Thank you for the opportunity to respond to your concerns regarding the following referenced account - Case # [redacted] - [redacted]. In review of your concerns, I reached out to our Manager [redacted] @ Seton Shoal Creek – in order to discuss confidential details of...
billing and addressing any possible concerns you may have regarding this matter. Please note that billing for Shoal Creek is handled directly by facility. In addition I am providing contact information for Ms. [redacted] @ 512 [redacted] for your records.Respectfully, [redacted]Revenue Cycle Supervisor - Customer Service Patient Financial ServicesSeton Family of Hospitals Administrative Offices
Ms. [redacted], Thank you for allowing us the opportunity to address your concerns about your experience during your visit to Seton Medical Center Williamson on May 1, 2016. I would first like to clarify that Austin Regional Clinic (ARC) is not owned or operated by Seton - it is a...
separately owned and managed company apart from Seton. After reading through your description of your visit this appears to be a quality of care issue in which you are most concerned about your interactions with the physician and the registration staff. Because this is not a true billing question, I cannot immediately address this issue. However, I have escalated this matter to the appropriate departments to review your account and respond. This information was forwarded on May 6, 2016. Please allow 15-30 days for them to investigate and reply. In the interim I have placed your account on hold with the billing process for 30 days to give us the opportunity to research and respond to your concerns. We apologize that you had a negative experience at our facility. We pride ourselves on providing a positive interaction and look forward to the opportunity to address your complaint. Thank you, [redacted]Customer Service SupervisorPatient Financial ServicesSeton Family of Hospitals
Complaint: [redacted]
I am rejecting this response because:Thank you for your reply, Mr. [redacted]. I reviewed the ACEP Tool guidelines, and here are my observations:1. An instruction to take an OTC is not listed among Level 2 "Possible Interventions." In fact, "Instructions" is listed as a Level 1 intervention. 2. The website also states that "each hospital may utilize its own unique system for assignment of E/M levels, provided that the services are medically necessary." Taking ibuprofen is not "medically necessary," it is an optional medication that patients may choose to use at their own discretion but is not critical to treating the illness itself. 3. Furthermore, "each hospital may utilize its own unique system for assignment of E/M levels, provided that...the coding methodology...correlates with institutional resources utilized to provide a given level of service." And, "The coding guidelines should be based on hospital facility resources. The guidelines should not be based on physician resources." What extra "institutional" and "hospital facility" resources did a doctor's recommendation to take OTC require?4. Finally, the website states that Medicare will pay "the 'average' US hospital" $59.30 for a Level 1 and $109.50 for a Level 2 Emergency Room Visit. You have charged us over 6 times that amount and over $300 extra for the OTC recommendation alone. Is it 6 times more expensive for you to facilitate a one minute physician consultation along with ibuprofen recommendation than for an "average hospital"? Can you provide any reasonable grounds for charging additional $300 for an OTC recommendation?Based on these criteria, we believe that my husband's case was not coded consistently with ACEP guidelines and that your price is several times multiple to the actual costs incurred by the facility. Please adjust my husband's case to a Level 1 code and adjust our bills to a fair level.I know your hospital holds itself to a high level of ethical standards in many areas. Please revise your billing practices to more accurately reflect those standards and prove to patients that you are here to do "human-care" and not "financial exploitation of human misfortune."
Thank you, I hope we can work this out.
[redacted]
I contacted [redacted] who processes all refunds who stated that a check for 325.00 was mailed on 10/25/16 and cashed on 11/2/16 with check number [redacted]. This check was addressed to [redacted]. Please let me know if there is anything further I can assist...
I am sorry to find out you had such a bad experience with our facility and treatment. Please call our Customer Service department and let them know of the treatment, then ask to be transferred to the Patient Relations department. Customer Service can be reached by calling the number on the...
bill, which should be [redacted]. The Patient Relations department is responsible for our patients care and treatment while at the hospital and oversee all internal investigations regarding a patients complaint about their treatment by staff.
