UPMC Physician Services

December 5, [redacted] RE: Patient Complaint from [redacted] Dear Ms [redacted] :Thank you for your letter dated November 14, regarding a complaint filed by [redacted] Ms [redacted] was questioning a recent visit to UPMC urgent care in ***.The account was reviewed and billing is correctIt is indicated on both the website and the office that “This location is a wamedical care facility, providing urgent care servicesYour bill will reflect physician office services, and may be paid differently by your insurer than a bill for services rendered at other urgent care facilities.”I hope this information has clarified any outstanding questionsIf you need any additional information, please feel free to contact me at ###-###-####.Sincerely, [redacted] CRP Project Coordinatorcc: [redacted] ***, Manager Central Registration and Scheduling

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.January 4, 2015Revdex.com of Western PA [redacted] ***Re complaint ID [redacted] Dear [redacted] :We are in receipt of your letter dated December 10, as of December 28, Enclosed you have included a response from [redacted] The following is our response:The insurance company, [redacted] has indicated to us that the billing by your Urgent Care for this visit differs in that the physician who attended to our child on July 14, [redacted] submitted his services utilizing his billing code as an EMERGENCY ROOM PHYSICIAN AND NOT A STANDARD PHYSICIAN OR URGENT CARE MDThe very next week, I utilized the same exact urgent care facility and had no further bills or balance due as that doctor billed as an urgent care doctor/regular MDThe claim has nothing to do with the insurance company, rather that your doctor, [redacted] used an improper billing code indicating he was acting in his capacity as an ER/ED doctor when in fact he was not.As well, at no TIME nor in any location at the office is it posted nor was it relayed that the services provided were considered emergency servicesAs such, if your doctor is billing as if he is acting as an ER/ED doctor outside of the emergency room, he is committing fraud and your entity is practicing unfair and deceptive trade practices.Sincerely, [redacted]

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.January 4, 2015Revdex.com of Western PA[redacted]Re complaint ID [redacted]Dear [redacted]:We are in receipt of your letter dated December 10, as of December 28, 2014. Enclosed you have included a response from [redacted]. The following is our response:The insurance company, [redacted] has indicated to us that the billing by your Urgent Care for this visit differs in that the physician who attended to our child on July 14, [redacted] submitted his services utilizing his billing code as an EMERGENCY ROOM PHYSICIAN AND NOT A STANDARD PHYSICIAN OR URGENT CARE MD. The very next week, I utilized the same exact urgent care facility and had no further bills or balance due as that doctor billed as an urgent care doctor/regular MD. The claim has nothing to do with the insurance company, rather that your doctor, [redacted] used an improper billing code indicating he was acting in his capacity as an ER/ED doctor when in fact he was not.As well, at no TIME nor in any location at the office is it posted nor was it relayed that the services provided were considered emergency services. As such, if your doctor is billing as if he is acting as an ER/ED doctor outside of the emergency room, he is committing fraud and your entity is practicing unfair and deceptive trade practices.Sincerely, [redacted]

December 5, 2014[redacted]RE: Patient Complaint from [redacted]Dear Ms. [redacted]:Thank you for your letter dated November 14, 2014 regarding a complaint filed by [redacted] Ms....

[redacted] was questioning a recent visit to UPMC urgent care in [redacted].The account was reviewed and billing is correct. It is indicated on both the website and the office that “This location is a walk-in medical care facility, providing urgent care services. Your bill will reflect physician office services, and may be paid differently by your insurer than a bill for services rendered at other urgent care facilities.”I hope this information has clarified any outstanding questions. If you need any additional information, please feel free to contact me at ###-###-####.Sincerely,[redacted]
CRP Project Coordinatorcc: [redacted], Manager Central Registration and Scheduling

Review: I had gall bladder surgery last year. I was having some issues so I made an appointment to talk to the Dr. A** she did was schedule a bunch of tests that I could not afford and then charged me almost 300.00 for an office visit. I disputed the bill with Physician services and was ignored, not even a "the bill stands" no response at all. I then started making payments on this outrageous bill. I received a letter yesterday in the mail. It stated the account had been turned over to collections. My credit is very important to me and I do everything I can to keep it in good standing. If I hadn't been paying I would understand their actions but I was paying them. I am making arrangements to pay the collection agency today, but this practice is not ok.Desired Settlement: I want to make sure that my credit is not damaged by the disgraceful actions of UPMC

