Sharp HealthCare

Dear Ms. [redacted],
This letter is in response to your complaint filed with the Revdex.com on May 12, 2014. Sharp Rees Stealy has reviewed your medical record with the doctor, and the physician you spoke with at Sharp Rees Stealy about your medical condition. The...

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 room. A credit of $175.00 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 $3,387.00. You were given a self- pay discount of 25% which brought the balance to $2,340.25. 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 discounts. To date, the financial packet has not been returned.
At this time the balance of $2,340.25 is outstanding and should be paid to Sharp Chula Vista Hospital unless additional financial information is received. Please 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

Sharp HealthCare has communicated directly with our patient in writing. The letter provided a signed copy of the patient's Conditions of Admission (COA) agreement, directing the patient to item number two where the legal relationship is explained between a Hospital and...

Physicians.Should you have any questions regarding this matter, please contact me at [redacted]. I would be happy to speak with you.Sincerely,
[redacted]
Sharp HealthCare
Manager, Patient Financial Services

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID [redacted], and find that this resolution would be satisfactory to me. 
I was able to speak directly with a representative of the hospital, who listened to my issues,...

adjusted what was being billed accordingly, and accepted my payment.  I am also in receipt of documentation from Sharp Hospital and the collection agency that the matter has been resolved and had been removed from my credit reports.
Regards,
[redacted]

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 doctor. The 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 tissue. The 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 pain. I 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 Kaiser. I 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]

July 1, 2014
[redacted]
1304 Santa Ynez Ave.  Apt 249
Chula Vista, CA 91913-1492
Dear Ms. [redacted], 
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 investigation. We 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 assistance. Our billing department was able to obtain a 25% discount for you and any other discount would need to be discussed with the hospital. Secondly, 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 2 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 adhesions. In 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 complaints. The 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 ED. Ibuprofen 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 diagnosis. You 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 $175.00 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

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 400,000.00 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 Dr. it would have been nice if you would have contacted me and asked for my side.  The Dr. not 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]

Thank you for contacting the Revdex.com regarding your healthcare experience. We are very sorry to hear that our services did not meet your expectations. Your concern was received in the Quality Management Department for review.
SRS has an extensive Quality Management...

Program, which includes the evaluation of all issues of concern brought to our attention. We are dedicated to providing high quality medical care and patient satisfaction.An evaluation of your concern has been conducted by the SRS Quality Management Department. A thorough evaluation helps to determine if the care you were provided met the community standard of care. Furthermore, it helps SRS to review the current Standards of Practice to identify any potential opportunities for growth and betterment. Please be aware that we take your concern very seriously.
Information 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 Code. For this reason, SRS is unable to discuss the outcome of Quality Management reviews or the disciplinary steps that may be taken within SRS.
All patient concerns are cumulatively tracked regardless of the outcome. This is a component of the overall Quality Assurance monitoring program which evaluates medical care provided to our patients. Communication is an essential component of medical care, and through communication, we can improve the services provided to our patients.
On 2/25/16, you were contacted via phone by the PFS Dept. to inform you that you would be responsible for a copay of $250.00 due at the time of service, 2/29/16.
In addition to the phone notification from the PFS Dept., a copy of the approval for surgical referral authorization was mailed to you on 1/18/16 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 rendered. You may have a co-payment at the time services are rendered. For questions regarding benefits or co-payment information, please call Health Net, Customer Service Department at 1-800-522-0088”.
You made the copayment of $250.00 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 $2,524.54.
The PFS Dept. has spoken with you on several occasions and you have been offered the following payment options:Discount 20%: $2,019.63Monthly payment plan 12 months $210.38Loan 24 months $112.34Loan Pt Pref. 24 months$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 Dept. or for any questions, please call [redacted].
You also have the right to initiate an independent review with your health plan by contacting them in writing. If so, please address your concerns to your health plan, Appeals/Grievance Department.
Sincerely,
[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 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.

My wife was admitted to Sharp Memorial Hospital 13 July 2015. During the admission process I informed the hospital staff that my wife has an allergy to Codeine. On 14 July 2015 the hospital medical staff administratered Oxycodone. My had a reaction to the medication with her face becoming flush and started to perspire heavily. Thankfully this was the limit of her reaction. Always ask the hospital staff what they are giving your family members to make sure they don't make a mistake.

