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Westerville Internal Medicine Reviews (2)

The above complaint should not be against John K*** *** The physician of record is Yasmin M***, an MD at Westerville Internal Medicine. DrK*** is part of this group but did not handle any of the services for the patient. The patient requested an annual wellness visit back
in March of 2015. She had an Annual Wellness visit performed and the office visit was coded to reflect this. At that time, the patient did not need a PAP exam at it was not due until October. Usually Wellness Visits will either include the PAP test or the patient goes to their gynecologist for this test. The patient re-scheduled her PAP test after October of 2015. When she came in for her PAP, other concerns were discussed. At this point, since the Wellness Visit was already performed in March, using another Wellness Code could duplicate out the visits and the patient would owe more. Since it was an Office Visit, it was coded as such. The codes were reviewed by COPCP’s coding and compliance department and deemed correct. The claim was filed. Upon getting a bill for her $co-pay the patient contacted DrM***’s office. DrM*** went back to the coding and compliance department and they stated the coding was originally correct. When DrM*** spoke with the patient, the patient stated that she should not be charged her $dollar copay for this visit. She then stated that she should be able to have both a physical and a gynecological exam on separate visits within the same year for free, no charge to herShe stated this was done at previous doctor's officesWe explained that the preventative code was used once in March, for her annual exam, which she understood but stated that a preventative code be used for the gynecological exam in November of 2015. Upon review, the coding and compliance department stated that if her insurance company permitted this, which most insurance companies do not allow, we could change the code to a preventative visit; however, it may cost the patient more out of pocket if they deny the charge. The patient was adamant that the code be changed to preventative. DrM***, through the advice of coding and compliance changed the code to a preventative code. Please note that this is not the way that insurance companies usually handle their wellness visits. Usually, you get one wellness code per a month period. DrM*** in no way was trying to trick the patient or the insurance company. She followed best practice rules and was within her rights to bill the claim the way it was originally. There was not any type of fraud or negligence involved. DrM*** did discuss other matters at the second appointment and it was within her rights to handle it the way she originally did. Thank you for your time. Michael D*** ***

There are two major points I would like to reject/clarify:1. There was a reference to a Dr. K[redacted]. I have no idea who that is and have never mentioned that name in any of my correspondence.  I'm not sure why he was mentioned in the response from Dr. M[redacted]'s office. My issue is with Dr. M[redacted] and the business office coding my appointment correctly.  2.  The office keeps referring to my appointment in November as a wellness visit, similar to a physical exam.  Federal law allows women to have a wellness (physical) exam each year with no copay as well as a gynecological exam each year with no copay.  It is true before moving to Columbus I visited my primary doctor for my yearly physical and my OBGYN for my gynecological exam.  When I visited Dr. M[redacted] in March for my physical, she mentioned that she could also do my yearly gynecological exam.  Since I had not found a new OBGYN in Columbus, I decided to take her up on that. However, guidelines dictate that I wait 12 months between gynecological exams and my last exam had been in October, 2014.  I knew I needed to wait twelve months to schedule the next one - thus the November, 2015 appointment.  Dr. M[redacted] has told me repeatedly it does not matter that she asked me about other issues at that appointment, the appointment was booked as my yearly gynecological appointment and that is how it should be coded.  I find it hard to believe that in the medical coding world there are not two separate codes - one for a yearly wellness (physical) exam and one for a gynecological exam. Those two exams are so extremely different, it would be like coding a yearly dental cleaning and a root canal the same.  If this office doesn't have access to appropriate code, then please find out what the correct code is for a gynecological exam and resubmit it.  What is happening in this office may not be fraud, but it also doesn't pass the smell test.  Women in this country are entitled to both of these exams; the doctor in this office solicited her services for both exams; and now the office seems to cheating the system by saying they can't code these two exams differently.  Most people would just pay the $20 and be done with it, but that office is not entitled to my $20 - I am entitled to my two exams.Regards, [redacted]

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Address: 484 County Line Rd W Ste 200, Westerville, Ohio, United States, 43082-7078

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