complaint has nothing to do with "type" column #3 except handwritten financial. The remainder of consent form, implies to check 2 of 4 box choices. All 4 choices (as I understand them) are in relation to someone who is still a patient. In closing; I am rejecting signing this Consent for release of Alcohol or Drug Abuse Patient Information form. 3) I AM, IN SOUND MIND, UNDER PENALTY AND PERJURY, I CERTIFY THAT I THE COMPLAINTANT in this Revdex.com financial complaint. All verifying personal information requested by Revdex.com about myself and the validity of this complaint are true and correct. I am authorizing, Schick Shadel and/or its employees to release all/and any information to Revdex.com in regards to financials: letters/phone calls to/from me, billing charges, payment history, and any collections letter or conversations. Citing partial--OCR HIPAA-- USES AND DISCLOSURES FOR TREATMENT, PAYMENT, AND HEALTH CARE OPERATIONS [45 CFR 164.506]... access to protected health information for treatment, payment, and health care operations, based on those who need access to the information to do their jobs... Disclosures to consumer reporting agencies (limited to specified identifying information about the individual, his or her payment history,                                         ...⇄                                         ...⇄ Complaint: [redacted] (cont.pg. 2)As stated in my complaint, upon arrival on Weds. 10/2/13, my 'witness' and I met with a Schick employee "X" (protected name) in the Admissions Dept., "X" explained what I could expect during their 13-day treatment program. I told her I didn't have insurance coverage, and maybe I would just stay for 3-4 days. I wasn't sure if I wanted to stay for the entire 13 days. "X" stated it was ok if I paid for treatment charges a couple days at a time in advance and that she would let me know the amounts I needed to pay based on days I was there. "X" was adamant that it's Schick policy that all charges must be paid in their entirety prior to discharge."X" told me and my 'witness' that a lump sum of $3,450.00 needed to be paid that night, to cover admittance and few days of treatment. I wasn't given a hand-out or printed cost of treatment breakdown, but I was at a vulnerable time in my life and was  looking for a hospital type setting to get my head on straighter. So, I paid 'X' the $3,450.00 with a credit card. Three days later, on Friday 10/5, I was called into the admissions office by "X", she told me another $4000 was due. I call my 'witness' and later that night my 'witness' arrived at Schick and gave "X" $4000 in cash. On (Tues.10/8), I met with 'X' in her office, I told her I felt I was ready to go home. She expressed to me all the 'faradic' treatment reasons I should stay the remaining 6 nights to complete they're program and I would be discharged on 10/15 and how I could return 2x overnight free for their included after care. I remember feeling like I was in a 'car salesman' office, feeling pressured to stay and thinking, "Did she want me to stay for my recovery or stay for the 'census' count and money". Ultimately my choice was to stay. 'X' said she would call my 'witness' and tell her the amount of money she needed to bring to Schick. Later that day, I spoke to my 'witness' and she said, "Wow, 'X' lady is persistent, she called me at work to let me know you were staying in treatment and told me to bring $11,500.00, I said ok. that I'd need to go to bank and get check, so I'd  bring it to Schick after work, it's a long drive and there would be traffic, but then she called me 2 more times at work wanting to know if I'd be bringing the money before she left for the day". My 'witness' arrived at Schick after "X" had left. So, the next day (Wed. 10/9) I presented to 'X' a cashiers check for $11,500.00, the amount she said I needed to pay in advance of my discharge. During my entire stay at Schick, I was never given any paperwork, documentation or breakdown of costs or charges for my 13 days of treatment. To this day, I'm unaware if Schick provides treatment cost information to the uninsured 'self-payer'. Each time "X" asked for a payment, she told the amount and I paid. There was (3) requests for payment and I paid every time she requested. Each time I paid 'X' she gave me a receipt. Total payments $18,950.00.   Complaint: [redacted] (pg. 3)I completed Schick 13-day program and signed my discharge paperwork on the morning of 10/15, I said my 'goodbyes' to staff. Never a mention of a balance owed on my account. Even when I returned to Schick for their  (2) 'free' aftercare overnights (I paid additional $600 to Schick to have a private room on both the 2 overnights) on 11/24/2013 and 1/19/2014. Both those 2 nights I stayed in aftercare, I had sobriety conversations with 'X' and other staff. Never, was I informed by 'X' or any employee at Schick about a balance due on my account. Feb. 2014 (1- month after my last overnight at Schick) imagine my surprise when I received in the mail a "Balance Forward" statement showing I owe $1000. After several phone calls to Schick about the balance, I still didn't have a clear idea why I had a balance owed. So on, 3/26/2014, I sent Schick Director, billing dept. and 'X' certified letters requesting explanation of balance (more details of what I received back from Schick in original complaint). Schick then sent my account to collections, which in my opinion, was in direct retaliation for questioning numerous inept policies, procedures and overall health-care-operations I experienced during my 13-day and 2 aftercare stays. It's my belief that Schick Shadel, a private-for-profit hospital/treatment facility is operating with immense 'lack oftransparency in regards to cost of services' for private payees. In addition, as it reads to me, Schick Shadel hospital is in non-compliance with: RCW 70.41.400... NOTES: Findings—Intent—2006 c 60--(states in part)...it is the intent of the legislature to encourage hospitals to design the implementation of health information technologies so as to allow the hospital to provide the patient, prior to or upon discharge, clearly understandable information about the services provided during the hospital stay, and the bills the patient is likely to receive related to each of those services.In closing, I do not owe Schick Shadel $1000.00. Their billing records in my case, that I've reviewed even show I don't owe the monies. Neither, Schick Shadel nor it's employees implemented the above RCW code in my situation. In fact, during my stay, I, myself and other patients heard/observed numerous regulation deficiencies within the operations of Schick Shadel.  Sincerely,[redacted]