The MetroHealth System

email sent to the pt and the Revdex.com5/22/ [redacted] Dear [redacted] : This letter is in response to the inquiry that you made to the Revdex.com, which was reported to our office of Patient Relations on 5/19/The following information is being provided to address the issue(s) brought to our attentionCustomer Feedback Issue: You reported the following concern(s):You had questions concerning the facility charges related to a recent visitInvestigation Process: Steps taken to resolve issue(s):The MetroHealth System billed charges in accordance with the documentation in your medical record and the balances due were a result of the your out of pocket expenses, per your benefit planResolution: Final result and date completed:Services billed are correctThe outstanding balance of $is the deductible amount due per the way your insurance company processed the claim per your benefitsYour current insurance benefit, 1/1/17-12/31/17, has a $individual deductible, and as of 5/19/2017, you have $remainingAfter your deductible has been satisfied, your individual out of pocket (OOP) is $3,for the calendar yearThe amount due of $is the patient responsibility on the Xray charge and the xray charge alone, your explanation of benefits (EOB) from your insurance company will reflect that same information.MetroHealth is not billing inappropriatelyThe balance of the $is for the physical xrayThe corresponding provider charge of $with a balance of $is for the provider reading the xrayHospital Contact and Telephone Number: Shannon T***, 216-957-3258Supervisor, Customer Service Advocacy Thank you for bringing this matter to our attentionIt is our goal to provide each of our patients with the highest possible quality of medical and hospital servicesIf you should need any further assistance with this issue, please do not hesitate to contact me at the telephone number provided aboveSincerely, Shannon T***

This letter is in response to the message that you made to our Office of Patient Relations on 11/23/The following information is being provided to address the issue(s) brought to our attentionCustomer Feedback Issue:You reported the following concern(s): 11/21/2015: Patient [redacted] [redacted] disputes the billing of services rendered as an outpatient hospital visitHe would like these services rebilled as an office visit, therefore his insurance company would process at 70% per his benefit planInvestigation Process: 12/17/2015: The MetroHeath System verified the accuracy of the balances dueAll outstanding balances are correct per explanation of benefits from the patient's insurance companiesThe MetroHealth System bills as an outpatient hospital facility, please refer to the Provider Based Billing section at www.metrohealth.orgThere will be a physician and facility charge for most outpatient visitsMrSchwartz's insurance plan has a separate benefit for services rendered in an outpatient hospital setting, which is why he has balances toward his out of pocketResolution: 12/21/2015: A message was left for Mr [redacted] to advise that as a one time courtesy the balance for the facility fee would be waived, but he would be responsible for the physician balance dueHe has the direct line for a MetroHealth staff member, should he have any additional questionsHospital Contact and Telephone Number: [redacted] Thank you for bringing this matter to my attentionIt is our goal to provide each of our patients with the highest possible quality of medical and hospital servicesIf you should need any further assistance with this issue, please do not hesitate to contact meSincerely, [redacted]