My wife had two strokes while under the care of the doctors at Sharp Memorial Hospital. The second stroke occurred during open heart surgery. It was several days after the heart surgery when my wife did not come out of anesthesia that the doctors suspected my wife had suffered a stroke. By then it was too late to administer clot busting drugs. The best the doctors could do for my wife was to raise their hands and say sorry and too bad I don't know what say. This was the same doctor that assured my wife and myself that they could adequately address any stroke risk during surgery. They were wrong. My wife is paying the price. She now resides in a nursing home with no movement of her limbs. She has regained some speech and can eat solid foods. We are now suffering under a crushing financial burden for which my Blue Cross Blue Shield does not cover. After the stroke the Neurologist washed his hands of my wife's case and did not return. Sharp Memorial's definition of treatment for stroke patients is to walk them up and down the halls like zombies. The whole time my wife was in Sharp Memorial the Social Workers were trying to get me to with hold food and water from my wife until she died. Maybe if they would spend as much effort caring for my wife as the spent trying to get me to kill my wife, she may have avoided the stroke. Do not take family members with stroke risk to Sharp Memorial for treatment because they do not know how to handle strokes.

Review: I came to Sharp OP physical therapy for 4 visits. Each had a $20 copay which I paid each time I went in (you are required to pay at the time of service). I was getting a bill for $16. I called them and they said there was one copay amount of $16. I advised them since I paid $20 each time they owe me $4. She stated she saw all four payments of $20 and they agreed. No refund came. Only a bill for $20 now. I called and they stated I had two accounts, one for cervical spine therapy and one for thoracic spine therapy. She (the manager now) said one account had a credit and one account had a balance. She said the account that had a balance had not been processed by insurance. If this is the case they should be following up with the insurance not harassing my. I am now getting phone calls and bills threatening to send me to collections. The type of insurance I have is has a capitated contract with this physical therapy department. The insurance doesnt really pay them, but patients DO NOT GET BILLED FOR THIS. ( I used to work in medical billing ). Patients only have to pay their copays which I have.Desired Settlement: They need to adjust the outstanding balance on the one account and refund me the overpayment on the other. They also need to stop calling me, and sending me bills saying that they are sending me to collections.

Consumer

Response:

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]

Review: My son's pediatrician sent a request to the Sharp speech therapist for speech therapy. I was contacted by them to set up an appointment and was told that I was only going to be responsible for a $15 copay and that they had talked to my insurance and that the service was covered. I agreed to the appointment telling them that the only reason I would go is because there was only a $15 copay and nothing else I cannot afford more than that. After countless calls and no answer I am being billed for $388. I have been talking to the billing department since September 2014 and have not been able to resolve this issue. The customer service is terrible because I am told I will get a call back with and answer on my situation and never do.Desired Settlement: I am not able to pay the $388 being billed so I would like that charge to be removed.

Business

Response:

