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UPMC Pinnacle Rating
Address: PO Box 2353, Harrisburg, Pennsylvania, United States, 17105-2353
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Address: PO Box 2353, Harrisburg, Pennsylvania, United States, 17105-2353
Phone: |
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In September of 2018, I went to Fast Care in Enola Pa. I was told they couldn't treat me because I needed an x-ray and that I needed to go to urgent care. I received a bill showing a zero balance in October 2018. On 12/21/18 I received a bill for $66 for a level 3 office visit. This was months after I had been there. I contested the bill on 1/15/19 stating that I did not have an office visit, I was told I had to go to urgent care because they could not treat me. I did not hear back from customer service until 4/19/2019 and it stated they would review and get back to me. In August, without ever addressing my issue or sending a response, they sent the charges to collections. I have always paid my bills with them on time. I had paid for the care I actually received that day at Urgent Care on time, which they can verify because they are all a part of the same health system. On 9/13/19 I contacted them again and said they sent me to collections without ever responding to my issue. I received a response that someone checked my vitals so that is what the charges were for. They charged me for a level 3 office visit, not a vitals check. Also, in the 9 months I had been trying to get resolution on these charges, this is the first time they said that. They are just looking for excuses to make me pay these charges. If these were valid charges, why did it take over three months for a bill to be generated? I have no problem paying for care I receive but I find it fraudulent for them to charge me a level 3 office visit when all I was told was I had to go to urgent care because they could not treat me. Even if my vitals were checked, charging someone a level 3 office visit for that is fraudulent representation of services rendered. Vitals are not even a separate line items on medical bills. It's included in an office visit. These charges are fraudulent.
HI, Thank you for sharing your concern. In our review of ***'s complaint we found the following:
*** was seen at Fast Care Enola 9/19/2018 where a physical examination including vitals was done based on presenting symptoms. the charge was a level III office visit 15 minutes, and the charge was $100, in which *** applied a $66.20 patient portion. After the examination was performed the Physician Assistant referred her to an emergency dept or Urgent Care for a Chest X-ray to determine or rule out a possible condition.
Patient statements were generated 12/21/2018, 1/16/19 & 2/11/19.
*** sent online inquiries on the following dates:
1/14/19 an online request was sent by *** to *** information System (IT) helpdesk to which they responded 1/15/19 advising how to get the request to the correct department. Our IT department then did forward the request to our Customer Service department. At that time a Customer Service representative sent her concerns to billing followup to review, but failed to advise *** of her action taken of her concern.
3/8/19 was a 3rd request sent by *** to which we responded 4/19/19 that the account was still being reviewed.
In review our communication to *** was lacking and we will be adjusting the balance due $66.20 to $0.0. We apologize for our lack of timely response.
[A default letter is provided here which indicates your acceptance of the business's response. If you wish, you may update it before sending it.]
Revdex.com:
I have reviewed the response made by the business in reference to complaint ID, and find that this resolution is satisfactory to me.
Regards
I was born 08/01/1999. On August 7, 2017 I had my tonsils removed. I was 18 years of age. *** sent a bill to my mother, *** for $2520. My mother assumed she was responsible for this bill and made payment arrangements. In November 2018, I received a bill from *** for $432. My mother called *** and explained that I was not working and I was a full-time student. The woman explained to my mother that I was entitled to apply for financial assistance since I was over the age of 18. I applied and I was approved. Attached letter. My mother told *** that we have a problem because the prior bill that she has been paying on I was over the age of 18 when services were performed and that bill should be in my name. In January 2019, *** returned my mother's money and sent the bill to me. I created an online account with *** and updated my address (per their request) and sent them 2 emails in which they did not respond. On 02/27/2019, I contacted their office; explained I was not working and I am a fulltime student and that I have no means to pay this bill and it should be included in the financial assistance. They spoke to a supervisor who stated the bill is to old and I was responsible for the bill. If the bill was in my name from the original first billing, back in 2017, I would have still eligible for financial assistance because my circumstances did not change; instead due to their error I am being penalized. I am honor student at *** University, enrolled in their honors program, and this matter is causing me additional stress. My uncle is prepared to assist me in this matter with legal action against *** if not resolved.
