Springdale Pediatric Medicine

Review: Our son is only 5mths old & this facility has been taking co-pays for well-visits when they shouldn't have. On 2 of the 5 ck-outs, we were told BY THEIR CASHIERS that the ins doesn't seem to request a co-pay, but took the money anyway "until it was cleared up." Since Nov 2013, I've been fighting for the rtn of our co-pays. We recd 3 voice mails from 2 different ppl stating that all $150 was being rtn'd. We've only recd $90 to date (1/7/14). They now claim that they don't show a co-pay being pd on his 1st visit, although I find it hard to believe that they would've allowed us to lv w/o "paying at time that svcs are rendered" & considering it was the 1st time we've been there. We're also being told that the 2nd visit was coded as a sick visit, although we never scheduled a sick visit. Nor has anyone EVER eluded to the fact that he was sick. I stressed to them that my son's only 5mths old & I think I'd be able to remember if he was sick @ any point. Since we refuse to concede to their false info, I've asked them what recourse parents have when medical ofcs rpt false info, but no one's answered except to tell me that that's what the dr coded & it can't be changed. The pediatrician's ofc mgr places the blame on the billing ofc, although the billing ofc only goes by what the pediatrician directs them. How can they be permitted to keep money that doesn't belong to them & for false reasons?!Desired Settlement: I've told them that since the 1st visit receipt cannot be located, as we probably pd cash & thus, had no need to record it anywhere, that we'd eat that $30. However, we refuse to allow them to rpt a sick visit when that's a lie. So we want the remaining $30 co-pay rtn'd.

Business

Response:

Dear **. [redacted],

I am writing in reference to the above-captioned complaint against Springdale Pediatrics which was filed with your office by [redacted].

**. [redacted] alleges that she has been over charged a $30 co-pay by Springdale Pediatrics for a medical appointment involving her son which occurred on August 6, 2013.

Please understand that a co-payment is a contractual requirement of a patient (subscriber) mandated by his/her insurance company. The ter** of the insurance plan govern when and how a co-payment must be charged by a participating provider. Each insurance plan is different and has different requirements for when (or if) a co-payment is to be charged. **. [redacted] son is insured by [redacted]. The WellSpan Medics' Group (d/b/a Springdaie Pediatrics) also contracts with [redacted], and is considered a “participating provider/ As a participating provider, Springdale Pediatrics is required to charge a $30 co-pay for ail visits, other than those for preventative care. Co-payments are collected at the time of service. Receipts are issued when co-payments are made.

In **. [redacted]’ case, preventative visits were scheduled on July 30, 2013, August 6, 2013, August 28, 2013, September 26. 2013, and November 26, 2013. Our records show that $30 co-payments were collected for the visits on August 6, 2013, August 28, 2013, September 26, 2013, and November 26, 2013.

After confirming with [redacted] that co-payments are not charged for preventative visits under the [redacted] insurance plan, we reimbursed **. [redacted] for the co-payments made on August 28, 2013, September 26, 2013, and November 26, 2013.

We have no record of a co-payment being paid or collected on July 30, 2013, and despite numerous requests, **. [redacted] has been unable to produce any evidence of that as well. We do not believe that a co-payment was made on this occasion.

On August 6, 2013, **. [redacted] brought her son to the practice for a check-up. However, at the visit, our physician noted abnormal findings on a screening exam and discussed those results, as well as an additional issue, with **. [redacted]. The abnormal findings were documented in the child's medics I record, and the visit was coded as a medical rather than preventative, visit.

Since the August 8th visit was a medical visit, a co-payment was appropriately charged for the visit When **. [redacted] disputed the nature of the visit, we asked our coding specialist to review the documentation from the visit to ensure that the visit was properly documented and coded. The documentation and coding was deemed appropriate for the care the child received at that visit, and we declined to reimburse the co-payment. So: despite the fact that **. [redacted] may have scheduled the visit as a preventative visit, the fact remains that at the visit itself, the doctor noted the abnormal findings and the other issue, and discussed the same with **. [redacted].

We deeply regret that **. [redacted] is upset with our office and feels that the co-payment was unjustified. We have offered to transfer her son’s care to another provider office.

Please let me know if you have additional questions. Thank you very much.

Sincerest Regards

Consumer

Response:

[To assist us in bringing this matter to a close, you must give us a reason why you are rejecting the response. If no reason is received your complaint will be closed Administratively Resolved]

Review: [redacted]

I am rejecting this response because:

It's amazing how Springdale likes to rewrite history. 1st of all, they weren't even sure if co-pays should've been taken or not. They would simply take the money "until it was cleared up." That's why they state "after confirming w/ [redacted] that co-pays are not charged for preventative visits." After the 2nd instance where one of their cashiers hinted to the fact that it didn't appear as though we should be paying for well-visits, I decided to call [redacted] myself. Otherwise, they never would've bothered to return our money. When I relayed this information to Springdale & demanded my money, they felt they still had to call the**elves to confirm what I was telling them. Again, both Physician's Billing Services & Springdale's office manager, [redacted], left SEVERAL **gs apologizing & stated that all $150 WAS BEING REFUNDED.

There were no "numerous requests" to produce a receipt for 7/30/13. There was only 1 request. Since this was our 1st visit there, we apparently paid cash. Regardless, we've already accepted that we'd have to eat this loss & said as much to them right from the start. Since we couldn't produce a receipt, we never fought the co-pay for this visit. Please keep in mind that this is the same office that initially insisted that a co-pay was to be kept for 7/23/13 ... the day our son was born!

Attached, you'll see that part of their Summary indicates that the "Treatment Plan" was a "Follow Up 1 week weight check." Does that sound abnormal? Feeding problem? "Additional issue?"