Per your request I have reviewed the complaint that was referred to you, the BetterBusiness Bureau. I have researched to see where we could improve in our process offollowing up with our patients.I 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 calls.06.20.2014 site Representative CAY JO called [redacted]s 800.67 6.2583 spoke with Til aReference#[redacted] speech therapy was quoted at $50.00 COPA Y, No deductible andservice covered at 100%. Visits are based on Medical Necessity and Pre Certification is notrequired. [redacted]s representatives do not check on OX codes however procedure code92521, 92522,92523 and 92507 are all valid and billable.09. 11 .2014 patient mother called spoke to [redacted] to inform that onsite advised her only a $ 15.00copay would apply to the visit. However 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 her.09.22.2014 Site Rep called PFS Customer Service and asked that we call patient mother for claimreview09.23.2014 CSR [redacted] called Insurance [redacted]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 insurance.09.23.2014 Patient mother returned call to Customer Service Representative ([redacted]) LUNJE5took the call and advised patient mother [redacted] is working on the account09.23.2014 [redacted] placed call to patient mother to advise she is working on account and willcall insurance on 09.24.201410.03.2014 Patient mother called, ROBTE2 took call and call dropped10.03.2014 Patient mother called again [redacted] took call and advised patient mother she wouldlet [redacted] know to call her back with an update.10.03.2014 [redacted] called [redacted]s 800.444.2726 spoke with [redacted] and explained per call on06.24.2014 REF#[redacted] benefits for Speech Therapy were verified and noprecertification was required, [redacted] advised she would send the claim back for reconsideration,she explained to [redacted] to allow 14 days for response and provided REF#[redacted]10.06.2014 Patient mother called spoke with [redacted] advised CSR that her insurance denied theclaim and explained to CSR that she is waiting on a call from [redacted], CSR explained topatient mother to a llow more time for insurance to reprocess the c laim10.07.2014 [redacted] called patient mother to advise that she spoke with insurance and theyare reprocessing the c laim to allow time.10.10.2014 Patient mother called advising she is waiting on a call back from [redacted] CSRHILMO explained time frame and advise to allow time11.06.2014 Patient mother called to inquire on status of c laim [redacted] explained to mother that asof 10.28.2014 SRS received a letter from [redacted]s advising the claim was received andreviewed. CSR advised she would delay dunning level and asked to check status of claim withinsurance in two weeks.12.18.2014 Patient mother called to follow up on claim [redacted] took information and advisedpatient mother he would relay message to [redacted]01 .07.2015 Patient mother called to make credit card payment on the balance of $388.0001 .1 2.2015 [redacted] called patient mother to review account and see how she can assist her.Pt mother advised of everything that has happened during her calls [redacted] advised patientmother that she will research account and get back to her in two business days. [redacted]reviewed account and submitted coding request to make sure that DX code used wasappropriate and also submitted refund request in the amount of $164.93.01.14.2015 TL [redacted] called [redacted]s at 800.444.2726 spoke with [redacted] who advised claimwas sent to home plan on 10.03.2014 for reprocessing, 10.06.2014 home plan advised claim wassent to technical team for review, 10.09.2014 final decision was made advising claim wasprocessed correctly as developmental delay is not a covered benefit.At this time, we have decided to refund [redacted] $388.00. Though the denial forservices was appropriate per the insurance, we do not feel we provided the very best customerservice we could have.If you have any questions please feel free to contact me. [redacted] Team Lead CCD

Consumer

Response:

I have reviewed the response made by the business in reference to complaint ID [redacted] and find that this resolution would be satisfactory to me. I will wait for the business to perform this action and, if it does, will consider this complaint resolved.

Regards,

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.

Review: Following a visit to the emergency department, I received a number of bills, including one for the ED. I requested itemized bill since the amount seemed high. I discovered that there were charges for medications and services that I did not received during my visit (my wife, who is a Nurse Practitioner and holds a PhD in Nursing was with me the entire time).

I repeatedly tried to explain this by phone to the billing department, but was simply told that a nurse had looked at my file and verified that all the charges were correct. I then requested to have an in-person meeting with a representative of the billing department so that we could go over the issue line by line, and was told that was not possible.

I finally gave up. I will not pay a bill if it is not correct. I am able and willing to pay the bill, but not until it is correct.

I recently discovered that the full amount plus interest is now reporting on my credit reports and delinquent and in collections (even though I have not heard from any collections agencies).Desired Settlement: I would like:

1) That this stop being reported to my credit reports until I am able to sit down and review the billing, line by line, and come to an agreement.

2) The medications and services to be removed from the billing so that I can pay the correct amount.

Consumer

Response:

I have reviewed the response made by the business in reference to complaint ID [redacted], and find that this resolution would be satisfactory to me. I was able to speak directly with a representative of the hospital, who listened to my issues, adjusted what was being billed accordingly, and accepted my payment. I am also in receipt of documentation from Sharp Hospital and the collection agency that the matter has been resolved and had been removed from my credit reports.

Regards,

Review: On August 10/2014 I admitted to Sharp hospital for a bump above my eyelid. Doctor diagnosis was Sty. After injecting powerful antibiotic, I was released with Patient education paper regarding Sty. My eye situation not only didn't get better but it got worse. After so many unnecessary doctors visits,finally I was able to see an Ophthalmologist on August 13th. There he told me none of other treatments would have helped my eye and since it was getting worse with infections, eye redness and extreme pressure he end up doing a surgery to open up and drain eyelid.