Thank you for the opportunity to respond to your concerns regarding the following referenced account - Case # [redacted] - [redacted]. In review of your concerns, I reached out to our Manager [redacted] @ Seton Shoal Creek – in order to discuss confidential details of...
billing and addressing any possible concerns you may have regarding this matter. Please note that billing for Shoal Creek is handled directly by facility. In addition I am providing contact information for Ms. [redacted] @ 512 [redacted] for your records.Respectfully, [redacted]Revenue Cycle Supervisor - Customer Service Patient Financial ServicesSeton Family of Hospitals Administrative Offices
Ms. [redacted], Thank you for allowing us the opportunity to address your concerns about your experience during your visit to Seton Medical Center Williamson on May 1, 2016. I would first like to clarify that Austin Regional Clinic (ARC) is not owned or operated by Seton - it is a...
separately owned and managed company apart from Seton. After reading through your description of your visit this appears to be a quality of care issue in which you are most concerned about your interactions with the physician and the registration staff. Because this is not a true billing question, I cannot immediately address this issue. However, I have escalated this matter to the appropriate departments to review your account and respond. This information was forwarded on May 6, 2016. Please allow 15-30 days for them to investigate and reply. In the interim I have placed your account on hold with the billing process for 30 days to give us the opportunity to research and respond to your concerns. We apologize that you had a negative experience at our facility. We pride ourselves on providing a positive interaction and look forward to the opportunity to address your complaint. Thank you, [redacted]Customer Service SupervisorPatient Financial ServicesSeton Family of Hospitals
Complaint: [redacted]
I am rejecting this response because:Thank you for your reply, Mr. [redacted]. I reviewed the ACEP Tool guidelines, and here are my observations:1. An instruction to take an OTC is not listed among Level 2 "Possible Interventions." In fact, "Instructions" is listed as a Level 1 intervention. 2. The website also states that "each hospital may utilize its own unique system for assignment of E/M levels, provided that the services are medically necessary." Taking ibuprofen is not "medically necessary," it is an optional medication that patients may choose to use at their own discretion but is not critical to treating the illness itself. 3. Furthermore, "each hospital may utilize its own unique system for assignment of E/M levels, provided that...the coding methodology...correlates with institutional resources utilized to provide a given level of service." And, "The coding guidelines should be based on hospital facility resources. The guidelines should not be based on physician resources." What extra "institutional" and "hospital facility" resources did a doctor's recommendation to take OTC require?4. Finally, the website states that Medicare will pay "the 'average' US hospital" $59.30 for a Level 1 and $109.50 for a Level 2 Emergency Room Visit. You have charged us over 6 times that amount and over $300 extra for the OTC recommendation alone. Is it 6 times more expensive for you to facilitate a one minute physician consultation along with ibuprofen recommendation than for an "average hospital"? Can you provide any reasonable grounds for charging additional $300 for an OTC recommendation?Based on these criteria, we believe that my husband's case was not coded consistently with ACEP guidelines and that your price is several times multiple to the actual costs incurred by the facility. Please adjust my husband's case to a Level 1 code and adjust our bills to a fair level.I know your hospital holds itself to a high level of ethical standards in many areas. Please revise your billing practices to more accurately reflect those standards and prove to patients that you are here to do "human-care" and not "financial exploitation of human misfortune."
Thank you, I hope we can work this out.
[redacted]
I contacted [redacted] who processes all refunds who stated that a check for 325.00 was mailed on 10/25/16 and cashed on 11/2/16 with check number [redacted]. This check was addressed to [redacted]. Please let me know if there is anything further I can assist...
you with.
I am sorry to find out you had such a bad experience with our facility and treatment. Please call our Customer Service department and let them know of the treatment, then ask to be transferred to the Patient Relations department. Customer Service can be reached by calling the number on the...
bill, which should be [redacted]. The Patient Relations department is responsible for our patients care and treatment while at the hospital and oversee all internal investigations regarding a patients complaint about their treatment by staff.