Pinnacle has responded to this complaint - see case ID # *** filed by ***.
In our response to ***'s mother, ***, *** Pinnacle has advised in multiple responses, the application Alexis completed for Financial Aid was past the 1 year lookback to cover the date of service listed above, August 7, 2017. *** also requested all payments made onto the account from August 7, 2017 be refunded to her, and the guarantor be updated to ***'s name, which *** Pinnacle complied with those requests.
As previously explained, the Financial Aid application completed by *** was found to be incomplete, lacking the entire household income information as noted on the application signed by *** listing the household as 3. Date of service 7/13/2018 was within the 1 year lookback as per our policy; therefore we honored the write off. As explained in case ID# ***, the application *** Pinnacle received by *** would not have covered the date August 7, 2017. As previously explained, the household income for 3 with medical insurance must be at or below $53,325 in 2019 and $51,950 in 2018, to be eligible for financial assistance. Also per our Charity Policy, Financial Assistance is not to be utilized to cover high deductible amounts for those insured. This is an additional key part of the case for this situation in addition to the untimely filing of their application.
*** Pinnacle considers this case closed.
[To assist us in bringing this matter to a close, you must give us a reason why you are rejecting the response. If no reason is received your complaint will be closed as Answered]
Complaint: ***
I am rejecting this response because: again, it is not my fault the bill is over 1 year old. *** billed the wrong person. In fact, when I called them their CSR stated the bill was sent to my mother because I was a minor. I had to tell their CSR that was incorrect; I was 18 years of age on 08/07/2017. Then the CSR went to say well you are under your mother's insurance. As my mother explained to me, since the Obamacare, she can keep all of her children on her insurance until they are 25 years of age. My brother owned his own home, was married and had dependents of his own and she was able to keep him on her insurance.
Again, as my mother has told you and that was your issue with her complaint; you wanted me to update my address. So I updated my mailing address. I don't live with my parents and I have lived with my parents since I was 18 years of age. I presently live in a dorm room from August to May of every year (the 2 months I am home June and July) I stay at friends' houses. In fact this past Spring Break I was in Myrtle Beach for Spring Training. I did not go to Millersburg at all. I provided *** my household income; unless, you are requesting proof of income off all of my roommates? I support myself. I am responsible for this bill because it is in my name...not my room mates or my friends.
I applied for a tutoring job here at *** and I have an interview this week; but in the meantime, I am living off of my Christmas money given to me, a scholarship I received from *** and my $119 tax return. I believe *** needs to realize that some people when they turn 18 are forced to support themselves because their parents are no longer required to support them. Regardless, if this bill is over a year old my circumstances presently are that I am full time student who is not employed and I have no means of paying this bill. I am asking that you forgive this bill under the financial plan I was approved for or write the bill off.
Regards
In response to the rejection submitted, *** Pinnacle has taken the following actions:
*** Pinnacle reached out to our Foundation and advised them of your desperate situation. We advised the Foundation of your need and the hardship you are indicating this has caused you. The billed amount $2540.28, date of service 8/7/17, to which your mother, ***, originally accepted and assumed the payment plan responsibility 11/8/2017 and made timely monthly payments until November 2018, at which time she requested her monies be refunded and the bill be transferred into your name and billed to you. Thus not allowing you to submit a completed financial aid application in a timely manner, resulting in this particular visit, greater than the 1-year lookback; therefore, not qualifying for financial assistance.
The Foundation has reviewed your circumstances and has found available monies in the indigent fund to assist you in paying the patient portion applied by your insurance. The amounts applied by your insurance to you were as follows; $2159.04 deductible and $381.24 coinsurance equaling $2540.28 as patient responsibility. The Foundation has authorized a one-time payment to cover the amount $2540.82 only. Also as a courtesy, and taking into consideration the information you have provided to us on your indigent status indicating you are a full-time college student receiving no financial assistance from your parents, and very little in the way of assets and resources, *** Pinnacle has requested our Medicaid vendor to screen you for Pennsylvania Medical Assistance. As per our Charity Care policy, it is not the intention of financial assistance to be utilized to assist in paying high deductibles, coinsurance, or copays for those insured in such insurance plans.