I was misdiagnost by sharp hospital. I thought by going to hospital , I will get treated but send home.

When my sister brought my concern regarding misdiagnose by sharp hospital to Patient Relations specialist (Ms.Jodi Gross) after waiting a month for answer , Ms Jodi wrote me an email to explain according to review by medical committee, care was given to me was correct. REALLY...........

Business

Response:

We have conducted an internal investigation of the complaints brought to your attention by Consumer ID #[redacted]. 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 care. The 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,

[redacted], MPH, MSW

Patient Relations Specialist

Consumer

Response:

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.

In very simple words , I believe Sharp hospital has commited fraud by misdiagnosing and mistreating me while at their care and charging me and my insurance for their profit not honest medical care , I am extremely disappointed and dissatisfied by them.

Regards,

Business

Response:

Dear Ms.[redacted],

This letter is in response to the appeal brought to your attention by Consumer ID #[redacted]. The complaint has been carefully reviewed by the Sharp Memorial Hospital Executive team and our Patient Grievance Subcommittee. After thorough investigation, the care was deemed to be appropriate. Therefore, Sharp Memorial Hospital’s position remains the same.

Review: This is in regards to account #[redacted] for my wife, [redacted], and a charge for time spent in a Sharp Memorial observation room on November 1, 2013 during a blood transfusion.

My wife was provided a blood transfusion at Sharp Memorial Hospital in the South Tower - the observation rooms over two days - October 31th and November 1st, 2013. Arrangements for the blood transfusion had been made between my wife's doctor at the Sarcoma Oncology Center in Santa Monica, and Dr. [redacted] at Sharp Rees-Stealy. We were told by the Sarcoma Oncology Center doctor that the blood transfusion would be for 3 units of blood due to my wife's very low hemoglobin count - 6.0. When we arrived at Sharp Memorial on October 31th, the nurse said the order was for 2 units of blood. I told the nurse that we were told 3 units of blood, but she refused to follow up with Dr. [redacted] since it was "too late" (about 7 pm).

The following morning my wife again asked the nurse if she could check the order to see if it should be 3 units, but the nurse did not check. At about 2:00 pm, my wife asked the nurse again, and this time she did follow up with Dr. [redacted], who confirmed that 3 units should be provided. My wife had just finished the second unit around this time too.

The third unit did not start until 8 pm. The nurse told us part of the delay was due to a mistake upon the part of the tech who ordered the blood. She said the order neglected to specify that the blood needed to be irradiated.

Therefore, the 5 1/2 hour delay between completion of the second unit and start of the third is due to two Sharp mistakes: failure to act upon our initial request on October 31st to consult with the prescribing doctor regarding the order, and an error in the order for the third unit (failure to specify irradiation). We should not be responsible for the charges related to use of the observation room since these are due to Sharp errors. On Sharp's invoice this is charge #[redacted] for November 1th, which is currently 23 hours. This should be reduced to 17 1/2 hours.

My wife has provided authorization for my access to her medical and billing records at Sharp. I can provide a copy of the authorization form.

I previously filed this complaint with Sharp on January 12th, 2014, but have not received a written response.Desired Settlement: Time reduced for observation room charge from 23.0 hours to 17.5 hours. I wish to have a written response to this complaint from Sharp. Note that this charge was paid by my health insurer, Aetna, so I wish the refund to be paid to Aetna at Aetna's rate of compensation, which is lower than the amounts given. These amounts are from Sharp's invoice.

Business

Response:

Dear [redacted],

Thank you for forwarding the concerns brought to your attention by [redacted] on February 15, 2014. A follow-up letter 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 858.939.3388.

Thank you,

[redacted], MPH, MSW

Patient Relations Specialist

Sharp Metropolitan Medical Campus

7901 Frost Street

San Diego, California 92123

Phone – 858.939.3388

Fax – 858.939.4485

Consumer

Response:

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.