Review: I have been receiving services from UPMC for over a year, and have been harassed by predatory billing practices by UPMC Physician Services.(1) I currently have two insurances - UPMC - [redacted] (I am Primary) and [redacted] PPO (I am secondary, my husband is primary).(2) UPMC Physician Services first bills my UPMC health plan, receives payments for services, and bills me the remaining balance. Then it bills my [redacted]-IL plan and receives further payments.(3) [redacted]IL sends me an EOB that indicates I don't owe UPMC Physician Services anything. UPMC Physician Services still asks me to pay balance amount, and I get harassment from collection agency.(4) I am attaching all documents for service date 6/20/2014 as an example. 4 Services were provided and UPMC health plan was billed a total of $1,301. UPMC health plan contracted rates allow $481.62 for these services, and paid $433.47. Then [redacted]IL was billed, which paid $82.55. So, UPMC Physician Services received a total of $516.02 in payments, which is in excess of allowed $481.62. Even after this, UPMC Physician Services is asking me to pay additional $25.92!(5) Similar billing practices were employed throughout 2014. UPMC Physician Services is getting paid in excess of allowed amounts, still harassing me for payments, and pocketing the excess money with excuse - "oh, the health plan may ask us to refund that!" This is a fraudulent practice!!!Desired Settlement: (1) I want UPMC to stop this predatory billing practices. When I have an EOB from [redacted] showing I do not own anything, I should not be billed anything.(2) If I have two health plans, I am responsible for the lowest contracted rate. UPMC should not bill me the higher allowed amount.(3) UPMC should acknowledge payments from both UPMC and [redacted] plans, and in case of overpayment (i.e. Allowed Amount = $90, UPMC paid $80, [redacted]IL paid $20) it should refund money to insurer - not just swallow it!

Review: I recently disputed the cost of, and asked for a cost breakdown for the following:PNEUMATIC ANKLE CONTROL SPLINT(CPTL4350)I felt the cost of the charge was too high. I was informed the charge will stand and there is nothing I can do about that cost. I am now asking that UPMC does something to help those who may have the same issue I did.I understand the code refers to the cost of the splint, plus fit and adjustment, I would still like to be provided the cost breakdown for each of those items (Splint Cost, Fitup and Adjustment Cost), and anything else wrapped up in, or associated with the code.The cost for the device, fit & adjustment that was billed to my insurance is much higher than I would expect ($153.00). My insurance covered the standard medicare cost of $78.72, leaving the remaining balance my responsibility. I want to know what this "standard" cost consists of.As I had mentioned in previous emails and phone calls to UPMC, the device I was given can be purchased online between $28-$61 depending on the retailer. That price is for the exact same ankle brace, not an equivalent one.The "fit and adjustment" consisted of a nurse placing the brace on my ankle and adjusting three Velcro style straps, while telling me not to put it on too tight when I do it at home.. Total "fit and adjustment" time was under two minutes.Two minutes of work, and a $30 brace should not cost a patient $153, even the medicare price of $78.72 is high in my mind. My research has found that the pricing model over and above the medicare price is typically profit, which is fine, but UPMC is a non-profit organization I thought?.To be clear, I'm not asking that my charge be removed, I just want to know exactly what I was charged for.I am also asking that in the future, patients be notified of these types of cost ahead of time before accepting treatment. Personally I would have refused the Splint, and purchased my own had I known what I would be charged for such a simple procedure.Desired Settlement: In summary I would like UPMC to provide the following:1.) The individual cost of each item covered by PNEUMATIC ANKLE CONTROL SPLINT(CPTL4350)code. Including base cost and markup, if applicable.2.) UPMC's response to the suggestion of providing patients up front costs for similar procedures, so proper financial decisions may be made.I have been in discussion with UPMC since the end of May 2013, and still do not have answers to these questions.

Review: In early June UPMC sent me a statement for $10. I replied immediately on June 6 by email to the effect that I’d already paid $20 copay, and therefore UPMC owed me $10, not the other way around. UPMC did not respond. However, they then sent me what appears to be the same statement, but under a different account numbe. I wrote letters requesting a refund on 8 July, 26 September, and 13 November. I did not receive a reply.Desired Settlement: Refund for amount owed, plus interest.

Review: On 7-6-13 I went to the Emergency Room at UPMC Hamot and was admitted. My health insurance is designed that if you are admitted from the Emergency Room, your $50 co-pay is waived. I received a bill from UPMC Physician Services for the $50 co-pay and when I called them, I was told "you weren't admitted, you were kept for observation". I was never told I was being kept for observation. I was told I was being admitted. I sent for copies of my ER paperwork. There is nothing on it that indicates I was just being "kept for observation". I was "admitted" to a room on the 6th floor and kept there for 2 days. Besides the $50 co-pay, I was also charged a $20 co-pay every time a doctor came in to see me (4 times $20). Where is the transparency? Patients have a right to be told they are being kept for "observation" and that they will be liable for the $50 co-pay plus co-pays for any doctor visits, allowing them to decline this service. What if my hospitalization had lasted for weeks? A $20 charge every time a doctor came to see me could have resulted in a very huge bill.Desired Settlement: I would like UPMC Hamot to code my 7-6-13 hospitalization as an "admission" because I was not told I was being kept for "observation". If they do that, my insurance company (Blue Cross/Blue Shield) will waive the $50 co-pay. I do not feel I should have to pay $20 co-pays for the 4 doctor visits while I was in-patient. I also feel UPMC should be required to tell their patients when they are just being kept for "observation" and allow the patient the option of declining.

