Complaints

This profile includes complaints for Sutter Health's headquarters and its corporate-owned locations. To view all corporate locations, see Find Local Branches.

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  Sutter Health

  2200 River Plaza Dr Sacramento, CA 95833-4134

• 

  Sutter Health

  1201 Alhambra Blvd Ste 410 Sacramento, CA 95816-5243

• 

  Sutter Medical Foundation

  45 Castro Street San Francisco, CA 94114-1022

• 

  Eden Medical Center

  20103 Lake Chabot Rd Castro Valley, CA 94546-5305

• 

  Sutter Pacific Medical Offices

  3883 Airway Drive Santa Rosa, CA 95403

The complaint text that is displayed might not represent all complaints filed with BBB. Some consumers may elect to not publish the details of their complaints, some complaints may not meet BBB's standards for publication, or BBB may display a portion of complaints when a high volume is received for a particular business.

• Initial Complaint

  Date:05/22/2023

  Type:Service or Repair Issues
  Status:

  ResolvedMore info

  Complaint statuses

  Resolved:

  The complainant verified the issue was resolved to their satisfaction.

  Unresolved:

  The business responded to the dispute but failed to make a good faith effort to resolve it.

  Answered:

  The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.

  Unanswered:

  The business failed to respond to the dispute.

  Unpursuable:

  BBB is unable to locate the business.

  My spouse and I recently opted to change our primary care physician (PCP) in April 2023. The transition process appeared to proceed smoothly, as both our insurance provider and Sutter Health acknowledged the change. We received updated medical cards, and the online system also reflected the updated information. In April, my wife successfully scheduled a Transfer of Care appointment by calling in.However, when I needed to visit my PCP for a medical issue and scheduled a new patient appointment, approximately a week prior to the scheduled date, Sutter Health contacted me. They informed me that our PCP panel was closed for new patients, indicating that I would be unable to see a doctor. According to them, the reason behind this was that my insurance company did not possess the most up-to-date list of doctors who were accepting new patients. Additionally, they claimed there were no available doctors at the ****************************** When I requested to escalate the matter, the representative stated that the manager would have conveyed the same information and that there was nothing they could do.It is not my responsibility to ensure that Sutter Health provides an updated doctor list to the insurance company. As a consumer, my spouse and I followed the proper procedure to change our PCP, yet we experienced a two-month delay due to their negligence. Their explanation for the delay, claiming an inadequate doctor list, seems baseless and has caused an unnecessary hindrance to my timely access to medical attention. Their suggestion to seek emergency care if I required prompt assistance is unsatisfactory.The service and responses we have received from Sutter Health have been highly unprofessional and utterly disappointing.See note below after call:Telephone Encounter ************ at 05/22/23 **** Situation: Patient added to providers panel with incorrect process Background: PSR contacted patient and warm transferred to ******* M. In NPR. Error will be corrected This message originates from: a PSR at S3 **** Contact Center

  Business Response

  Date: 05/29/2023

  A ******** Service Agent at ********* ********************** Foundation spoke with the patient on 5/24/23 advising that someone from NPR will be calling him and his wife on June 1st, to reassign to an ************* and schedule an appointment. 

  Customer Answer

  Date: 06/01/2023

   
  Better Business Bureau:
  
  I have reviewed the response made by the business in reference to my concern, and find that this resolution is satisfactory to me.

  Update: Sutter Health NPR did call right at the time they promised and registered both myself and my spouse to a doctor.  They also scheduled an earliest appointment for us to get some medical attention.  It's great they follow through and provided solution.

  
  

• Initial Complaint

  Date:05/15/2023

  Type:Service or Repair Issues
  Status:

  AnsweredMore info

  Complaint statuses

  Resolved:

  The complainant verified the issue was resolved to their satisfaction.

  Unresolved:

  The business responded to the dispute but failed to make a good faith effort to resolve it.

  Answered:

  The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.

  Unanswered:

  The business failed to respond to the dispute.

  Unpursuable:

  BBB is unable to locate the business.

  On 3/1/23, my daughter went to see her pediatrician for annual physical. This is covered 100% by our insurance. During the visit, the pediatrician asked daughter if she had any other issues. Daughter said she had shoulder pain. Pediatrician referred daughter to specialist. I was billed $247 for talking about shoulder pain. My insurance co-pay for that was $25. On 3/17/23, daughter went to see referral doctor ************* I had pre-cleared with my insurance and I was told that I have a $25 co-pay for office visits to specialists. I was pleased with Dr's attention to daughter's shoulder pain. When Dr. suggested that we take a look at her shoulder with ultrasound, I assumed that this would be a routine part of the office visit. It was not until I received the bill that I discovered that the ultrasound (which took no more than 2 minutes to perform) had been billed under an additional CPT code for $602, and my insurance co-pay was $457.59 for the ultrasound. I was blindsided by the charge.At no point during our visit were we informed that the ultrasound would incur an additional charge. $602 for 2 minutes.I called the ****************** and the rep told me the ultrasound was a separate "diagnostic" charge. She said I was responsible for the charge or sent a request for review via email. I emailed PAMF on 5/1/23 and did not receive a response.I believe that it is important for healthcare providers to be transparent and communicative about the costs of their services. Patients should not be blindsided by unexpected charges or feel as though they are being penalized for a lack of information. I believe that if I had been informed about the cost of the ultrasound prior to the test, I would have had the opportunity to ask questions, weigh our options, and make an informed decision about my daughters care.I respectfully request that the charge for the ultrasound be waived.