Business

Response:

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], MPH, MSW

Patient Relations Specialist

Sharp Metropolitan Medical Campus

7901 Frost Street

San Diego, California 92123

Review: On 04/14/2014 I went to Sharp Urgent Care on 3rd Ave in Chula Vista, CA. I was experiencing pain on my left adomin and my blood pressure was high. This is a chonic problem due to previous surgeries that I have had. I was previously treated at Kaiser and Sharp for these issues. After my last surgery in September 2013, I was told by Kaiser that I had a lot of adhesions in that left area that is causing the pain but surgery in that area would be too dangerous so I will have to learn to deal with it with medications and pain management. My insurance with Kaiser ended in February and on 4/14/2014 I woke to pain and found that my blood pressure was real high. I went to Sharp Urgent care to be seen. I brought my Kaiser medical paper work to show what medications that I am currently taking. At this time I was out of multiple medications which included pain pills and blood pressure pills. I was told that I would have to leave a 175.00 deposit and pay the difference after treatment from urgent care physician. The MD told me that it was better for me to go to the Emergency Room because it will be less expensive. I first agreed. The MD left the office to let the front office know that he will not be treating me and he was also going to contact the emergency room to let them know I was coming. When the MD came back in the room I told him that I would rather just been seen by him and I will pay the 600-800 fee that I was quoted by the front office. He again told me that he just wants to save me money and I could save money by going to the ER. He even told me that legally they cannot charge me to be seen unlike urgent care. He told that the ER will bill me at a later time. I took his advice and went to the ER. I explain my issues with the ER doctor and he told me that he could do a CT scan to see what is going on in my abdimon area but those scans can cause cancer and also you cannot see scar tissue in the scan. He told me that I know my own body and if I feel like I just need my medications refilled that he will just do that and refer me to my primary care doctor. I told him that I do not want to be exposed to cancer because I already have enough health issues. He gave me a prescription for pain pills and blood pressure pills. They said I had to pay a 200.00 deposit and released me. On 4/28/2014. I received a bill from the ER for 2340.25. They did apply the 200.00 that I had already paid but I was shocked to see that the bill was over 800.00 because I was told by the Urgent care doctor that I was going to save money by ER. I spoke a patient advocate that told me that there was nothing that she could do because she only represents the Sharps Hospital not Sharp Urgent care. I spoke to [redacted] who is a patient advocate for Sharps urgent care. I told her that I was misled into thinking I was saving money by going to the ER. She told me the reason that he sent me to the ER was because he felt like I may have had a cyst in my ovary. I let her know that that could not have been the reason because I had told him that my ovary had already been removed. I explained to her again what was told to me. She told me that there was nothing that she could do for me but she definatly was not going to help me with the bill. I asked about the deposit of 175.00 that they took from me without rendering any services. She told me that I did have a 175.00 credit but if I wanted my money back I would have to request it. At this time I realized that I was just ripped off by Sharp and they have no intention of trying to resolve the issueDesired Settlement: I will like to pay the amount that I would have to pay if the MD would have just seen me at urgent care which is between 600-800.00. I will also like my 175.00 either refunded to me or applied to my balance.

Business

Response:

Dear Ms. [redacted],

This letter is in response to your complaint filed with the Revdex.com on May 12, 2014. Sharp Rees Stealy has reviewed your medical record with the doctor, and the physician you spoke with at Sharp Rees Stealy about your medical condition. The 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 room. A credit of $175.00 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 $3,387.00. You were given a self- pay discount of 25% which brought the balance to $2,340.25. 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 discounts. To date, the financial packet has not been returned.

