Sharp HealthCare

Dear Ms***, This letter is in response to your complaint filed with the Revdex.com on May 12, Sharp Rees Stealy has reviewed your medical record with the doctor, and the physician you spoke with at Sharp Rees Stealy about your medical conditionThe doctors’ specialty is emergency medicine and is very aware of the costs of care in the emergency room The doctor explained to you that you would be better served going to the ER because the urgent care could not provide the full work up you required to safely treat the symptoms you presented at the urgent care and therefore, directed you to the emergency roomA credit of $that you initially paid to Sharp Rees Stealy will be credited back to your credit card In addition, the hospital billing was reviewed and the total charges for services at the emergency room were $3,You were given a self- pay discount of 25% which brought the balance to $2,It is noted in your account that you are currently not employed and that the hospital sent you a financial packet to complete as you may be eligible for further discountsTo date, the financial packet has not been returned At this time the balance of $2,is outstanding and should be paid to Sharp Chula Vista Hospital unless additional financial information is receivedPlease contact me if you have additional questions regarding your account We thank you for choosing Sharp HealthCare to provide your health care needs Sincerely, Vice President, Managed Care Operations

This is a follto a prior complaint I made against Sharp Healthcare - complaint ID [redacted] As part of the resolution of that complaint Sharp said it would make an adjustment to the bill for observation room timeSharp said: "Our billing department has been informed and they will work with Aetna to reimburse and/or rebill as appropriate." It has been over two months and Sharp has failed to make any adjustments to their claimAbout a week and half ago I tried contact the Sharp representative who made this statement, but have received no response I wish for Sharp to make the billing adjustment as promised

Revdex.com: I have reviewed the response made by the business in reference to complaint ID [redacted] , and have determined that this proposed action would not resolve my complaint For your reference, details of the offer I reviewed appear below As, like the other representatives I talked to, no one seems to listen and the Dr is not telling the truth First of all I own a business and make over 400,a year I don't qualify for any assistance I already told the reps at Sharps this information Secondly instead of you just taking the word of the Drit would have been nice if you would have contacted me and asked for my side The Drnot only referred me to the ER, he also referred me to a clinic on 3rd ave that he said would save me money I told him that I was only confortable with Sharp or Kaiser I still don't believe that I should be responsible for this entire bill because I was mislead I was told that he said that he sent me to the ER because he thought that maybe my ovary had ruptured If he would have listened to me, he would have known that I had them removed in September This is not about the money, it is about the principle I don't think I should have to pay for the scam that your doctor and your organization did to me Regards, [redacted] ***

I am writing in follto Complaint # [redacted] This morning I was able to connect with the Manager of Patient Access Services The patients bill will be modified today and sent to Aetna for reprocessing We apologize for the delay in the process Please let me know if you have any questions or need any additional information Thank you, [redacted] [redacted] ***, MPH, MSW Patient Relations Specialist Sharp Metropolitan Medical Campus Frost Street San Diego, California

Dear [redacted] ***, Thank you for forwarding the concerns brought to your attention by [redacted] on February 15, A follletter was sent to [redacted] on April 28, 2014, and his concerns will be reviewed with our Hospital Grievance Committee for a determination of his request Should you have additional questions, please do not hesitate to contact me at Thank you, [redacted] [redacted] ***, MPH, MSW Patient Relations Specialist Sharp Metropolitan Medical Campus Frost Street San Diego, California Phone – Fax –

To Whom it May Concern,I just wanted to let you know that I received a response from sharp healthcare indicating that they researched my account and determined that I do not owe them anything and that they in fact owe me $and I will be refunded.Thank you very much for your assistance[redacted]