Also attached, you'll see their Summary indicates that the "Reason for Visit" was simply a "weight check." Does that sound abnormal? Feeding problem? "Additional issue?"

They, the**elves, indicate in their response that we brought our son in on 8/6/13 "for a check-up." We were coming in as a typical visit just like the others. We have no idea what they are talking about by now claiming "as well as an additional issue." What additional issue? We've gone from them stating that I brought him in for a sick visit, then it turned into to a feeding problem (mind you, he obviously has NO feeding issue) & now to "abnormal findings." Every time they're asked for a reason, they come up w/ new ones to justify keeping the co-pay. The screening exam was from in the hospital! But for some reason, the 1-week follow-up visit was normal? Again, it doesn't matter what occurred during the visit itself. The visit was scheduled as a well-visit, JUST LIKE ALL OF THEM! They even clearly state that "DESPITE THE FACT THAT **. [redacted] MAY HAVE SCHEDULED THE VISIT AS PREVENTATIVE." I find it a bit disconcerning that despite visits being pre-scheduled & at the dr's direction, medical offices are free to change them as they see fit in order to benefit the**elves. This just can't be. Is this to mean that if we came in for a well-visit & my son caught a cold, that they then have the authority to re-code the visit from well to sick? Never mind the fact that THIS VISIT WAS ABSOLUTELY NO DIFFERENT THAN ANY OF THE OTHERS. Dr. [redacted]'s consult was exactly the same on 8/6, as it was on 7/30, 8/28, 9/26 & 11/26. YET, THEY REIMBURSED THOSE CO-PAYS. As 1st time parents...w/ a newborn...would we not have been upset if we were told that there were all these issues? Yes, that makes total sense, doesn't it??

Since we loved having Dr. [redacted] as our son's pediatrician & she fit great w/ our family & extended family, I've repeatedly asked to speak w/ Dr. [redacted] directly since I strongly believe that no one's bothered to discuss this with her. To date, nothing. Trying to hide something?

It would be appreciated if Springdale didn't try to give yourselves credit as if they've bent over backwards. At no time did they offer to transfer my son's care to another provider office. How comical. I was the one who told them to cancel the 1/31/14 WELL-VISIT because I was pulling him from their facility since I could imagine their continuous office confusion only snowballing. The only solution offered after I said I was pulling him was that they would "note the computer to not accept co-pays & would simply bill." Funny how they all of a sudden have control over accepting or not accepting co-pays, when they were adamant that the co-pays MUST BE PAID AT TIME SERVICES ARE RENDERED. If they have the capability of deciding such a thing, then this is an office decision & not a medical insurance decision. Correct?

It's astounding that they've created such a mess over a $30 co-pay. They should be very proud of the**elves.

Regards,

Business

Response:

Dear **. [redacted],

I am writing in reference to the above-captioned complaint against Springdale Pediatrics which was filed with your office by [redacted]. This is the second complaint we have received from **. [redacted] via your organization regarding the same issue. We feel that we have already responded to the allegations with our initial response. For ease of reference, we are reprinting our response below:

**. [redacted] alleges that she has been over charged a $30 co-pay by Springdale Pediatrics for a medical appointment involving her son which occurred on August 6, 2013.

We received a second compliant via your organization. We feet that we have already responded to the initial allegations with our response.

Please understand that a co-payment is a contractual requirement of a patient (subscriber) mandated by his/her insurance company. The terms of the insurance plan govern when and how a co-payment must be charged by a participating provider. Each insurance plan is different and has different requirements for when (or if) a co-payment is to be charged. **. [redacted] son is insured by [redacted]. The WellSpan Medical Group (d/b/a Springdale Pediatrics) also contracts with [redacted], and is considered a “participating provider.” As a participating provider, Springdale Pediatrics is required to charge a $30 co-pay for all visits, other than those for preventative care. Co-payments are collected at the time of service. Receipts are issued when co-payments are made.

In **. [redacted]’ case, preventative visits were scheduled on July 30, 2013, August 6, 2013, August 28, 2013, September 26, 2013, and November 26, 2013. Our records show that $30 co-payments were collected for the visits on August 6, 2013, August 28, 2013, September 26, 2013, and November 26, 2013.

After confirming with [redacted] that co-payments are not charged for preventative visits under the [redacted] insurance plan, we reimbursed **. [redacted] for the co-payments made on August 28, 2013, September 26, 2013, and November 26, 2013.

We have no record of a co-payment being paid or collected on July 30, 2013, and despite numerous requests, **. [redacted] has been unable to produce any evidence of that as well. We do not believe that a co-payment was made on this occasion.

On August 6, 2013, **. [redacted] brought her son to the practice for a check-up. However, at the visit, our physician noted abnormal findings on a screening exam and discussed those results, as well as an additional issue, with **. [redacted]. The abnormal findings were documented in the child’s medical record, and the visit was coded as a medical, rather than preventative, visit.

Since the August 6th visit was a medical visit, a co-payment was appropriately charged for the visit. When **. [redacted] disputed the nature of the visit, we asked our coding specialist to review the documentation from the visit to ensure that the visit was properly documented and coded. The documentation and coding was deemed appropriate for the care the child received at that visit, and we declined to reimburse the co-payment. So, despite the fact that **. [redacted] may have scheduled the visit as a preventative visit, the fact remains that at the visit itself, the doctor noted the abnormal findings and the other issue, and discussed the same with **. [redacted].

We deeply regret that **. [redacted] is upset with our office and feels that the co-payment was unjustified. We have offered to transfer her son's care to another provider office.

Please let me know if you have additional questions. Thank you very much.

Sincerest Regards,