At this time the balance of $2,340.25 is outstanding and should be paid to Sharp Chula Vista Hospital unless additional financial information is received. Please 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

Consumer

Response:

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 400,000.00 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 Dr. it would have been nice if you would have contacted me and asked for my side. The Dr. not 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,

Business

Response:

July 1, 2014

1304 Santa Ynez Ave. Apt 249

Chula Vista, CA 91913-1492

Dear Ms. [redacted],

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 investigation. We 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 assistance. Our billing department was able to obtain a 25% discount for you and any other discount would need to be discussed with the hospital. Secondly, 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 2 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 adhesions. In 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 complaints. The 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 ED. Ibuprofen 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 diagnosis. You 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 $175.00 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

Consumer

Response:

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 doctor. The 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 tissue. The 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 pain. I 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 Kaiser. I 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,

Review: On Feb 27 , 2013 , Dr [redacted] , at sharp Rees- Stealy medical group, requsted an ultra sound due to the severe pain I had to my pelvic. Therefore, on the same date, I called the clinic to find out what this procedure cost and I was asked for the CPT code for the ultra sound procedure (CPT code #[redacted]) . I was told by more than one agent that the maximum total I would pay for this procedure is $261.45 . On March 4, 2013 , the ultra sound was done. Three weeks later , I was mailed a statement in the amount of $517.94 . I called the billing dept. to discuss the higher amount and was told that I needed to pay it . This was not the only time I was over charged ,in addition ,I had previously paid $123 dollars for the laboratory test that I was told it was at no charge to me on the first visit .Desired Settlement: I would like to pay the initial amount I was told to pay $261 only.

Business

Response:

May 1, 2013

Review: I have been under treatment for cancer and other health problems with this group, insured thrugh my job, back in July 2014, I had a horrible rush and itching, I needed to make an appointment, they send me an e-mail saying that I was assigned to another doctor, I went there, it was no good, she did not do anything for me, instead I was informed that they belong to another group, and needed to change all my doctors, I call Sharp Rees-Stealy, and was told that they have seen the e-mail, and it was a mistake, I had no intentions of changing my doctors, I ended up in the ER, having to pay $100 co-payment and nothing was done again, then I demanded they return me to my original medical group and doctors, so they send me a bill for $539.00, that I do not have to pay because the mistake was theirs, apparently they have two different medical groups, and I keep calling them, but all I hear is that the group is not the insurance, that it is a different entity, they know it was there mistake, but refused to fix it. I still do not understand their group insurance setup, but they do not explained to anyone how they conduct business, I do not have to pay them, I only pay the c0-payments when I see my doctors.Desired Settlement: That they cancelled this debt, fix their mistake, and tell all insure people, how their group and insurance business work.

Business

Response:

Dear Mr. [redacted],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 investigation. We 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 issues.Your concern was reviewed with Sharp Health Plan. In the Summary of Benefits, which I have enclosed, you are responsiblefor a $100.00 Emergency Services copay. If you are admitted to the hospital then the copay is waived.In addition, I reviewed your concern indicating you received a bill that did not have to be paid. In 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 information. The charges havebeen paid by your insurance plan.In your statement to the Revdex.com, you indicated changing physicians. Within SRS, you have the right tochange your Primary Care Physician if you are dissatisfied.If any further assistance is needed, please contact Sharp Health Plan, Customer Services Dept. at 800 359-2002.Sincerely,[redacted], L VNCare CoordinatorQuality ManagementSharp Rees-Stealy

Consumer

Response:

I have reviewed the response made by the business in reference to complaint ID [redacted], and find that this resolution would be satisfactory to me. I will wait for the business to perform this action and, if it does, will consider this complaint resolved.

Regards,

Review: My wife([redacted]) and I for annual checkup and they sent it to sharp lab. The lab service is a new service at the hospital. The lab at sharp hospital billed us the wrong code, and we kept receiving bills. We took initiative by contacting the sharp lab, the doctor office, and our insurance regarding these matter. We called our insurances 4 times and they said the lab billed the wrong code. We called the lab again, and the doctor office but nobody are doing anything. At the end we called the doctor office, we received the contact of the person in charge of our case. We talked to her on the phone and email regarding this issue but she refused to respond back and we are stuck with the bills. After months going back and forth with them, our bills got sent to the collector agents. The doctor at the office we visited for the annual checkup told us we are not the only people who are having the same issue. We have bill reports saved up as evidences, and also recorded the conversations between the doctor, the person in charge of the lab billings, and our insurance as well.Desired Settlement: remove the incorrect billings and charges on my wife and I. Make sure it doesn't affect my wife credit score and my credit score.

Consumer

Response:

The consumer indicated to the Revdex.com that this complaint has been resolved.