The monies in the Indigent fund are donated by the community ear marked for members of the community that have fallen on difficult times, such circumstances as you are describing. The Pinnacle Health Foundation would greatly appreciate if at some point in the future that you pay it forward and assist another community member that may have fallen upon a financial hardship.
*** Pinnacle sincerely hopes that this resolution now satisfies your inability to pay for your healthcare needs. Thank you.
I was in Harrisburg PA for several months with my wife for her job, my sister was diagnosed with Breast cancer and had just passed, I was told to go get a Mammogram, I did not have a job or insurance at the time. I went to *** - ***, Harrisburg, PA ***. they were aware of me not having insurance and referred me to Pinnacle Health to get a mammogram, there was a voucher for the exam and it was suppose to be free of charge. I got a bill for over $500 and my wife called and complained and explained I had no insurance and they told me they would contact *** about the voucher. Later on I get another bill and now a year later the bill comes again for $225.00 I was told I didn't have to pay it and now it's in collection. This is not something I owe and feel like they first tried to over charge. Please I do not have the means to pay this bill.
Thank you so much
Thank you for contacting UPMC Pinnacle regarding your concern.
I contacted *** to identify and discuss if any "vouchers" were provided to the patient for date of service 12/30/2017. According to ***, *** completed a financial assessment and found *** to be above the Federal Poverty Limits therefore *** was not eligible for free services. *** also advised *** does not provide vouchers. For their services the patient was considered self pay and paid for the office visit. *** also indicated he spoke to *** 2/13/2018 to discuss and advise she did not qualify for free or discounted services due to her income at their location, and they do not provide vouchers. *** contacted our Customer service the same day to advise there was no voucher and patient was to be considered self pay. At that time a UPMC Pinnacle Financial aid application was mailed to ***. A completed Financial assistance application was not returned. We also have a 1 year look back for financial assistance to which this date of service,12/30/2017 is now out of the date range to be considered for any additional financial assistance reduction.
The reason for the different amounts being billed to ***, UPMC Pinnacle offers a 40% discount for self pay patients. The total charges on the account from 12/30/2017 $564.00 - 40% disc= $338.40. UPMC Pinnacle utilizes a third party that runs behind self pay accounts and verifies if they qualify for any type of financial assistance or presumptive charity according to Federal Poverty Guidelines. Link below for review. *** did qualify for a 60% Presumptive charity reduction 4/15/2018 which reduced the patient responsibility due to $225.60. What this essentially means is UPMC Pinnacle did provide an additional reduction in the patient responsibility according to the Federal Poverty Guidelines. The reduction was not 100%, but based on her income she was approved for 60%.
I also verified in our documents a voucher was not presented at the time patient registered for her service. The only document provided was the physician order for a screening mammogram. *** is considered a self pay and the balance due on the account is $225.60.
***
***
thank you
[To assist us in bringing this matter to a close, you must give us a reason why you are rejecting the response. If no reason is received your complaint will be closed as Answered]
Complaint: ***
I am rejecting this response because: as you can see from the bill I have enclosed this company is lying and is ruining my credit, I did not have a job so I gave them no financial documents, and had no medical or I would not have gone to *** for treatment. The bill just kept getting larger they are just trying to get money by over charging for a service that was $132.00 on 1/3/2018 for a routine Mammogram. Any other provider would have just written this off it is disgusting what they are doing to me.
I refuse to pay the amount they are asking for. I will send notice to the local paper in Harrisburg, PA, that they are over charging for there services.
Regards
Patients receive 2 separate bills for radiology services. *** attached the *** bill in the amount $132.00. That is the bill for the read and interpretation of the images by the radiologist. UPMC Pinnacle bills separately for the exam, which includes the actual performance of the exam and the mammography technologist performing the exam. UPMC Pinnacle's amount due from the patient after the presumptive charity discount on 4/16/2018 is $225.60. I have attached the presumptive charity letter sent to *** with the UPMC Pinnacle account number, date of service, total charges, balance due and the amount of presumptive charity approved for review. The letter also indicates the discount does not apply to any professional or physician charges. UPMC Pinnacle does not bill for ***. *** would need to contact the telephone number on that bill to inquire about any discounts or financial assistance they may offer. She may reference UPMC Pinnacle approved her for a presumptive discount of 60%.
