UCSD Medical Group

Review: I recieved a annual physical exam 9/21/12. During that exam, the doctor noted elevated blood pressure and "hammer toe". My blood pressure was in the "pre-hypertensive" range; not super high.

My insurance plan includes the annual physical at no additional charge.

Apparently as part of informing me of my elevated blood pressure, the billing was coded for "annual physical" AND an office visit. which equated to approx. $135 out-of-pocked expense. I did not request any advice, but aparently the doctor noted he had given advice to the extent that the additional $135 "office visit" was charged.

I have been disputing this charge for so long now that it has caused my credit score to be negatively affected. I have requested more detail regarding why the charge (including to UCSD billing and their Customer Service department), but I only receive a response that "your account was coded and billed correctly". Aparently my word means nothing as my request for rationale for the charge is ignored and the canned "your account was coded and billed correctly" is repeated.

Up this point I have not asked for anything more than reversing the un-justified charge and clearing my credit blemish.

I am hoping the Revdex.com is able to help remedy the situation. I do not want to take more aggressive action.Desired Settlement: Rescind unexplained office visit, stop credit collection agency calls and clear credit blemish.

Business

Response:

I will need time to review the chart notes and have our compliance office review for accuracy.

Consumer

Response:

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.

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,

Review: I had an eye exam at UCSD on 11/18/2013. My vision insurance was not applied, and I was billed the full price of $230. I called 4 times to get my vision insurance applied, last time on 5/14/14 when I spoke with [redacted]. Each time, I was told the insurance would be applied. And each time, without any further explanation from UCSD billing, I would receive another bill for the full price. I sent a message to UCSD billing through MyUCSDChart on 8/24/14 explaining the situation, that no one was responding to my inquiries, and I was concerned the constantly pending bill would hurt my credit. I wrote if I did not hear back from them in 3 days, I would file a Revdex.com complaint. I heard back on 8/27/14 from [redacted] stating the billing was incorrect and that the balance has been removed from my account, and they were following up with the insurance on the matter. Without any further contact from UCSD billing, I received a new bill today (9/13/14) for the full price of $230.Desired Settlement: I paid the bill today. I would like to be refunded the amount that would be correctly covered by my vision insurance. If not, I would like an explanation of why my vision insurance cannot be applied in this situation. The lack of personal responsibility by everyone I have contacted in the UCSD billing department about this matter has been troubling to me. I note that the majority of Revdex.com complaints against UCSD have been to the billing department. This clearly reveals a problem with the department and should be addressed through restructuring.

Business

Response:

The doctors have to go online themselves to update info with VSP in order to be considered in network. Dr.[redacted] hasn’t done that yet. We can adjust off but patient will have a $10 copay.Patient paid $230 on 9/13/14. Patient liability for this date of service is only $10. Patient should allow up to 3 weeks to receive refund in the amount of $220.I hope this is satisfactory for the patient. Please give her our apologies.[redacted]Operations Manager, Customer RelationsUCSD Medical Group Business ServicesVoice # [redacted]Fax # [redacted]

Consumer

Response:

I have reviewed the response made by the business in reference to complaint ID[redacted], and find that this resolution would be satisfactory to me. I will wait for the business to perform this action and, if it does, will consider this complaint resolved.

Regards,

Review: UCSD has been billing my insurance a wrong doctor visit codes resulting me end up paying all the amount.

When I visited them on Aug 22 2104 they checked with insurance and my benefits and they told me that my co pay is $40 for this office visit to my primary care doctor.

I paid the $40 at the visit and rest should be paid by the insurance

However instead of putting office visit code they put outpaitient code that is nor covered in my benfits and my insurance denied the claim and I am made liable to pay all the changesDesired Settlement: They need to resubmit the claim with insurance with office visit code so that insurance can pay their liability.

This is my 20th issue with their billing this time and they were wrong every time. So they should do their work efficiently.

Business

Response:

This notification should be routed to UCSD Medica Group as it is a physician billing matter. The manager is [redacted], ###-###-####.

Consumer

Response:

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,

Business

Response:

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 ###-###-####.

Business

Response:

The correction was already made. The consult visit was changed to a Follow-up and rebilled. The insurance paid on 11/12/14. Patient has no liability at this time.

Review: UCSD is claiming an outstanding balance on my account and has threatened Collections. Entire balance was paid in May 2014, and I believe there is an error with their current records. I have contacted supervisor [redacted] 3 times in July for resolution, and she has failed to respond via email or phone. Emails were sent 7/8 and 7/11, voicemail was left on 7/15. The urgency of the matter is that UCSD has sent balance to [redacted] Inc. for Collections and threatened a negative credit report.Desired Settlement: I would like confirmation that:

1) the balance of $89.68 has been paid and UCSD has corrected the error.

2) UCSD has contacted [redacted]. and confirmed there is no longer a balance on this account.

Consumer

Response:

In regards to complaint ID [redacted], this was a physician bill.