July 1, [redacted] Santa Ynez Ave Apt Chula Vista, CA 91913- Dear Ms***, Thank you for your letter to the Revdex.com (Revdex.com) regarding your concern at Sharp Rees-Stealy (SRS)The concern was forwarded to the Quality Department for review and investigationWe are very sorry to hear that our services did not meet your expectations SRS has an extensive Quality Management Program, which includes the evaluation of all issues of concern brought to our attention and a thorough evaluation of your grievance was conducted by the SRS Quality Management Department based on your dissatisfaction with SRS billing issues Your statement of the problem as noted in the Revdex.com concern: 1.) you don’t qualify for any assistance, 2.) someone from SRS did not speak to you, and you do not believe you are responsible for the entire bill because you were misled and that your ovary was removed in September so it could not have been a ruptured ovary In reviewing your complaint, first we are sorry that you do not quality for any assistanceOur billing department was able to obtain a 25% discount for you and any other discount would need to be discussed with the hospitalSecondly, several of the SRS employees have spoken to you about your compliance The medical record documentation from your visit to Urgent Care (UC) states you complained of intermittent left lower quadrant pain that you had for years and worsened over the past several days It also states you reported that you had already undergone a GYN surgery but it was unsuccessful due to adhesionsIn addition, you requested medication for pain relief Given the diagnoses possibilities, the UC physician was concerned due to your stated surgical history, that a work up in UC would not properly assess your complaintsThe physician also took into consideration that you did not have insurance and gave you an option and recommendation of further care at the Emergency Dept(ED) He stated you agreed to go to the EDIbuprofen was prescribed for pain relief The UC physician further stated he would not tell a patient that going to an ED would be less expensive At the ED, you requested only pain medication and refused imaging that could have been used to assist in a diagnosisYou were prescribed narcotic and non-narcotic prescriptions and advised by the ED physician to follow up with your Primary Care Provider and to return the ED for worsening symptoms Your credit card was refunded the $UC deposit and a 25% discount was applied to the bill Your request to assist further with the ED bill is being denied If any further assistance is needed, I can be reached at 619.446.1886, for any questions Sincerely, [redacted] ***, LVN Care Coordinator Quality Management Sharp Rees-Stealy

Thank you for contacting the Revdex.com regarding your healthcare experienceWe are very sorry to hear that our services did not meet your expectationsYour concern was received in the Quality Management Department for reviewSRS has an extensive Quality Management Program, which includes the evaluation of all issues of concern brought to our attentionWe are dedicated to providing high quality medical care and patient satisfaction.An evaluation of your concern has been conducted by the SRS Quality Management DepartmentA thorough evaluation helps to determine if the care you were provided met the community standard of careFurthermore, it helps SRS to review the current Standards of Practice to identify any potential opportunities for growth and bettermentPlease be aware that we take your concern very seriouslyInformation generated from the Quality Management Department review is confidential, as expressed in the California Evidence Code, the Health and Safety Code and the California Business and Professionals CodeFor this reason, SRS is unable to discuss the outcome of Quality Management reviews or the disciplinary steps that may be taken within SRSAll patient concerns are cumulatively tracked regardless of the outcomeThis is a component of the overall Quality Assurance monitoring program which evaluates medical care provided to our patientsCommunication is an essential component of medical care, and through communication, we can improve the services provided to our patientsOn 2/25/16, you were contacted via phone by the PFS Deptto inform you that you would be responsible for a copay of $due at the time of service, 2/29/In addition to the phone notification from the PFS Dept., a copy of the approval for surgical referral authorization was mailed to you on 1/18/stating, “Please note that payment for services is dependent upon your eligibility with Sharp Rees-Stealy Medical Group and Health Net at the time services are renderedYou may have a co-payment at the time services are renderedFor questions regarding benefits or co-payment information, please call Health Net, Customer Service Department at 1-800-522-0088”You made the copayment of $on admission, but you were also responsible for a 20% co-insurance on the out-patient procedure, for which you are being billed in the amount of $2,The PFS Depthas spoken with you on several occasions and you have been offered the following payment options:Discount 20%: $2,019.63Monthly payment plan months $210.38Loan months $112.34Loan Pt Prefmonths$114.00Upon review of the concern with Patient Financial Services (PFS) Department, it has been determined that you are responsible for the 20% co-insurance for services performed on 2/29/16.To discuss this matter directly with the PFS Deptor for any questions, please call [redacted] You also have the right to initiate an independent review with your health plan by contacting them in writingIf so, please address your concerns to your health plan, Appeals/Grievance DepartmentSincerely, [redacted] *** Care Coordinator Quality Management Sharp Rees-Stealy