As per the last response from UPMC Pinnacle, it is noted ***, not UPMC Pinnacle, completed a financial screening and found *** to be over income for their financial assistance program. Also per ***, they do not provide vouchers. If you feel that is in error please contact *** to discuss as I was advised they did not provide a voucher.
UPMC Pinnacle's account for the exam, the performance of the actual exam and mammography technologist, was found to be eligible and approved for presumptive charity at a 60% reduction from charges. Presumptive Charity, as noted per our Charity Care and Financial Assistance Policy located on our website, refers to uninsured individuals that is presumed eligible for Charity care ( or financial assistance) when adequate information is provided by the patient or through other sources such as credit reporting information that allows UPMC Pinnacle to determine that the patient qualifies.
Should *** wish to discuss the difference in the bills or have questions related to the 2 bills she received, or the amount of presumptive charity she may call me at and ask for Michelle.
On August 1, 2107; my daughter turned 18. That same month, my daughter had her tonsils removed. When the bill came from the procedure it was in my name. I owed $2540.28. Because I could not afford to pay the whole bill at one time; I set up payment arrangements. I have been paying monthly on this balance. To date my present balance is 1042.28.
In June 2018; my husband lost his job. We filed for financial assistance w/*** on our medical bills for the year 2018. I received a letter stating we were denied.
On 11/6/18 I questioned the denial. I told them my daughter was 18, last year, when she had her tonsils out and *** sent the bill to me and not my daughter. Diane told me that was because I was the guarantor. I stated I am the guarantor now. But when we are requesting financial assistance you saying we can not count her in our family because she is over the age of 18. I told her we have a problem. Diane stated she will review with her supervisor.
11/07/18 Diane called me back and stated a family of 2 can not make more 41,150 and a family of 3 can not make more than 51,950. Please be advised that ***'s website 251-300% will receive a 80% discount and 301-400% will receive a 60%. I know we will qualify for a 60-80% discount.
I called their office back to question their website; they stated they know their website was wrong. They told me they are trying to assist me with my daughter's bill of $400 (new for 2018) because she is over the age of 18 and the bill is her responsibility. I stated my daughter is a full-time student at *** and is not working (which Diane knew). I told Diane that was not fair, I paid over $1500 on her prior bill because the bill came in my name (which it should not have).
I asked what can we do about the balance I am currently paying on; she said nothing it is too late; if my daughter would have applied last year, she would of qualified for financial assistance.
Thank you for contacting *** Pinnacle. In review of the concern regarding your daughters date of service 8/7/2017, at the time the account was pre-registered, 7/19/2017, she was still a minor and you were listed as the guarantor. At the time of registration, 8/7/17 I cannot see an edit that stopped the account to correct the guarantor to your daughter. I have requested our Information Technology dept review to see why this did not happen. I do see on 4/10/2018 the guarantor was updated to reflect your daughter, ***.
Per notes you called into Customer Service 11/8/2017 requesting a payment plan for the amount applied by *** as patient responsibility to deductible, $2159.04 and coinsurance $381.24 for a total patient responsibility $2540.28. At that time the payment plan was longer than 3 months, so a payment plan was established with ***, a 3rd party banking institution *** Pinnacle uses to accommodate the payment needs of our patients. The payment plan was established for $106.00 for 24 months. To date is current and payments are being made.
In review of the questions regarding Financial Assistance, the application process and completing the application for your family and /or your daughter. The documentation provided by you in this complaint, the page with the chart of discount percentages, indicates about halfway down "Financial Assistance means receiving care at a discounted rate. Patients who are uninsured for a medically necessary service can receive financial help if they meet all 3 criteria.
- No insurance coverage for the medically necessary service
- Ineligible for governmental or other insurance coverage
- Family income is excess of 250% ( but not exceeding 400%) of the Federal Poverty Guidelines."
