UMass Memorial Medical Group

Umass billing outpatient services instead of office visit services causing a deductible to be owed instead of an office visit. I took my daughter to a sports medicine doctor at Umass Medical Group . My insurance has a copayment for specialist visits so when I went to the visit I was expecting to pay a copayment. I received a bill that went towards my deductible because the provider has an office in the hospital. I called on this and spoke to [redacted] the [redacted] and was told that Umass bills it as an outpatient instead of of and office visit becaused the office is located in the hospital. She informed me that they will not change this way of billing and I owed the deductible. It is not right that Umass is billing patients for their overhead cost and patients are being penalized for a doctor have an office inside a hospital. I take my other daughter to [redacted] doctor at [redacted] hospital in Worcester and only pay a copayment. Also patients should be educated prior to their appointment so a patient can make that determination if they can afford the deductible or not at that time of service and have the option to find another doctor in an "office".Desired SettlementI am looking to pay my copayment of 60.00 for the specialist visit.Business Response When a patient is seen by a physician located in a hospital setting, it is appropriate to bill as an outpatient clinic visit. Depending on the patient's insurance plan there may be a different patient liability for this service vs a private office setting. We have verified that the charges are accurate and were submitted appropriately. We are in the process of having the claim reviewed by our contracting department to ensure the insurance processed correctly. We did offer a 20% prompt pay discount as well as a payment arrangement but neither were sufficient. Consumer Response (The consumer indicated he/she DID NOT accept the response from the business.)I feel as a patient that Umass should educate patients prior to a visit that they bill office visits as an outpatient visit so patients are aware of any out of pocket expense. I was under the impression that I had an office visit with a specialist therefore my specialist copayment would apply. Billing an out patient location code it is saying the visit was more than a consult which it wasn't! Final Business Response We do our best to educate patients. We did verify with the site directly that they do have posted signs that advise there is a facility charge associated with the visit and they have been providing hand outs to the patients with this same information. This is per requirement of the Attorney General. Final Consumer Response (The consumer indicated he/she DID NOT accept the response from the business.)I never saw a sign and was never handed anything. When I originally called to complain even the woman I spoke to at the billing office never told me that they have a sign and they hand out a letter that was my biggest complaint to her that the patient were educated. I would've definitely canceled my appointment if I saw that sign or hand or something.

Umass billing outpatient services instead of office visit services causing a deductible to be owed instead of an office visit. I took my daughter to a sports medicine doctor at Umass Medical Group . My insurance has a copayment for specialist visits so when I went to the visit I was expecting to pay a copayment. I received a bill that went towards my deductible because the provider has an office in the hospital. I called on this and spoke to [redacted] the [redacted] and was told that Umass bills it as an outpatient instead of of and office visit becaused the office is located in the hospital. She informed me that they will not change this way of billing and I owed the deductible. It is not right that Umass is billing patients for their overhead cost and patients are being penalized for a doctor have an office inside a hospital. I take my other daughter to [redacted] doctor at [redacted] hospital in Worcester and only pay a copayment. Also patients should be educated prior to their appointment so a patient can make that determination if they can afford the deductible or not at that time of service and have the option to find another doctor in an "office".Desired SettlementI am looking to pay my copayment of 60.00 for the specialist visit.Business Response When a patient is seen by a physician located in a hospital setting, it is appropriate to bill as an outpatient clinic visit. Depending on the patient's insurance plan there may be a different patient liability for this service vs a private office setting. We have verified that the charges are accurate and were submitted appropriately. We are in the process of having the claim reviewed by our contracting department to ensure the insurance processed correctly. We did offer a 20% prompt pay discount as well as a payment arrangement but neither were sufficient. Consumer Response (The consumer indicated he/she DID NOT accept the response from the business.)I feel as a patient that Umass should educate patients prior to a visit that they bill office visits as an outpatient visit so patients are aware of any out of pocket expense. I was under the impression that I had an office visit with a specialist therefore my specialist copayment would apply. Billing an out patient location code it is saying the visit was more than a consult which it wasn't! Final Business Response We do our best to educate patients. We did verify with the site directly that they do have posted signs that advise there is a facility charge associated with the visit and they have been providing hand outs to the patients with this same information. This is per requirement of the Attorney General. Final Consumer Response (The consumer indicated he/she DID NOT accept the response from the business.)I never saw a sign and was never handed anything. When I originally called to complain even the woman I spoke to at the billing office never told me that they have a sign and they hand out a letter that was my biggest complaint to her that the patient were educated. I would've definitely canceled my appointment if I saw that sign or hand or something.

I saw [redacted] at UMMG on 12/21/12 for my yearly physical/checkup Coded wrong and BCBS did not pay UMMC has not corrected even 2 call and 1 ltrI have diabetes and I wanted to have a diabetes MD perform my yearly physical. My wife called BCBS and was told it was my choice who I wanted to use for my yearly checkups. My wife called UMMG and made my appt to see [redacted] and told them it was for a yearly physical, when I went to the appt I told them it was for my yearly physical/checkup. I saw [redacted] at UMMG on 12/21/12. We received bills from UMMG for full amount of visit. My wife called and was told that the visit had not been submitted as a yearly physical and therefore, full amount due from me as deductible not reached. My wife told them that it was for a yearly physical and they needed to correct billing code to reflect same and resubmit to BCBS as yearly physicals were covered in full and should not be applied to the deductible. We continued to receive bills and my wife called again. We continued to receive bills and we sent a letter to UMMG to correct billing code and resubmit to BCBS. We continue to receive the same bill.Desired SettlementI would like UMMG to correct the billing code to reflect that this was a yearly physical and resubmit to BCBS.Business Response Contact Name and Title: [redacted]Contact Phone: [redacted]Contact Email: [redacted]Patients wife called our billing office on 1.30.13 and stated the charges and coding are incorrect and this should not be applied to patients' deductible per insurance co, we told her this would be looked into and a representative would call patient back.4.26.13 A research representative verified per appointment history that this visit was scheduled as a diabetes check with a specialist; she called the patient and left a voicemail for a call back regarding this. (No return call received)Complaint received from Revdex.com on 10.17.13 we sent an email to the doctor office contact to have the charges and coding verified.Patients' visit on 12.21.12 have been reviewed with doctors office and it has been confirmed per his chart that the service provided was not for a yearly physical and the billing is correct. The office confirmed that the patient was seen for a new patient diabetes check not a yearly physical, office contact also confirmed that the doctor is a specialist and does not perform routine yearly exams.[redacted] called patient 10.23.13 and explained complaint received, he requested I call his wife because she filed the complaint; he provided her telephone number [redacted] I called and left a voicemail with my direct line to discuss the results of the research.10.23.13 balance released from hold to begin billing patient again.