Sutter Medical Foundation - North Region

To whom it may concern, We have reached out to [redacted] and determined that per contract no pre-auth is required Also, [redacted] has reprocessed the paid claim on 9/15/and this reflects a 20% co-insurance for which the patient is liable Patient made payment on 9/19/and this item is now at a zero balance Thanks, Sutter Medical Foundation

Sutter's stance is that the services were rendered and appropriate. My complaint is "not" that they didn't render the services, but that they were unnecessary. If the person interpreting the x-ray had done it accurately, then the surgery would not have transpired. My complaint is that Sutter wants to charge me for unnecessary surgery performed on me and then make me pay for it . The surgery should have never taken place, because there was nothing that could be done, once they cut open my head. The lump was due to a lump on my skull, not a cyst as the x-ray physician had reported ; there was not a cyst to be removed. The surgery was costely, I had to take time off work and I have severe pain for many months afterwards...and stressed out because I was not sure that I would ever totally recover from the surgery that was unwarranted. I do not feel as though I should pay for the x-ray physician's incompetency. In fact, I have already paid for it, through suffering and taking unnecessary time off work. As far as I know, Sutter is not a "Teaching" facility...the doctors who work there are supposed to be qualified and licensed and know what they are doing. I should not have to pay for the incompetency of their x-ray physicians

Good morning,
The Qualilty Management team has reviwed this case and their decision is final. We are unable to make any adjustments to the charges

To whom it may concern,
A review was done on the services provided, and the care and services billed are appropriate
The patient resource center has been informed and a letter is being generated (if you have not received it already) informing you of the specifics
Sincerely,
Sutter
Medical Foundation

Revdex.com:
I have reviewed the response made by the business in reference to my concern, and find that this resolution is satisfactory to me.
Thank you for your assistance, I greatly appreciate it I called Sutter and they removed the pre-authorization fee
Thank you,
***

To whom it may concern,
We have reached out to [redacted] and determined that per contract  no pre-auth is required.  Also, [redacted] has reprocessed the paid claim on 9/15/14 and this reflects a 20% co-insurance for which the patient is liable.  Patient made payment on 9/19/14 and...

this item is now at a zero balance.
 Thanks,
 Sutter Medical Foundation

In August/September of 2017 my primary care physician at Sutter North Healthcare, 460 Plumas Blvd, Yuba City, CA, 95991, without any warning or notification, discharged me from his practice without even talking to me about it, or telling me when I saw him in person during an office visit less than a month before. I called for refills on my Rx's and was told my doctor would no longer be writing any RX's -or refilling any- for me because I had been discharged 2 weeks prior. THAT was my first notification that there even was any problem. When I spoke to the administration, they tried to say I was sent letters. I explained that I do not live at my mailing address, and that I had not been receiving any mail at my mailing address anyhow because the Post Office had not been delivering mail to the address for over 100 days, which I had just discivered. The woman was very rude and told me: "You did too get notification, it's not our fault if you aren't getting your mail". Really? Well, I beg to differ, and I've got the law on my side. I did not only not receive any letters, my doctor never said anything and further, in over 4 years of communications through myhealthonline, not a single thing was ever said. NOTHING. I have made 21 attempts to get Sutter North to deal with this and the only response I have received is a reply to one of my emails that said: "We will escalate your concerns to the administration" and NOTHING more. They had 30 days to deal with my complaint, and they never even contacted me. I can prove that I have filed all the complaints(I have copies of every single email and all of myhealthonline communication) and I can prove mail was not delivered to my mailing address from the U.S. Postal Service. And when I die get my mail that had accumulated at the Post Office since it was not being delivered, there was not a single letter from Sutter North. And they told me any kind of mail like that would have been returned to sender as "Undeliverable" because they were well aware that they were not delivering mail to my address. I am in no way at fault for the stopping of mail delivery to my mailing address, and will get into specifics if need be. Further, I was being treated for a chronic and an acute medical condition that I was suddenly not getting any care for at all. I have contacted an attorney and I WILL BE FILING A LAWSUIT against SutterNorth Medical because you violated my rights as a consumer, a patient, and breached your Duty of Care. And my doctor never said anything to me, made no provisions for my continuity of care, and did not care that my Rx's were suddenly stopped, one of which was for high blood pressure medication that is required because of my medical condition. As a result of the abandonment of care, I have not been getting it, and I am furious and I could very well lose my life as a direct result of your unethical actions. SShe
I want this entire matter investigated, I would very much like to provide the proof and ALL the facts, and then I want to be provided the medical care I have been being wrongfully denied. If not, then I will provide it in court.
Kimberley Mason-Widing
[email protected]