Well other than being diagnosed by what has to be a low grade mn, (because I took the test on my own and scored zero, that's zero on the diagnostic category that he judged I would fit into, first minor, and then full on zero, it was peachy I saw a psychiatrist once before and he tried to get me into his business of selling bras in home partiesThat guy was far superior to Leonid MarkhamAnd Sharp follows this mn, and rubber stamps himI'd stay a good miles away from Sharp They must be crazy You might get cut I'm blunt

Revdex.com: I have reviewed the response made by the business in reference to complaint ID [redacted] , and have determined that this proposed action would not resolve my complaint For your reference, details of the offer I reviewed appear below [I am still not satisfied with your responds so this time I have attached proof that your Sharp personal has their facts wrong I have had multiple surgeries that have removed my uterus and ovaries and I do have a lot of scar tissue I did say that I believe that the scar tissue is the problem and I had been being treated for that and blood pressure issues due to the pain As the doctor at urgent care should have known is that you cannot see scar tissue with any type of scan I was told this from the ER doctorThe ER doctor told me that it would be a waste of my money to do that scan because it would not show the internal scar tissueThe ER doctor told me that the scan would not show the scar tissue and asked me what would I like to do I told him that although I do take multiple medications that I would only need the medication for the pain and my blood pressure because my blood pressure goes up when I am in painI told him I will follow up with my primary when I get insurance what was going to be with Sharp but I decided to back to KaiserI wan not only given Ibruprofen and pain pills, I was also given blood pressure pills The doctor at urgent care could have did the same thing without charging as much I would have been fine with just the blood pressure pills and Iburprofen until I seen my regular doctor They gave me percet that is a pain pill that is terrible But I know he was just trying to stop the pain Attached you will find my prescription for blood pressure pills that will prove to you that they either don't remember what happed or they are lying Regards, [redacted] ***

Sharp Health care is a ripoff , I pay over 48,000 dollars a year , and you rip me off for 20.00 dollar copay for doing nothing but wasting my time, and trying to set up another visit so I can pay another 20.00 dollars , how do you people sleep at night? You ask the dumbest questions on your form that I had to fill out, is this what the Un-affordable Obama care act as made you do. Thief's ripoff artist's scammers is what you are , if I worked there I would be ashamed, you have turned healthcare into used car sales bait and switch. I will be dropping my healthcare and go get ripped off by another provider .

We have conducted an internal investigation of the complaints brought to your attention by Consumer ID #*** I have reviewed the records related to her visit to the Sharp Memorial Hospital Emergency Department and the following is a summary of our investigation
We
understand that times of medical care are stressful and it is important that the medical team takes the time to communicate with the patient and family and ensure they understand the plan of careThe patient’s chart was reviewed and her concerns were discussed with the Hospital Grievance Committee Physicians on staff at Sharp Memorial Hospital are private practitioners, not agents of the hospital, and are a self-governing body; therefore, the patient’s concerns regarding the medical care were also forwarded to the medical staff committee that addresses grievances against physicians We are not able to provide specific details of the committee’s review as those records and proceedings are confidential under California law; however, please be assured that her concerns are taken seriously.
After thorough consideration, the hospital care was determined to be appropriate; therefore the patient’s request for reimbursement and waiver of the bill for this visit has been denied We understand that this is not the outcome that she was hoping for and we are sorry that her experience was anything short of excellent
Patient satisfaction is a high priority at Sharp Memorial Hospital and we appreciate the opportunity to evaluate and improve our systems and processes Please do not hesitate to contact me should you have any additional questions or concerns.
Regards,
*** ***, MPH, MSW
Patient Relations Specialist