MetroHealth 2/19/Revdex.com, Inc Euclid Ave, 4th Floor Cleveland, OH 44115-Fax: 216-861-To whom it may concern: This letter is in response to the email your office sent to MetroHealth's Office of Patient Relations on 2/15/The following information is being provided to address the issue(s) brought to our attentionCustomer Feedback Issue: You reported the following concern from our patient(s): Patient [redacted] ***: "I received a bill from MetroHealth for $for a service I received on June 29, I paid the $copay at the time of serviceMy explanation of benefits (EOB) shows that I only owe the $MetroHealth sent me a bill for this date of service three (3) times and I called every time and explained that I already paidThey then sent me to collections for the billI have had a few correspondence with the collection agency and they finally sent me verification of the debtThe verification shows that I only owed $out of pocket, which I have a receipt for and provided to themI had received numerous bills from MetroHealth last year which they ended up adjusting since had already paid, or they did not apply the insurance adjustment before sending the bill." Investigation Process: Steps taken to resolve issue(s): The patient's account was reviewedThe patient did make her copay at the time of service, on 6/29/The hospital account showed a balance due because the copay sitting on the patient's physician account, that has been corrected and applied to the hospital accountIt was also reviewed why a contractual adjustment was not posted to a November date of serviceThe file we received to post the remit electronically had the incorrect code in the file, which moved the balance from insurance liability to patient responsibility in errorResolution: Final result and date completed: The patient's accounts for both dates of service, 6/29/and 11/has been corrected and show a zero patient responsibilityMetroHealth is currently in the processes of updating our workflow to catch the unapplied copays, and make sure the money is applied before a statement is mailed to the patientHospital Contact and Telephone Number: Shannon Thomas, Supervisor Customer Service Advocacy 216-957-Thank you for bringing this matter to our attentionIt is our goal to provide each of our patients with the highest possible quality of medical and hospital servicesIf you should need any further assistance with this issue, please do not hesitate to contact me at the telephone number provided aboveSincerely, Shannon T***

This letter is in response to the correspondence received by the Revdex.com in our Office of Patient Relations on 7/01/ The following information is being provided to address the issue(s) that have been brought to our attention.Customer Feedback Issue: You reported the following concern(s): 7/01/2015: Patient [redacted] reported potential issues with billing for services rendered at the Middleburg Heights November Family Medical Center and lack of resolution on previous call attempts.Investigation Process: All outstanding balances were reviewed to verify accuracy of the charges and billing of the claims to the insurance company The representatives Ms [redacted] had previously spoken to were coached on how the calls should have been handled.Resolution: A complete review of all Ms***’s issues were reviewed All charges were billed correctly to her insurance company based on her medical record All balances due are a result of the patients out of pocket medical costs We are working with Ms [redacted] to explain charges and a potential payment plan regarding her outstanding balancesHospital Contact and Telephone Number: [redacted] Thank you for bringing this matter to my attentionIt is our goal to provide each of our patients with the highest possible quality of medical and hospital servicesIf you should need any further assistance with this issue, please do not hesitate to contact me.Sincerely, [redacted] Customer Service [redacted]

This letter is in response to the message that you made to our Office of Patient Relations on 10/21/The following information is being provided to address the issue(s) brought to our attention Customer Feedback Issue: You reported the following concern(s): Patient visited MetroHealth for preventive care but was billed for both a preventive care and diagnostic office visit Investigation Process: 10/22/2015: The MetroHeath System reviewed the accuracy of the chargesIt was determined that the documentation did not support the billing of a medical office visit in conjunction with the preventive office visit Resolution: 10/22/2015: The medical office visit charges were removed from the accountThe services are being rebilled to insurance for the correct chargesThe patient and the patient's husband have been notified of the resolution Hospital Contact and Telephone Number: [redacted] Thank you for bringing this matter to my attentionIt is our goal to provide each of our patients with the highest possible quality of medical and hospital servicesIf you should need any further assistance with this issue, please do not hesitate to contact me Sincerely, [redacted] Customer Service Advocacy Team [redacted]

It is the understanding of our office that representatives for the MetroHealth System are communicating regularly with the patient as they move towards a resolution. *** Department of Patient RelationsOffice of Patient ExperienceThe MetroHealth SystemPhone: 216-778-5800Fax: 216-778-4701E-mail: [email protected]

