UCSD Medical Group

Mr [redacted] had services on 3/11/Mr [redacted] was sent four statements requesting paymentsWithout any response from him UC San Diego Medical Group assigned his account to collections on 6/28/Mr [redacted] called our office on 7/8/We took the insurance information from him and submitted a claimHe was instructed to call the collection agency and work with them, as they now owned his account After a complete audit, it was determine that nothing was done unprofessionallyUC San Diego Healthcare submit claims to insurance and work with insurance to optimize reimbursement Without the information there is not much we can doMr [redacted] had a number of opportunities to reach out to us and give us his correct insurance information so we could submit a claimMr [redacted] 's Statement indicated clearly that the coverage we had on file was Aetna Managed ChoiceThat coveraged expired 3/1/ The issue relating to our cost of service is a total different matterWe are a teaching hospital and our fees are put into place according to what is reasonable and customary for the areaWe offer discounts and payment plans for patient that are without coverageIf Mr [redacted] had reached out to us we certainly would have worked with him, giving him a much better outcome

I notified UCSD Medical Group of this complaint as I cannot correct the matter I work for UCSD Medical Center and this billing matter falls under UCSD Medical Group A contact is [redacted] , Manager of Customer Relations ###-###-####

I am sorry the offer of a payment plan was not satisfactoryUCSD is very senitive to the financial needs of our patientsWe are willing to extend the payments over many months to assist in the expensesAs stated in an earlier response, the lab work was ordered by her physician as a standard of careHer insurance applied the services to her yearly deductible per her contract with themThere was no fraud or act of intentional disceptionThe lab work ordered falls within the guidelines for the care requested

Revdex.com: I have reviewed the response made by the business in reference to complaint ID [redacted] and have determined that this proposed action would not resolve my complaint For your reference, details of the offer I reviewed appear below UCSD claims they could not identify my case I have provided account numbers numerous times via phone, email, and on the Revdex.com complaints The responsible individual is attempting to mask her delayed response time and lack of due diligenceI am still waiting for written confirmation that my account balance is $ Regards, [redacted] ***

Revdex.com: I have reviewed the response made by the business in reference to complaint ID [redacted] , and have determined that this proposed action would not resolve my complaint For your reference, details of the offer I reviewed appear below The issue is not whether my insurance plan covers the costs, it is the fact that they don't disclose their costs, and that what they charge AFTER getting you into the facility is unreasonably high when compared to similar services elsewhere They do not disclose that they consider their office facility a hospital facility and they charge hospital rates for an office visit The administrator who answered mentions "discounts for services" as an option but when I inquired directly with UC San Diego Medical Group they did not offer any discounts, even when I asked about discounts Regards, [redacted] ***

The issue was resolved on July I could not identify the patient as she is registered as [redacted] , not *** as indicated on her complaint with Revdex.com

Revdex.com: I have reviewed the response made by the business in reference to complaint ID [redacted] , and have determined that this proposed action would not resolve my complaint For your reference, details of the offer I reviewed appear below.This is not an acceptable responseAs requested, my date of birth is [redacted] Account # [redacted] and listed under [redacted] should be aware of the inquiry as I left multiple emails and voicemails I need confirmation that I have zero balance on this account, and she and her staff have not followed up Regards, [redacted] ***

RevDex.com: I have reviewed the response made by the business in reference to complaint ID [redacted] , and have determined that this proposed action would not resolve my complaint. For your reference, details of the offer I reviewed appear below. Regards, [redacted] ***

Patient received the standard of care for his diagnosis on 11/1/11. Total charge for exam and test was $704. His insurance paid and indicated the patient was responsbile for a co-insurance liability of $39.30. An eye exam was done at that time, which again, is the standard of care... to determine if any progress or progression of disease has been made. The $40 eye exam was not a covered benefit of patient's insurance. Patient received four Statements. We do know his address was correct at the time of billing as it was confirmed during one of his calls. Assignment to collection was 12/14/12 appropriately.

Revdex.com: I have reviewed the response made by the business in reference to complaint ID [redacted] , and have determined that this proposed action would not resolve my complaint For your reference, details of the offer I reviewed appear below Regards, ***l [redacted] The UC Medical Group response is extremely unprofessional, their denial and undocumented phonecalls that I have accomplished to date were ignored I plan to pursue this further with their administrative staff

First of all, no rejection has been madeAll I asked was for some additional time to have our compliance office review the physician's chart notes to determine if the charge was substantiated by physicians documentationThe billing office does not make that determination I received notification Friday by our Compliance office that the charge was not appropriate and the physician will need to remove the charge I have contacted the collection agency and requested the charges be removed and all negative credit rating relating to this charge be removed [redacted] Operational Manager UCSD Medical Group Physicians Business Office

Without additional information ie...Medical Record Number or DOB I am unable to identify the patient by the first and last name only. My comment will need to be general. When a patient is seen in a hospital-licenced location the cost assoicated must comply with specific Medicare federal... regulations and is the national model for integrated healtcare delivery systems such as UC San Diego Health Systems. At this time we are not able to reach out and provide pricing information to every patient prior to services, but recognize the need to improve patients awareness. Without the ability to look at Ms. [redacted] particular services my guess is her insurance applied the services in an out-patient hospital facility to her yearly deductible OR possibly the insurance considered removal of warts not medically necessary according to her benefits. I do understand that medical care is expensive and strongly recommend patients read their benefits and understand the limitations of their particular insurance. UC San Diego offers many options to assist in paying for medical bills. A reasonable payment plan or discounts on services not covered by insurance are just a few.

The correction was already madeThe consult visit was changed to a Folland rebilledThe insurance paid on 11/12/Patient has no liability at this time

They show the face of awful, unethical healthcare billing practicesThe students declared their status as students, but not their $600/ hr billing claim as gyno studentsThe resident doctor charged a whopping $2k+ for her minutes as a part of her role in my careMy test results were a month late and follow on consultationI made it known to the doctor that I need my referral for further care mailed to me so I can seek further care in a more transparent systemMy insurance has been charged over 4k in fees for annual physical, a gyno exam, and standard blood work

The doctors have to go online themselves to update info with VSP in order to be considered in networkDr.*** hasn’t done that yetWe can adjust off but patient will have a $copay.Patient paid $on 9/13/Patient liability for this date of service is only $Patient should
allow up to weeks to receive refund in the amount of $220.I hope this is satisfactory for the patientPlease give her our apologies.*** ***Operations Manager, Customer RelationsUCSD Medical Group Business ServicesVoice # *** ***Fax # *** ***

Reviewed the issue againOur position remains the same

In regards to complaint ID ***, this was a physician bill

The issue is not with how the office visit was coded, but the site of servicePatient was billed for lab workThe Laboratory is owned by the hospitalAccording to patient's benefits anything billed out by a facility such as her lab charges are applied to her yearly deductibleThere is no
fraudulent billing being doneMy staff and myself has explained this many times to the patientShe wants her lab charges to be written off. It would jepordize our contract with her insurance if we waived her deductibleThe hospital has offered her a reasonable payment plan to assit her with her liability. Please let me know if there is anything else I can do regarding this complaint

I have reviewed the issue again and our position remains the sameThank you

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID ***, and have determined that this proposed action would not resolve my
complaint. For your reference, details of the offer I reviewed appear below
I wish to see a full resolution to this matter, as requested,in the original complaint text before I can accept this matter be closed The business response to date gets us no closer to resolution
Regards,
*** ***