Dear Mr***,
Thank you for your letter to the Revdex.com (Revdex.com) regarding your concern at Sharp Rees-Stealy (SRS)Theconcern was forwarded to the Quality Department for review and investigationWe are very sorry to hear that our servicesdid not meet your
expectations.SRS has an extensive Quality Management Program, which includes the evaluation of all issues of concern brought to ourattention and a thorough evaluation of your grievance was conducted by the SRS Quality Management Department based onyour dissatisfaction with SRS billing issuesYour concern was reviewed with Sharp Health PlanIn the Summary of Benefits, which I have enclosed, you are responsiblefor a $Emergency Services copayIf you are admitted to the hospital then the copay is waivedIn addition, I reviewed your concern indicating you received a bill that did not have to be paidIn speaking with yourinsurance company, Sharp Health Plan, and the SRS Patient Financial Services Dept., you do not have any current charges.The document you received is called an Explanation of Benefits and provides you with billing informationThe charges havebeen paid by your insurance planIn your statement to the Revdex.com, you indicated changing physiciansWithin SRS, you have the right tochange your Primary Care Physician if you are dissatisfiedIf any further assistance is needed, please contact Sharp Health Plan, Customer Services Deptat 359-Sincerely,
*** ***, L VNCare CoordinatorQuality ManagementSharp Rees-Stealy

I am in receipt of your second letter to Ms*** ***, Legal Secretary for Sharp HealthCare (SHC)Ms*** has requested I respond on her behalf to your correspondenceSharp HealthCare has again communicated directly with our patient in writingWe have once more directed our patient to review the Conditions of Admission (COA) agreement previously provided, directing the patient to item number two, where the legal relationship is explained between a Hospital and PhysiciansShould you have any questions regarding this matter, please contact me at *** ***I would be happy to speak with youSincerely,
*** *** Sharp HealthCare Manager, Patient Financial Services

Per your request I have reviewed the complaint that was referred to you, the BetterBusiness BureauI have researched to see where we could improve in our process offollowing up with our patientsI have listened to every call that the patient's mother made to Customer Service,
aswell as those calls we made to her and the insurance company ..Please see below for a list of callssite Representative CAY JO called *** ***s spoke with Til aReference#*** ** speech therapy was quoted at $COPA Y, No deductible andservice covered at 100%Visits are based on Medical Necessity and Pre Certification is notrequired*** ***s representatives do not check on OX codes however procedure code92521, 92522,and are all valid and billablepatient mother called spoke to * *** to inform that onsite advised her only a $ 15.00copay would apply to the visitHowever she is getting a bill for $388.00, CSR explained that perthe insurance Explanation Of Benefits the service was not a covered benefit and directedpatient mother to the site that first assisted herSite Rep called PFS Customer Service and asked that we call patient mother for claimreviewCSR *** ** called Insurance *** ***s and was directed to a different number,CSR called mother and left message that she is working on account and to please allow time forher to contac t insurancePatient mother returned call to Customer Service Representative (***) LUNJE5took the call and advised patient mother *** ** is working on the account
*** ** placed call to patient mother to advise she is working on account and willcall insurance on Patient mother called, ROBTEtook call and call dropped
Patient mother called again *** took call and advised patient mother she wouldlet *** ** know to call her back with an update*** called *** ***s spoke with *** and explained per call onREF* *** ** benefits for Speech Therapy were verified and noprecertification was required, *** advised she would send the claim back for reconsideration,she explained to *** ** to allow days for response and provided REF* *** ***
Patient mother called spoke with *** advised CSR that her insurance denied theclaim and explained to CSR that she is waiting on a call from *** **, CSR explained topatient mother to a llow more time for insurance to reprocess the c laim
*** called patient mother to advise that she spoke with insurance and theyare reprocessing the c laim to allow timePatient mother called advising she is waiting on a call back from *** ** CSRHILMO explained time frame and advise to allow time
Patient mother called to inquire on status of c laim *** explained to mother that asof SRS received a letter from *** ***s advising the claim was received andreviewedCSR advised she would delay dunning level and asked to check status of claim withinsurance in two weeksPatient mother called to follow up on claim *** *** took information and advisedpatient mother he would relay message to ***
Patient mother called to make credit card payment on the balance of $** *** called patient mother to review account and see how she can assist her.Pt mother advised of everything that has happened during her calls *** advised patientmother that she will research account and get back to her in two business days***reviewed account and submitted coding request to make sure that DX code used wasappropriate and also submitted refund request in the amount of $TL *** called *** ***s at spoke with *** who advised claimwas sent to home plan on for reprocessing, home plan advised claim wassent to technical team for review, final decision was made advising claim wasprocessed correctly as developmental delay is not a covered benefitAt this time, we have decided to refund *** *** *** $Though the denial forservices was appropriate per the insurance, we do not feel we provided the very best customerservice we could haveIf you have any questions please feel free to contact me
*** Team Lead CCD