This letter is in response to the correspondence received by the Revdex.com in our Office of Patient Relations on 6/10/The following information is being provided to address the issues(s) that have been brought to our attention.Customer Feedback issue:You reported the following concern(s):6/11/
Patient *** *** was required to pay up front for a procedureHe claims that we refused to file a claim with his insurance companyHe filed a claim on his own behalf for the professional charges and payment was remitted to the hospitalHe is requesting a refund of the payment that he made prior to the service.Investigation Process:6/11/2015: it was determined that Mr***'s professional charges were adjudicated based on his direct billingWe submitted both the professional and technical claim on his behalfThe technical claim had been rejected.611912015: In one of the discussion with Mr***, he had stated that he ?led an appeal with his insurance and won the appealHe forwarded this information to us for review and submit to the insurance to assist with the review.Resolution:We contacted the insurance company and manually forwarded the rejected technical claim for processingWe also forwarded the appeal documentation he sent usWe requested a complete review of Mr***'s claimsOnce the technical charges are considered, in addition to the professional charges re-reviewed, the insurance will provide us with their final adjudicationThis review is considered escalated with the insuranceOnce adjudication is final, we will be able to determine what the patient responsibility is, and whether a refund is applicableWe are in contact with Mr*** at least once a week to keep him up to date on the status of his claim, most recent communication was on 6/25/We have asked him lo contact us if he receives any information from his insurance company so we may review it and follow up with them if necessary.Hospital Contact ago Telephone Number:*** *** *** ***Thank you for bringing this matter to my attentionit is our goal to provide each of our patients with the highest possible quality of medical and hospital servicesIf you should need any further assistance with this issue, please do not hesitate to contact me.Sincerely,*** *** *** Customer Service***

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID ***, and have determined that this does not resolve my complaint. For your reference, details of the offer I reviewed appear below
A rep from the hospital has been in regular contact with meAt this time the hospital has filed new claims with my insurance due to wanting more from insurance than was initially paidI think I am still entitled to a refund, and once things are finalized with my insurance I will likely receive that refund, but until that happens I do not want to close this complaint
Regards,
*** ***

6/1/2017 *** *** ***
*** *** ***
*** ** *** Dear *** ***: This letter is in response to the inquiry that you made to the Revdex.com, complaint ID *** which was reported to our office of Patient Relations on 5/31/The following information is being provided to address the issue(s) brought to our attention. Customer Feedback Issue: You reported the following concern(s): You had questions concerning the facility clinic charges related to a recent visit. Investigation Process: Steps taken to resolve issue(s): The MetroHealth System billed charges in accordance with the documentation in your medical record and the balances due were a result of the your out of pocket expenses, per your benefit plan. Resolution: Final result and date completed: Most of MetroHealth locations and services are billed as Hospital Outpatient Departments (HOPD), enclosed is a flyer describing HOPDPlease also visit our website at: latps://www.metrohealth.oreffinancial-services/faci/about-orovider-based-billing...⇄ services will have a provider and hospital componentThe $Clinic charge you are referring to, is the hospital component to the provider office visit chargeYour insurance company has not received a claim for the $charge and they will not; based on MetroHealth's contract with your insurance company the adjudication of the clinic charge is inclusive in the provider claim and paymentAs stated in the previous letter, the balance due is truly on the Xray charge, and your explanation of benefits has reflected that same information. Hospital Contact and Telephone Number: Shannon T***, 216-957-Supervisor, Customer Service Advocacy Thank you for bringing this matter to our attentionIt is our goal to provide each of our patients with the highest possible quality of medical and hospital servicesIf you should need any further assistance with this issue, please do not hesitate to contact me at the telephone number provided above. Sincerely, Shannon T***

