Stevens & Son Landscaping & Lawncare

May 23, 2016Dear [redacted]I am in receipt of your correspondence dated May 16, 2016 regarding a complaint filed by [redacted] against Gastroenterology Specialists, a practice within the [redacted] Physician Group ([redacted]).In review of the account, the patient did have two outpatient...

procedures on June 5, 2015, the date in question, The first was a colonoscopy with biopsy for which we charged $759,00. By its very nature, a colonoscopy with a biopsy is not considered preventative. A gastro-intestional endoscopy was also performed in conjunction with the colonoscopy with biopsy. The charge for the endoscopy was $711.00. The attached explanation of benefits from [redacted]'s insurer, shows that they paid $269.97 for the colonoscopy with biopsy, and [redacted] took a corresponding $421.54 contractual adjustment, leaving the patient a balance of $67.49 for this service. [redacted] also paid $88.97 for the endoscopy, with [redacted] taking $599.79 as the contractual adjusting, leaving a patient balance of $22.24 for this service, The total patient balance for these two services was $89.73 which the patient paid via check on July 28, 2015.The patient has a zero balance on the professional component with [redacted] Gastroenterology Specialists for the services in question.[redacted] however does owe $774.88 to [redacted] Hospital for the technical component of the services rendered on June 5, 2015. While Dr. G[redacted] did indeed order a colonoscopy, he has no way of knowing what the findings will be until the colonoscopy has been performed. Attached are the reports for both the endoscopy and the colonoscopy and both reports show that multiple biopsies were taken in the performance of each procedure, [redacted]'s follows the accepted diagnostic and procedural coding practices as subscribed by the Centers for Medicare and Medicaid (CMS), as do all providers and third party insurers who participate with the Medicare and Medicaid programs. The colonoscopy could not be coded as preventative because other indications were found. In the colonoscopy report, it is also recommended that the patient have another colonoscopy in three years. The normal timeframe for an uneventful colonoscopy is every ten years,In summary, the hospital is billing [redacted] for a balance after her [redacted] insurance made payment in the amount of $3,099.56 against their total technical component charge of $15,134,55. The hospital took a contractual adjustment of $11,260.11 leaving the patient balance of $774.88. This balance may be either due to a co-insurance amount or a deductible.Please do not hesitate to contact our office again if you should need any additional information.Sincerely,E. John B