In the *** Pinnacle Charity Care and Financial Assistance Policy C-667, also available on our website, located on page 5 , section XXI, it states " Except in cases of those individuals within 250% of the Federal Poverty Levels, this policy does not apply to patients who are insured or underinsured; for example, it is not the intent of this policy to provide free care or discounted care to patients who have health insurance with high deductibles or coinsurance."
For the dates of service in question, 2017 and 2018 for your daughter, you and ***, you were insured with ***. The balances due are a result of deductible and coinsurance assigned by ***.
I have reviewed the Financial Assistance application submitted in October and found the household income provided for a family of 3, with medical insurance is above the 250% level. According to the Federal Poverty Guidelines a family of 3 may be at or below $51,950.
Your daughter may complete a financial aid application. You indicate above she is a full time student and not working. Per the policy we will request the same documentation such as tax returns, paystubs and bank statements. If she does not file taxes separately, we will request the reason why and the return where she is claimed as a dependent along with the household income. If she has no income, we will request statements from the person (s) assisting with daily living expenses, the amount and reason.
I apologize if someone gave you the impression our website was incorrect. The information listed is accurate and does reflect the correct Federal Poverty Levels.
We cannot refund the monies paid to *** as this was a contract agreement entered into with a banking institution. Your daughter may be able to contact *** and request a new payment plan in her name. If at any time your household income changes, please contact us to review your application again.
Thank you.
Since *** Pinnacle is now being notified, per this correspondence, that ***’s daughter no longer lives with *** at her residence we require a true residential address for ***. *** signed and certified at the bottom of her application that the information contained in the application is true and complete. The patient’s residential address is a required response on the financial assistance application. Please let us know if you need a copy of ***’s completed application. Please have *** provide *** Pinnacle with her true residential address by calling Customer Service *** to update her demographic record. Otherwise, *** Pinnacle will continue to utilize the address that was previously provided by the patient. Please note the current address *** Pinnacle has for ***, as per her application, banking, and tax return documents, is the same as ***’s address. *** may reapply for financial assistance by providing all of the required documentation with her real current address. As per our Charity Care policy in section XX ‘It is the patient’s responsibility, or their guarantor, to provide a correct address at the time of registration to ensure mailed statements and notifications are received’.
If the child resides in the same household as the parent/guardian and the child is claimed as a dependent on the parent/guardian taxes then the child should be added to the financial aid application. *** had that scenario in 2016 as per her federal tax return. In 2017, her daughter *** filed her own federal tax return using the same household residential address. Both tax returns utilized the same current residential address, as did both financial aid applications. Therefore, their household members equate to three. As previously communicated in *** Pinnacle’s first response, *** Pinnacle utilizes the Federal Government poverty income guidelines. Per these income guidelines, and also, as per our Charity Care Policy, for calendar year 2018 a family household of 3 cannot have income more than $51,950 in that year and a family of 2 in the household cannot have income more than $41,150. In both of the Breslin’s charity care application cases, according to the addresses provided, even taking both household number scenarios into consideration the household family income was higher than the poverty income allowed amounts to qualify for financial assistance. In addition, even if *** Pinnacle went back the twelve months from the approval letter date of ***’s application, as *** is requesting, the 8/7/17 date of service falls out of the one-year time frame allowed by our Charity Care policy. It is imperative to follow up timely when the need arises to apply for free care.
The deductible and coinsurance amounts owed to a provider and/or facility for services are dictated by the patient’s health insurance plan. That is a legal contract between the subscriber of the insurance with the health insurance company and the covered members on that plan. *** Pinnacle is required, as per our own contract with the insurance company, to bill the guarantor the amounts dictated by the insurance plan as patient responsibility. The $2,540.28 balance (assigned deductible and coinsurance as per the insurance) does not fall within the 6 months of financial aid coverage with a date of service over a year old - 8/7/17. Therefore, *** Pinnacle is required to bill the guarantor for that date of service. *** Pinnacle has forgiven the $496.27 patient balance for the date of service 7/13/18 as that did fall within the one-year limitation. As a courtesy, *** Pinnacle has also requested a refund of the payments already made thus far to ClearBalance by *** on her daughter’s behalf over the last year. We will bill *** as per ***’s request for the open balance from 8/7/17. *** Pinnacle has met all of ***’s requests as allowed per our Charity Care policy and our contract with her insurance plan Capital Blue Cross. *** Pinnacle will consider this investigation closed and will be taking no further response actions. Thank you.