Review: I went to Sutter Medical Foundation Urgent Care located at 444 Plumas Blvd, Yuba City, CA 95991 on 02/26/13 because it was after hours, so I couldnt go to my primary doctor. Sutter Medical Foundation is considered to be In-Network for insurance purposes. I received a bill from Sutter Medical Foundation stating that my insurance is not covering because its being billed as Out of Network. I called to find out what was going on, and was told that this will be re-billed to my insurance to show In-Network. I received the bill again, and called to find out what was going on. I was told that this will not be re-billed, because the doctor that was on duty was filling in for the regular doctors for the day. Therefore the Physicians Assistant that helped me was under the supervision of the doctor that was covering the regular doctors. My complaint is that I went to my local, In-Network facility. It is out of my control if the doctor was out for whatever reason and a sub came in to fill in. I should not be billed for an out of network doctor who didnt even see me. My insurance will not cover the costs unless its billed correctly, and shows that it is In-Network. Everyone that I have talked to in the billing department understands my situation and says that occasionally this happens because they dont know if a doctor will call out sick and have someone else fill in; however theres nothing they can do to change it. My complaint is that I went to an In-network, therefore I should be billed as In-network.Desired Settlement: I would like Sutter Medical Foundation to bill my insurance the correct way, which is In-Network, since I went to an In-Network facility. From there, my insurance will cover my coverage for In-Network and the remaining, if any, would be my responsibility. In this case, I have met my deductible, therefore my insurance would pick up the rest for 2013 year.

Business

Response:

To whom it may concern at Revdex.com,

We at Sutter apologize for the inconvenience that Ms. [redacted] experienced in dealing with the bill for the urgent care visit on 2/26/13. The insurance carrier had incorrectly processed the claim as out-of-network, when in fact the visit to the urgent care provider was an in-network visit. We have provided education to our billing staff, advising that in instances such as these, we need to appeal for payment, since the pateint's assigned provider is a Sutter Medical provider, and the urgent care provider is also a Sutter Medical provider. Do not hesitate to contact Sutter in the event the insurance carrier incorrectly reprocesses your claim.

Sincerely,

Consumer

Response:

I have reviewed the response made by the business in reference to complaint ID [redacted], and find that this resolution is acceptable to me; however the response that was given to the Revdex.com Northeast California was NOT the response that was given to me from Sutter. I was informed that it was not an insurance error, it was Sutter billing that would not resubmit the bill to the insurance company. I had two disputes through Sutter and was declined both times, which lead me to the Revdex.com report. Each time I spoke to a representative, he/she had agreed with me that this was incorrect, however there was nothing he/she could do to change the billing. My concern is that this will happen again and I hope that I do not have to go this route and submit a claim just to make sure that the billing is done correctly. I appreciate the Revdex.com's assistance in getting this matter resolved. Thank you

Sincerely,

Review: My wife's doctor recommended an MRI for her knee. She had the procedure and then when we received the bill from Sutter Medical Foundation, they billed us for a "preauthorization fee" that [redacted] charged them for not preauthorizing the procedure. In talking to the insurance, it's the provider's responsibility to get the pre authorization, not the patient is what they mentioned. The provider (Sutter Medical Foundation) is saying that it was my responsibility to get the pre-authorization, but that's not true. The patient doesn't even know what code to ask for authorization.I've been going back and forth with [redacted] and Sutter Medical Foundation now for nearly 3 months and I don't know what else to do.Desired Settlement: I want Sutter Medical Foundation to remove the pre-authorization fee of $293.60 that they are charging me, because that was their fault for not pre-authorizing the procedure with [redacted], not my responsibility.

Business

Response:

To whom it may concern,

We have reached out to [redacted] and determined that per contract no pre-auth is required. Also, [redacted] has reprocessed the paid claim on 9/15/14 and this reflects a 20% co-insurance for which the patient is liable. Patient made payment on 9/19/14 and this item is now at a zero balance.