Consumer

Response:

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 response. As 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,

Review: On November 1, 2011, I went to UCSD Shiley Eye Center for the sole purpose of a field test as a follow-up to a 9/7/2011 initial preventative care exam for glaucoma. This service required $0 copay per my insurance. Following the field test performed by a technician & over my objection, the doctor repeated the initial tests and more, without cause in my opinion.

Regardless, I should not have been liable for any such services if in fact they were in keeping with glaucoma preventative care. Remember, this service required $0 copay. Almost a year later in late 2012, I received a statement from UCSD Medical Group for $79. I responded in writing that the charges were not justified and unfounded based on my insurance coverage. I never received a reply to my letter. Moreover, I never received any statement of liability from the insurance company - which is normal procedure.

I thought the matter was resolved until I discovered a collection notice on a recent [redacted] credit report.

On March 31, 2014, I wrote to UCSD Medical Group (Billing Manager) asking that the item be removed from my credit record but the request was denied. The unanswered question is why this matter went to a collection agency in the first place without any warning & without any subsequent contact at all from that agency. Isn't there a protocol to be followed before taking such action? Why were the issues raised in my 2012 letter not addressed? Furthermore, what reputable organization would wait a year to seek a legitimate payment? I am very suspicious of their motive(s) in this matter & believe it be all about profit. Thank you any help you can provide.Desired Settlement: Help me clean this blemish from my otherwise stellar credit record.

Business

Response:

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.

Consumer

Response:

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 statement that I received "four statements" is a bold-face lie. When I contacted the collection agency they claimed a "wrong address" as the reason I had not been contacted - true or false? More importantly, upon receipt of a statement following the initial one, I addressed this matter in writing and did not receive a response, to date. Why not? The letter was posted on December 13, 2012. Moreover, I don't buy the line about the services being dictated by eye conditions. I do not have glaucoma! They even repeated the refraction process that was done on the previous visit - which I had paid for. Was that necessary? I think not! This could easily be construed as a deliberate act to bill Medicare needlessly. I will continue to pursue a satisfactory resolution of this matter wherever it leads.

Be advised that this is the same group that wrongly charged me a $15 copay which my insurance company advised me to pay and submit a claim for reimbursement. For some unexplained reason & after more than six months, the insurance company sent the $15 to UCSD Medical Group instead of me. It then took several months for me to receive the $15 from UCSD. It was only sometime after this fiasco that I received any billing statement(s). As stated previously, I never received any statement of liability from my insurance, so the figures quoted don't mean anything to me. I stand firmly that the billing was not justified & in no way timely - which further aroused my suspicions. Thank you for your efforts in this matter.

Regards,

Business

Response:

Reviewed the issue again. Our position remains the same

Review: I went to visit doctor kingston on 8 /22/2014 for annual visit at the clinic ,not at the hospital , but ucsd charged my insurance coding hospital visit, which is wrong code. Ucsd billing practices are unethical and deceptive. We are being billed as hospital facility for non hospital related services such as regular office visit. It's fraudulent billing practice, worst billing system in place for medical facility. I tried calling at [redacted]st 50 times , they transfor my call here and there , customer service agents were rude with attitude especially if they know I am with foreign accent. Over all it's wrong how they billed me as hospital visit for doctor visit. P[redacted]se have them fix it as just doctor visit code.Thank you,Desired Settlement: Please have them code this as just doctor visit.

Business

Response:

The issue is not with how the office visit was coded, but the site of service. Patient was billed for lab work. The Laboratory is owned by the hospital. According to patient's benefits anything billed out by a facility such as her lab charges are applied to her yearly deductible. There is no fraudulent billing being done. My staff and myself has explained this many times to the patient. She wants her lab charges to be written off. It would jepordize our contract with her insurance if we waived her deductible. The 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.

Consumer

Response:

I have reviewed the response made by the business in reference to complaint ID [redacted], and find that this resolution would be satisfactory to me. I will wait for the business to perform this action and, if it does, will consider this complaint resolved.

Regards,

Consumer

Response:

Dear [redacted], this is [redacted] again , I am not satisfied with how ucsd responed to my complaint. I never accepted their response, I don't know what happened to my email since I usually open my email on the phone. Sorry next time I will be careful. Again, at ucsd Hillcrest I went for well woman clinic visit , definitely never enter hospital on that particular day. They never explained this prior to my visit over at check in desk, they didn't hand me the receipt when I walked out. They can't charge me hospital lab charge when I was just in the clinic. I am in the situation in tight buget, single mom with two kids. I can't pay for the service that wasn't given to me. their billing practice is fraudulent, unethical to innocent people. I am not the only person , there are more than 100 patients complaining similar to my situation. P[redacted]se help me. Thak you , [redacted]

Dear [redacted], I forgot to clear this in previous email, the well woman visit I went for was done to me includes lab work which is just checking with tounge by the same doc.at the same minute. They are making story, I dint have any extra lab work , show me the prove that I sign it?? That day was just well woman visit at the clinic , I have no complaints with my insurance, they pay total amount in full for well woman clinic visit, but yes for hopital its comes out of deductible , its normal like any other insurance. Ucsd can not code extra hospital visit where the patients only gets well woman service at the clinic. The lab work they are talking about is lie . Ucsd ripping money from innocent patients.