2/18/
Revdex.com, IncEuclid Ave, 4th Floor Cleveland, OH 44115-
To whom it may concern: This letter is in response to the email your office sent to MetroHealth's Office of Patient Relations on 2/9/The following information is being provided to address the
issue(s) brought to our attention
Customer Feedback Issue: Our patient reported the following concern(s): "I went to metro-health and was billed the billing charges of which my insurance company paidI was also billed a facility fee which my insurance refuses to pay, even after metro swore to me I would not be charged this facility feeEven if this is legal to bill in this matter, which it should not be, it is unethical to lie to your patientsI pay thousands of dollars per year to have the best insurance, so that my office visits are coveredWith these practices of metro, I am still left paying over dollars per doctor visit out of pocket."
Investigation Process: Steps taken to resolve issue(s): After review of the account it was determined that the charges billed for the 10/31/date of service are accurate based on the patient's medical recordThe patient filed an original complaint with the Revdex.com on 10/21/2015, complaint ID ***, regarding the 8/31/date of serviceThe 8/31/date of service was originally billed as both preventive and medical office visits, it was the medical office visit that was leaving the balance due for the patient on the facility sideAfter review of the medical record it was determined that the medical office visit was billed in error, therefore the charge was removed from the patient's account, thus not leaving any patient responsibility for the patient for date of service 8/31/There was still a facility charge for the preventive visit, however, based on the patient's insurance plan, she does not have any out of pocket for preventive office visitsThe patient and her husband were notified of the review results by a MetroHealth staff member on 10/22/and a letter was faxed to the Revdex.com on 10/26/
The patient was seen at MetroHealth Medical Center for a medical office visit on 10/26/This visit was after she and her husband were notified of the review results related to the 8/31/date of service
On 1/26/2016, the patient filed a complaint with the *** *** *** in regards to the 10/26/date of serviceA response was faxed to the *** *** *** on 2/1/The letter explained why the patient didn't have a medical office visit charge and why the out of pocket was removed for the 8/31/date of serviceIn reference to the date of service in question; 10/26/2015, the patient's insurance did cover the medical office visit for the facility, the balance due is the patient's benefit plan deductible Resolution: Final result and date completed: The patient responsibility for date of service 10/26/2015, $is correct per her benefit planHer yearly preventative visit took place on 8/31/The visit on 10/26/was not a preventative visit, therefore it is subject to an out of pocket expense for the patientShe only has preventative visit a yearInformation about Provider Based Billing can be found at www.metrohealth.org
Hospital Contact and Telephone Number: Mary Ann O*** Associate Director, Patient Financial Service 216-957-mo***@metrohealth.org
Thank you for bringing this matter to our attentionIt is our goal to provide each of our patients with the highest possible quality of medical and hospital servicesIf you should need any further assistance with this issue, please do not hesitate to contact me at the telephone number provided above
Sincerely,
Mary Ann O***

This letter is in response to the message that you made to our Office of Patient Relations on 12/23/The following information is being provided to address the issue(s) brought to our attention
Customer Feedback Issue: You reported the following concern(s): 12/23/2015: Patient *** *** disputes billing statements stating payments had already been made
Investigation Process: 12/29/2015: The MetroHeath System verified the accuracy of the balances dueAll payments made toward any outstanding balance was reviewed and corrected as necessary
Resolution: 12/29/2015: All accounts for Mr*** have a zero balance dueMr*** will receive a certified letter containing zero balance itemized statements and a letter from MetroHealth as he has requested
Hospital Contact and Telephone Number: *** ***, Supervisor Customer Service Advocacy Team 216-***
Thank you for bringing this matter to my attentionIt is our goal to provide each of our patients with the highest possible quality of medical and hospital servicesIf you should need any further assistance with this issue, please do not hesitate to contact me
Sincerely,
*** ***

This letter is in response to the message that you made to our Office of Patient Relations on 12/18/The following information is being provided to address the issue(s) brought to our attentionCustomer Feedback Issue: You reported the following concern(s): 12/18/2015: Patient’s father,
*** *** for patient *** *** disputes the billing of services rendered as an outpatient hospital visit, specifically the facility feeInvestigation Process: 12/23/2015: The MetroHeath System verified the accuracy of the balances dueAll outstanding charges are correct per the patient’s medical record and the balances are correct per the patients benefit planThe MetroHealth System bills as an outpatient hospital facility, please refer to the Provider Based Billing section at www.metrohealth.orgThere will be a physician and facility charge for most outpatient visitsMr***’s insurance plan has a separate benefit for services rendered in an outpatient hospital setting, and no coverage benefit for a service rendered, which is why he has balances toward his out of pocketResolution: 12/23/2015: A MetroHealth representative spoke to Mr*** to advise of the results of the investigation, the balances are correct and standMr*** declined a detailed billing statement showing charges and insurance reimbursementMr*** told the MetroHealth representative he will be going to a private practice and hung upHospital Contact and Telephone Number: *** ***, Supervisor Customer Service Advocacy Team *** Thank you for bringing this matter to my attentionIt is our goal to provide each of our patients with the highest possible quality of medical and hospital servicesIf you should need any further assistance with this issue, please do not hesitate to contact meSincerely, *** ***

