South Texas Pathology Associates LLP

The account Mr [redacted] is referencing for South Texas Pathology Associates, LLP came to us as a self pay Our charges are downloaded from Methodist Hospital's computer and we did not receive any insurance information for this account I checked again, when I received this complaint, and it still doesn't have any insurance listed It shows it as Self Pay Our records indicate that we did send a statement to Mr [redacted] on 5/13/13, 7/24/,9/18/and 11/27/ After no response for an extended period of time, his account was turned over to our collection agency on 11/22/ The patient has now called and indicates he never received a statement from us He has provided information for us to send this claim to the VA at [redacted] and we have done so on 2/26/ Additionally, we have had his account returned from the collection agency and will accept as payment in full, whatever the VA pays

I’m writing in response to the above mentioned complaint The patient is disputing the validity of the pathology professional component charges, which were not covered by his insuranceThe Explanation of Benefits from his insurance company, however, does indicate patient responsibility of the full amount $96.00; additionally, forms signed by the patient at admission to the hospital indicate there will be a separate bill from the pathologists The professional component is a substantial service, even in situations where tests themselves are automated For every patient who uses the hospital's services, the pathology directly oversees all aspects of testing, including training and supervision of personnel and the performance of the continuous quality assurance activities necessary to assure accurate test resultsFor these services, the pathologist, who personally bears responsibility for the quality of test results, receives no compensation at all from the hospital The majority of insurance carriers reimburse for the professional component of laboratory testsIt is unfortunate that Mr***'s insurance does not reimburse for these servicesThey are, however, valid and medically necessary services provided to the patient See attached reference materials

The pathologists do NOT get paid by the hospitalThey are not hospital employees and are contracted to operate the laboratoryThe clinical pathologist bills the patient and their insurance for the professional component of laboratory services In Texas, professional component of laboratory tests is paid by insuranceWe are sorry Mr***'s insurance does not pay for the professional component; however, a service was provided and the clinical pathology services are legitimate and reimbursable If Mr [redacted] had asked for a discount, it would have been provided, as we don't want to penalize patients whose insurance does not payIt is important, however, that Mr [redacted] recognize that a service was performed, be it administrative in natureThe accuracy of Mr***'s automated laboratory results are due to the clinical pathologist operating the laboratory

Complaint: ***
I am rejecting this response because: Of course I signed whatever was put in front of me when I went into the ED because I was having chest pain and did not know whyAnd I also paid the $because I did agree to pay the amount, even though at the time I did not realize that I would be billed a professional fee for an automated test that was never seen or interpreted by the pathologist
Chext xray-radiologist read, no problem with professional feeEKG, ED doc read, no problem with professional feeLabs, ED doc reviewed, no pathologist even came close to looking at it, problemThis response below:
"For every patient who uses the hospital's services, the pathology
directly oversees all aspects of testing, including training and
supervision of personnel and the performance of the continuous quality
assurance activities necessary to assure accurate test resultsFor
these services, the pathologist, who personally bears responsibility for the quality of test results, receives no compensation at all from the hospital."
I did not negotiate the pathologists contract with the hospital, and I am sure that they have a base salaryIf the pathologist reads my intraoperative specimen, or does a blood smear and makes the diagnosis, fineBut I, as a consumer, should not be charged for what is the routine part of his/her job-QA, training, etc as described aboveThey should work that out with the hospitalIn fact, charging a professional fee for something you do not do seems somewhat fraudulent
Regards,
*** ***

I’m writing in response to the above mentioned complaint.  The patient is disputing the validity of the pathology...

professional component charges, which were not covered by his insurance. The Explanation of Benefits from his insurance company, however, does indicate patient responsibility of the full amount $96.00; additionally, forms signed by the patient at admission to the hospital indicate there will be a separate bill from the pathologists.
The professional component is a substantial service, even in situations where tests themselves are
automated.  For every patient who uses the hospital's services, the pathology directly oversees all aspects of testing, including training and supervision of personnel and the performance of the continuous quality assurance activities necessary to assure accurate test results. For these services, the pathologist, who personally bears responsibility for the quality of test results, receives no compensation at all from the hospital.
The majority of insurance carriers reimburse for the professional component of laboratory tests. It is
unfortunate that Mr. [redacted]'s insurance does not reimburse for these services. They are, however, valid and medically necessary services provided to the patient.  See attached reference materials.

The account Mr. [redacted] is referencing for South Texas Pathology Associates, LLP came to us as a self pay.  Our charges are downloaded from Methodist Hospital's computer and we did not receive any insurance information for this account.  I checked again, when I received this complaint, and...

it still doesn't have any insurance listed.  It shows it as Self Pay.  Our records indicate that we did send a statement to Mr. [redacted] on 5/13/13, 7/24/13 ,9/18/13 and 11/27/13.  After no response for an extended period of time, his account was turned over to our collection agency on 11/22/13.
The patient has now called and indicates he never received a statement from us.  He has provided information for us to send this claim to the VA at [redacted] and we have done so on 2/26/14.  Additionally, we have had his account returned from the collection agency and will accept as payment in full, whatever the VA pays.

The pathologists do NOT get paid by the hospital. They are not hospital employees and are contracted to operate the laboratory. The clinical pathologist bills the patient and their insurance for the professional component of laboratory services.
In Texas, professional component of laboratory tests is paid by insurance. We are sorry Mr. [redacted]'s insurance does not pay for the professional component; however, a service was provided and the clinical pathology services are legitimate and reimbursable.
If Mr. [redacted] had asked for a discount, it would have been provided, as we don't want to penalize patients whose insurance does not pay. It is important, however, that Mr. [redacted] recognize that a service was performed, be it administrative in nature. The accuracy of Mr. [redacted]'s automated laboratory results are due to the clinical pathologist operating the laboratory.