Review: This complaint is being filed against UPMC Physician Services dba [redacted]. My daughter, a minor child, was seen on July 14, 2014 at the urgent care referenced above that evening at 7:35 pm. Upon checking in, we provided our insurance card to [redacted], the front desk attendant and provided verbal answers to the necessary paperwork. The paperwork was then printed and we paid the co-pay instructed by [redacted]. of $20 that is the same as reflected on the card from Highmark BCBS and in the plan information as provided by Highmark.We were asked to have a seat and the nurse would come and get us and our daughter would be seen ASAP. We were then seen by Dr. [redacted]. Dr. [redacted] examined [redacted] and determined her illness to be due to allergies as we had just moved to the [redacted] area. Dr. [redacted] prescribed no medications. He did have a quick strep test done and informed us before leaving it was negative. He also informed us it would be sent to a lab for culture testing. We were told that IF it grew the culture he would contact us and then prescribe an antibiotic but he doubted anything was wrong with [redacted] other than allergies to the new environment. We checked out before leaving and were told that we owed nothing further. We received an explanation of benefits online from Highmark BCBS on July 31, 2014. The EOB stated that we were responsible for the deductible portion of the culture/pathology test of $14.73. We also noticed the EOB stated we were responsible for an additional $15 payment to the UPMC [redacted] The total we owed was now $49.73, less the $20 we had already paid. I then contacted [redacted] on August 1, 2014 via the customer service number. It was at this time I was instructed that [redacted] had billed the services as Dr. [redacted] was a specialist and not as the facility being an Urgent Care facility. It was suggested that I contact [redacted] and inquire as to why this was done. I called [redacted], spokeDesired Settlement: We are requesting that the records be corrected to show that the account has a zero balance. Require that the urgent care notify people PRIOR to being provided service if the individual is going to be practicing in their capacity as a specialist and how/how much the charge would be. Require the physician not be allowed to bill as a specialist when they are NOT providing those services; e.g. he is not acting as an er/emergency dept doc.

Business

Response:

December 5, 2014[redacted]

[redacted]RE: Patient Complaint from [redacted]Dear Ms. [redacted]:Thank you for your letter dated November 14, 2014 regarding a complaint filed by [redacted] Ms. [redacted] was questioning a recent visit to UPMC urgent care in [redacted].The account was reviewed and billing is correct. It is indicated on both the website and the office that “This location is a walk-in medical care facility, providing urgent care services. Your bill will reflect physician office services, and may be paid differently by your insurer than a bill for services rendered at other urgent care facilities.”I hope this information has clarified any outstanding questions. If you need any additional information, please feel free to contact me at ###-###-####.Sincerely,[redacted]

CRP Project Coordinatorcc: [redacted], Manager Central Registration and Scheduling

Consumer

Response:

Review: Billing Department UPC Physician's Services.

Account number : [redacted]

They submitted my account to the collection agency even though I am no longer responsible for the bill.

I was told that it is problem with the billing department. Numerous emails requesting for updates have all been unanswered. I've even asked if there should be another person I should be talking to. Nothing. Silence. Nada for MONTHS. Bad business practice. Total lack of customer accountability.

Get my name and credit t out of the collection agency ASAP.Desired Settlement: Get my name and credit out of the collection agency. Send me an official written response and apology as to why it took/it has taken months to resolve this.

Review: [redacted]I called UPMC to find out information about scheduling an appointment with Dr. Cheryl B[redacted]. When I called, I asked how much it would cost. I explained I did not have insurance till October 1st due to a new job, and I needed to see if I could afford the appointment. The receptionist at the front desk stated it would cost "140.00". I asked if that was for everything, fees, facility charges, etc. She stated yes. I then called a few days later and made the appointment. I had my appointment on September 16th, 2015. I paid 80.00 when I got there. I saw the doctor for 20 minutes, and had a urine screen.

I got three bills from this appointment, which cost over 1000.00. First charge was for the physician, which was around 250-280. (I do not have the bills with me, but have them at my house). The second bill was for a facility fee charge. This charge was over 400.00.

The third charge, was for 533.00 for a urine screen through [redacted]. I have talked to Quest. I have a written statement from a Quest Employee that states " We an offer testing far below 150.00$. If you have the client bill set up, and you accidentally check on a requisition insurance bill and the patient ultimately gets a bill because they are uninsured, absolutely that can be corrected".

I have tried contacted the billing office multiple times, and they will not correct this. It is still a 533.00 dollar bill. if they corrected the error, it would be under 150.00.Desired Settlement: To have the billing issue through Quest corrected by UPMC billing, and have the price of service reduced. Also, since I did not use the hospital facilities, I want the facility fee dropped as well.

Department of Neurology. This is a horrible office. Administrative staff more focused on eating and having personal conversations with each other rather than doing their jobs. An appointment scheduled 6 months in advance was cancelled 2.5 hours before hand. Only offer was to reschedule 3 months later. Very poor customer/patient care. I would strongly advise anyone to go elsewhere.