Revdex.com:I have reviewed the response made by the business in reference to complaint ID ***, and have determined that this does not resolve my complaint. For your reference, details of the offer I reviewed appear below.From: *** *** Date: Fri, Feb 19, at 4:PMSubject: Revdex.com complaint against Metro HealthTo: ***[email protected]
I do not agree with the resolution and there was no place to add information when I was directed to agree or disagreeMetro states that my preventative benefit services were covered at 100% which is why they agreed they made a mistake in billing a facility feeMy benefits also cover professional visits at 100% but they felt they could still collect a facility fee. My insurance understands this is a scam and a way for hospital systems to get the patients to pay their bills. As a medical provider myself I would never put my expenses on my patients, it is clearly unethical in so many ways. *** *** from *** *** *** addressed this and shared that medical facilities built in on are no longer aloud to charge patients these fee's. Unfortunately, I went to a facility that was built in 2014. After the issue in August if I was told I would be charged this fee I would have cancelled the appointment but, Shannon the rep that contacted me assured me I should keep my appointment. I checked my benefits and saw it would be covered at 100%. Between Shannon's assurance and my benefit check I never thought they would pull this scam again on me--
*** *** *** ***
*** *** *** **
*** ***
*** *** ** ***
*** *** **Regards,*** ***

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID [redacted], and have determined that this does not resolve my complaint.  For your reference, details of the offer I reviewed appear below.
THIS MATTER WILL NOT BE RESOLVED UNTIL I RECEIVE A...

ZERO BALANCE STATEMENT,  A STATEMENT OF ASSURANCE THAT COLLECTION EFFORTS HAVE STOPPED, A GUARANTEE THAT I WILL NOT RECEIVE ANY FURTHER BILLS FOR THIS ISSUER, AND A PERSONAL LETTER OF APOLOGY FOR HAVING TO DEAL WITH THE INCOMPETENCE OF THE ENTIRE METRO HEALTH BILLING DEPARTMENT.
Regards,
[redacted]

MetroHealth 5/23/2017 [redacted] Dear [redacted]: This letter is in response to the inquiry that you made to the Revdex.com, complaint ID[redacted], which was reported to our office of Patient...

Relations on 5/22/2017. The following information is being provided to address the issuels) brought to our attention. Customer Feedback Issue: You reported the following concern(s): Information received from Customer Service did not match information reflected MyChart Investigation Process: Steps taken to resolve issue(s): Resolution: Final result and date completed: We were able to review your account and were able to view the $12.58 credit. If you long into MyChart now, you will no longer see an outstanding balance or a credit. Hospital Contact and Telephone Number: Shannon T[redacted], 216-957-3258 Supervisor, Customer Service Advocacy Thank you for bringing this matter to our attention. It is our goal to provide each of our patients with the highest possible quality of medical and hospital services. If you should need any further assistance with this issue, please do not hesitate to contact me at the telephone number provided above.