[To assist us in bringing this matter to a close, you must give us a reason why you are rejecting the response. If no reason is received your complaint will be closed as Answered]
Complaint: ***
I am rejecting this response because:attached you will my PO Box Renewal. My PO Box address: my financial application and my bank statement does not reflect my PO Box. Our bank statements are not mailed to the address that they have on file; our bank statements are emailed to us, hence the non importance of updating it.
My daughter will contact *** with her residence address.
Regards
After I called and scheduled an appointment with my doctor at this office, Dr Anne M, I was contacted just minutes before my appointment by telephone. Another doctor at the office asked me to clarify why I wanted to be seen. I told her that I had recently completed a five hour exam by a psychologist involving my mental health. I was told by my psychologist to take my new diagnosis and test results to my primary care doctor to receive the proper medication. Once I explained everything to her she told me they refused to even meet with me about it and would never prescribe me medication to treat my disorder. I decided to find a new primary care doctor and requested that my records be transferred. I signed a release form. They told me they would send my new doctor the information but never did. When I called back to request it again they refused and told me they didn't have the information. I called back a third time demanding it and they gave me a number to call. The number was fake. They are still refusing to release my information to me. On top of it all they have been incredibly unprofessional and cold.*** at shrewsbury***shrewsburyPA
Thank you for providing this information. We take all patient concerns seriously and make all attempts to address accordingly.
I reviewed the concern from *** with the System Director for the Medical Practice as well as the Medical Director for UPMC Pinnacle Memorial. Findings were *** has not been seen in the office for 3 1/2 years. Due to this the office records are having to be retrieved from different computer systems and sent to the new provider *** requested. We do apologize for the delay, the office is still working on getting that done, and should be completed in the next few days.
In addressing the concern regarding the cancelation of ***'s appointment, the physician, Dr. M, does not prescribe that type of medication for adults, and according to the inquiry, the front office conveyed that information to ***.
If you need anything additional please let me know.
thank you
Michelle
I went to Pinnacle Health for my yearly preventative health check-up, which is 100% covered by my insurance. However, Pinnacle had Hepatitis check done on my blood work, which is not considered covered by preventative health. Pinnacle did not tell me they were testing for Hepatitis, and I asked multiple times if it will be 100% fully covered by my insurance, and they assured me it would be.
Low and behold, I get an almost $200 bill to pay, essentially a bait-and-switch. Insurance will not cover it, because checking for Hepatitis is not considered preventative. Pinnacle refuses to cover it and are saying my insurance should be paying it, because they coded it as preventative. I went back and forth between insurance and pinnacle with no resolution. Pinnacle then stopped responding to me for over two weeks and I got a letter in the mail threatening to send my bill to collections. Stating that there has been no communication about my overdue bill.
I have the full transcript of our time-stamped communication saved, as well as all physical mail sent to me.
Dear ***,
RE: ID # ***
Thank you for your inquiry. We have further investigated the lab test with this patients provider’s Office Manager and from what we can determine there seems to be a bit of a miscommunication or misinterpretation that occurred. It is not a normal process for a provider nor a staff member to tell patients they will not get a bill for services performed. The amount a patient is billed is based on the assigned amount as per the patient’s individual insurance plan benefits. Revdex.com Patient # *** should have received an explanation of benefits from his insurance company noting that this amount of $186.27 was assigned as part of his deductible as per his health insurance plan benefits. Ultimately it is the patient’s responsibility to know their individual insurance plan coverage and benefits. As a good faith gesture from his provider’s office they have adjusted off Revdex.com Patient # ***’s deductible balance of $186.27. Please let me know if you have any other questions.
Thank you for choosing UPMC Pinnacle for your healthcare needs.
Sincerely,
Della M
System Director Patient Financial Support Services