This is a follow-up to a prior complaint I made against Sharp Healthcare - complaint ID [redacted]. As part of the resolution of that complaint Sharp said it would make an adjustment to the bill for observation room time. Sharp said: "Our billing department has been informed and they will work with Aetna to reimburse and/or rebill as appropriate." It has been over two months and Sharp has failed to make any adjustments to their claim. About a week and half ago I tried contact the Sharp representative who made this statement, but have received no response. 
I wish for Sharp to make the billing adjustment as promised.

I am writing in follow-up to Complaint #[redacted].  This morning I was able to connect with the Manager of Patient Access Services.  The patients bill will be modified today and sent to Aetna for reprocessing.  We apologize for the delay in the process.  Please let me know if you have any questions or need any additional information.
Thank you,
[redacted]
 
[redacted], MPH, MSW
Patient Relations Specialist
Sharp Metropolitan Medical Campus
7901 Frost Street
San Diego, California 92123

To Whom it May Concern,I just wanted to let you know that I received a response from sharp healthcare indicating that they researched my account and determined that I do not owe them anything and that they in fact owe me $20 and I will be refunded.Thank you very much for your...

assistance.[redacted]
[redacted]

Well other than being diagnosed by what has to be a low grade mn, (because I took the test on my own and scored zero, that's zero on the diagnostic category that he judged I would fit into, first minor, and then full on. zero, it was peachy. I saw a psychiatrist once before and he tried to get me into his business of selling bras in home parties. That guy was far superior to Leonid Markham. And Sharp follows this mn, and rubber stamps him. I'd stay a good 100 miles away from Sharp. They must be crazy You might get cut. I'm blunt.

Emergency and Acute Care Medical Group Inc manages bills for Sharp Memorial. The company sent inappropriately to collections bills for two services I incurred at Sharp Memorial Hospital ER's. In both services they sent to collections the bills incurred for Physician Services because they failed to collect my insurance details from Sharp Memorial Hospital administration. Note that in any case I had received letters from the company to claim the payment and that they were the only party who claimed not to be paid because of lacking my insurance details (every other bill incurred was adequately processed and paid timely). In both situations where a service was incurred my insurance details was provided to the administration department of Sharp Memorial Hospital. This suggests the company has broken link in their process to collect the billing information and in their notifications via mail of any outstanding claims. The consequences of their process issues were put solely into my responsibility and was held accountable for their own mistakes, resulting in loss of working hours hanging on calls with my insurance, themselves and the collection agency to resolve the situation. In addition they damaged my financial credibility by sending the claims to the collections agency. I am positive I have not been the only patient being put on the spot for the same issues and encourage others in the same situation to write their reviews so they notice it, can fix their internal processes and no other patients are being put into the same situation. Be warned, if you are visited in any of the Sharp Hospitals you will have deal with this company, make sure they act appropriately. Since I am lucky enough to have a PPO, until I receive confirmation they have looked into this and fix it, Sharp Hospitals have lost my business.