I have reviewed the response made by the business in reference to complaint ID [redacted], and have determined that this does not resolve my complaint.  For your reference, details of the offer I reviewed appear below.
I refuse to allow a $241.00 charge to be billed to me for occupying a room.  The hospital has attempted to justify this charge by talking about everything except for the actual justification of it.  The fact remains that this charge is for occupying a room and it is ridiculous.  I maintain that this should be taken off my bill.   If MetroHealth wants to charge me this kind of an amount, they should produce a document that bears my signature which states that I have agreed to such exorbitant charges.  Just because they put it on a bill does not mean I have to pay them.  This is gouging at its worst.  I make $17.46 an hour - consider how long I have to work to satisfy such a charge.  I'll say again - there are cheaper rooms overlooking an ocean.  If I'm going to pay that kind of money to be in a room, it's going to be somewhere tropical and not somewhere I'm getting ripped off.I want the charge removed from my bill and I will not stop disputing it until it is removed.  It is WRONG to charge people this much money for something so ridiculous.  No explanation that MetroHealth has offered has changed my mind about this.  It is simply WRONG.
Regards,
[redacted]

This letter is in response to the message that you made to our Office of Patient Relations on 11/23/2015. The following information is being provided to address the issue(s) brought to our attention. Customer Feedback Issue:You reported the following concern(s): 11/21/2015: Patient [redacted]...

[redacted] disputes the billing of services rendered as an outpatient hospital visit. He would like these services rebilled as an office visit, therefore his insurance company would process at 70% per his benefit plan. Investigation Process: 12/17/2015: The MetroHeath System verified the accuracy of the balances due. All outstanding balances are correct per explanation of benefits from the patient's insurance companies. The MetroHealth System bills as an outpatient hospital facility, please refer to the Provider Based Billing section at www.metrohealth.org. There will be a physician and facility charge for most outpatient visits. Mr. Schwartz's insurance plan has a separate benefit for services rendered in an outpatient hospital setting, which is why he has balances toward his out of pocket. Resolution: 12/21/2015: A message was left for Mr. [redacted] to advise that as a one time courtesy the balance for the facility fee would be waived, but he would be responsible for the physician balance due. He has the direct line for a MetroHealth staff member, should he have any additional questions. Hospital Contact and Telephone Number:[redacted]
Thank you for bringing this matter to my attention. It is our goal to provide each of our patients with the highest possible quality of medical and hospital services. If you should need any further assistance with this issue, please do not hesitate to contact me. Sincerely,[redacted]

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID [redacted], and find that this resolution is satisfactory to me. 
Regards,
[redacted]

email sent to the pt and the Revdex.com5/22/2017 [redacted]
[redacted]
[redacted] Dear [redacted]: This letter is in response to the inquiry that you made to the Revdex.com, which was reported to our office of Patient Relations on 5/19/2017. The following...

information is being provided to address the issue(s) brought to our attention. Customer Feedback Issue: You reported the following concern(s):You had questions concerning the facility charges related to a recent visit. Investigation Process: Steps taken to resolve issue(s):The MetroHealth System billed charges in accordance with the documentation in your medical record and the balances due were a result of the your out of pocket expenses, per your benefit plan. Resolution: Final result and date completed:Services billed are correct. The outstanding balance of $171.39 is the deductible amount due per the way your insurance company processed the claim per your benefits. Your current insurance benefit, 1/1/17-12/31/17, has a $400.00 individual deductible, and as of 5/19/2017, you have $196.72 remaining. After your deductible has been satisfied, your individual out of pocket (OOP) is $3,275.00 for the calendar year. The amount due of $171.39 is the patient responsibility on the Xray charge and the xray charge alone, your explanation of benefits (EOB) from your insurance company will reflect that same information.MetroHealth is not billing inappropriately. The balance of the $171.39 is for the physical xray. The corresponding provider charge of $54.00 with a balance of $14.35 is for the provider reading the xray. Hospital Contact and Telephone Number: Shannon T[redacted], 216-957-3258Supervisor, Customer Service Advocacy Thank you for bringing this matter to our attention. It is our goal to provide each of our patients with the highest possible quality of medical and hospital services. If you should need any further assistance with this issue, please do not hesitate to contact me at the telephone number provided above. Sincerely, Shannon T[redacted]

I have reviewed the response made by the business in reference to complaint ID [redacted], and find that this resolution is satisfactory to me. 
Regards,
[redacted]