Thanks,

Sutter Medical Foundation

Review: On 8-29-2013, I had an X-Ray of my skull. I had a bump on the right side of my head which was sore and tender. The person who read the X-Ray ([redacted]) said it was a cyst. So, on 8-29-2013, I made an appointment with Dr. xxx for surgery.On 10-2-2013, I went in for surgery with Dr. xxx to remove the cyst. When he opened up my head, the bump turned out to be bone, and not a cyst like [redacted] had indicated in her report to him. Therefore, there was nothing to be done, so Dr. xxx sewed me back up.For many months after the surgery, my head was sore and I was in a lot of pain and discomfort and worried that I was never going to get well. In light of all of this, I do not feel obligated nor responsible to pay for the unwarranted bills relating to my head surgery. This could have all been prevented if [redacted] had diagnosed the situation properly.I have made several attempts to contact Sutter Medical, mostly by phone, and they keep telling me that they will get back to me or send me something in the mail. The only thing that I have gotten from them in the mail are more bills. And to my knowledge, they have not tried to contact me by telephone. On 3-3-2014, I called and they said they would get back to me in 30 days. I heard nothing.On 6-9-2014, I filed a formal complaint via the phone and I was supposed to hear something in 2 weeks; they said they were sorry and that they would expedite this. I have heard nothing.Now I receive a letter in the mail saying that they are turning me over to a collection agency.Desired Settlement: Credit on my bill for the X-Ray on 8-29-2013 for $146.00; bill for consult on 8-29-2013 for $213.00 and bill for surgery on 10-2-2013 for $427.00 - for a total credit of $786.00.

Business

Response:

To whom it may concern,

A review was done on the services provided, and the care and services billed are appropriate.

The patient resource center has been informed and a letter is being generated (if you have not received it already) informing you of the specifics.

Sincerely,

Sutter Medical Foundation

Consumer

Response:

Sutter's stance is that the services were rendered and appropriate. My complaint is "not" that they didn't render the services, but that they were unnecessary. If the person interpreting the x-ray had done it accurately, then the surgery would not have transpired. My complaint is that Sutter wants to charge me for unnecessary surgery performed on me and then make me pay for it . The surgery should have never taken place, because there was nothing that could be done, once they cut open my head. The lump was due to a lump on my skull, not a cyst as the x-ray physician had reported ; there was not a cyst to be removed. The surgery was costely, I had to take time off work and I have severe pain for many months afterwards...and stressed out because I was not sure that I would ever totally recover from the surgery that was unwarranted. I do not feel as though I should pay for the x-ray physician's incompetency. In fact, I have already paid for it, through suffering and taking unnecessary time off work. As far as I know, Sutter is not a "Teaching" facility...the doctors who work there are supposed to be qualified and licensed and know what they are doing. I should not have to pay for the incompetency of their x-ray physicians.

Business

Response:

Good morning,

The Qualilty Management team has reviwed this case and their decision is final. We are unable to make any adjustments to the charges.

Review: I was recommended for a colonoscapy by my primary physician to the procedure center of Sutter Medical Foundation. I had the procedure done on 8-5-2014 which was supposed to be just a regular preventive procedure because of my age. The doctor who preformed the procedure ended up making a coding error and I was charged a fee because my insurance only paid it at 80%. I was billed for almost $1000.00. I contacted Sutter Medical Foundation once I received the bill to ask them if the amount was correct, their reply was that they only charge for what the insurance doesn't pay. The next month it was sent to collections for which I paid just over $600 towards the bill, at $200 a month. In January I just didn't feel something was correct with the bill so I contacted my insurance where they informed me that it should of geen covered at 100%. I have contacted Sutter Medical several times about this issue and have had 2 different people tell me yes it was a coding error but that is where it gas stopped. I can't get anyone to rebill the insurance or let me speak to anyone who can help me get this resolved.coding error but that's where it anyone whoDesired Settlement: I need to have the bill recoded to show preventive, my insurance rebilled with the correct coding and my money returned from the collection agency and any money I paid to Sutter Medical Foundation towards that bill.

Business

Response:

In reviewing the charges for services provided on 8/5/14, we corrected the claim on 3/17/15, and rebilled the insurance. We apologize for our error. The insurance payment came in on 4/28/15. You no longer have any liability for the services provided on this date.Thanks,?

Consumer

Response:

I have reviewed the response made by the business in reference to my concern, and find that this resolution is satisfactory to me.

They still owe me around $700 for the amount I paid towards that bill and have not yet received the money.