Business

Response:

I am sorry the offer of a payment plan was not satisfactory. UCSD is very senitive to the financial needs of our patients. We are willing to extend the payments over many months to assist in the expenses. As stated in an earlier response, the lab work was ordered by her physician as a standard of care. Her insurance applied the services to her yearly deductible per her contract with them. There was no fraud or act of intentional disception. The lab work ordered falls within the guidelines for the care requested.

Review: I needed to get a subscription for a leg brace, and I was provided UCSD Medical Group as being covered by my healthcare PPO. As part of my examination, I did provide them my current coverage and was assured that my healthcare PPO would cover the cost of the examination. The first time I received the bill, I called UCSD Medical Group to have them correct the healthcare PPO that I had originally given them. I also instructed USCD Medical Group to bill my insurance provider directly. The 2nd bill I received, I noticed the UCSD Medical Group had not contacted my healthcare PPO, nor changed my address. I inquired and UCSD said their SYSTEM would not accept it. I had validated with my PPO that yes UCSD Medical Group was part of the covered medical facilities. UCSD Medical was instructed to MAIL the bill directly to the PPO versus sending me the invoices. The 3rd time I called UCSD, they did not seem to have any notes of my address change, or changes to the PPO that I have been requesting previously. I have to say the lack of respect and customer service is appalling and lack of initiative to get things right is the reason for this complaint.Desired Settlement: UCSD Medical Group was provided the address to mail the invoice to my healthcare PPO and should directly sent the bills there. I have a valid insurance, USCD Medical Group should call my PPO. Also they need to be truthful and stop making excuses that the SYSTEM won't take it. My healthcare PPO can't understand the delay from UCSD Medical Group to mail in an invoice. Their SYSTEM should not be the only means of submitting a medical claim. Also due to the lateness, I want UCSD Medical Group to stop moving forward with sending it to another collections agency and solve the immediate request of properly sending it through proper channels. Improve their customer service so patients are not wasting valuable time resolving their SYSTEM issues.

Business

Response:

Mr. [redacted] had services on 3/11/14. Mr. [redacted] was sent four statements requesting payments. Without any response from him UC San Diego Medical Group assigned his account to collections on 6/28/14. Mr. [redacted] called our office on 7/8/14. We took the insurance information from him and submitted a claim. He 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 unprofessionally. UC San Diego Healthcare submit claims to insurance and work with insurance to optimize reimbursement. Without the information there is not much we can do. Mr [redacted] had a number of opportunities to reach out to us and give us his correct insurance information so we could submit a claim. Mr. [redacted]'s Statement indicated clearly that the coverage we had on file was Aetna Managed Choice. That coveraged expired 3/1/14.

The issue relating to our cost of service is a total different matter. We are a teaching hospital and our fees are put into place according to what is reasonable and customary for the area. We offer discounts and payment plans for patient that are without coverage. If Mr. [redacted] had reached out to us we certainly would have worked with him, giving him a much better outcome.

Consumer

Response:

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]

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.

Business

Response:

I have reviewed the issue again and our position remains the same. Thank you.

Review: I visited a dermatologist doctor's office for a dermatological visit. The office was in a USCD Medical Group building outside of the UCSD hospital in Hillcrest, across the street. The building did NOT appear to be connected to the hospital. At the time of the office visit the full price of the visit was not disclosed to me. I expected to pay for the doctor's visit and happily paid the doctor when billed, but then I got a separate bill from UCSD Medical Group that was approximately $1,200.00 The separate cost was not disclosed or posted at the office and was a complete surprise. My insurance did pay half, but the problem here is that I feel this billing method is dishonest/unethical at worst, and improperly/poorly communicated at best. I will NEVER return to UCSD Medical Group considering this event and their approach to billing. The office should have costs clearly described for patients at the facility and clearly define the costs of an office visit there.Desired Settlement: I asked USCD Medical Group to void this bill which was not clearly presented when I made my visit. They declined so in fear of a negative credit report I paid it with my credit card. I would like to ask for a refund as I feel this additional cost of my office visit was not disclosed, and the excessive cost that I would expect from visiting a Hospital was billed even when I was at an office building away from the hospital. At the very least I believe the UCSD Medical Group should clearly post pricing at the doctor's office so patrons know what they are getting themselves into and understand the fact that UCSD Medical Group will be sending them a bill (that is easily over $1000 just for an office visit and liquid nitrogen wart freezing).

Business

Response:

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.

Consumer

Response:

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,