  Business Response

  Date: 05/23/2023

  A Sutter Representative reviewed the charges and determined that they are correct. The Representative spoke with the patients mother at length,explaining that the physicians are there to provide the best possible care.They do not know the billing details or whether her plan may result in costs to her. This is why it is her responsibility to know her insurance benefits. It was also explained she always has the right to refuse services until she can verify benefits. While the patients mother expressed that it was unreasonable to hold her to the standards of knowing her benefits and read details of her benefits to know she may have out of pocket costs, the charges are appropriate. This concern has been closed. 

  Customer Answer

  Date: 05/24/2023

  I am rejecting this response because I disagree that a patient "always has the right to refuse services until she can verify benefits." At the doctor's ******* the doctor said "let's take a look and see what the ultrasound says." The ultrasound was on a cart that was brought in. I did not know that was an extra charge because to me, the ultrasound flowed from the same office visit. I believe others in my situation would have assumed the same. In any event, it is unfortunate that I have to pay $500 out of pocket (this is my portion after my insurance paid $500+) for a 2- minute ultrasound. I'm still shocked by it, but I'm one small patient going up against Goliath. When I asked about next steps, the rep said either a payment plan or they would send the bill to collections. I felt that I was corned with no other choice but to pay, either now or later through collections (which would bring me more headaches).  I will pay, but now looking for doctors outside of PAMF or Sutter Health. The problem is, they have a monopoly in my area. ****** and ************ are not available to me through my insurance carrier. Very unfortunate and frustrating. 
  

• Initial Complaint

  Date:04/28/2023

  Type:Service or Repair Issues
  Status:

  AnsweredMore info

  Complaint statuses

  Resolved:

  The complainant verified the issue was resolved to their satisfaction.

  Unresolved:

  The business responded to the dispute but failed to make a good faith effort to resolve it.

  Answered:

  The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.

  Unanswered:

  The business failed to respond to the dispute.

  Unpursuable:

  BBB is unable to locate the business.

  The lab services were done last December 21, 2022 amounting to $232.80. When we were billed, we immediately called our insurance to verify that these services were covered. Our insurance processed it right away and made sure to ** that we won't have to pay for anything. The date of conversation/phone call was January 24, 2023. I also made a 3 way call with Sutter and they said they will re-process everything. Fast forward to April 20, 2023, we are still receiving bills and we called them back again (Insurance and Sutter), our insurance said that all of it were settled and Sutter needs to update their system and that they will send an email that contains the *** to them. Sutter also said they will match the coding and it will be taken care of. Today, we called Sutter again (April 28, 2023) because we have been receiving calls about our account being sent to a collections agency. We were asked by Sutter's agent to set up a payment plan because it will be forwarded to a collection's agency and bill adjustment won't make it in time even though we have already spoke with our insurance about covering it back in January. The amount is $352.80 this time. All of it were preventative care. I am hesitant to set up a payment plan because I did it before with my wife's account and we had to wait for 3 months to get our refund since it turned out that our insurance did pay for it and it became a double billing. Speaking with Sutter Health is stressful since most of them aren't willing to help and always saying that they couldn't do anything even though they are literally from the billing department. Our insurance keeps on saying everything was settled as long as it is a preventative care while Sutter keeps on denying that it was all paid for when they are the ones putting on incorrect CPT codes. They are pressuring ** to pay it right away or it will be sent to a collections agency even though we have already been settling this with them and asking for updates since January.

  Business Response

  Date: 05/09/2023

  A Sutter Representative reviewed this account. The insurance advised that they had reprocessed claim for payment in full. The balance has been removed from patient responsibility pending the new payment/ explanation of benefits. The Representative was unable to reach ********************** so a letter was sent informing him of this information.

  Customer Answer

  Date: 05/12/2023

  I am rejecting this response because the balance is still in the account and the insurance just informed me that the *** code being used was a medical diagnosis one which results in the claim being denied, whereas if the *** code was a preventative care, then it will all be covered which is it is. I can still see the balance and it hasn't been fixed.
  

  Business Response

  Date: 05/16/2023

  A Sutter Representative spoke with the patients health plan and has been advised that the claim was reprocessed. While we do not guarantee payment,we have placed the balance on hold pending the new payment and explanation of benefits.

• Initial Complaint

  Date:04/24/2023

  Type:Service or Repair Issues
  Status:

  ResolvedMore info

  Complaint statuses

  Resolved:

  The complainant verified the issue was resolved to their satisfaction.

  Unresolved:

  The business responded to the dispute but failed to make a good faith effort to resolve it.

  Answered:

  The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.

  Unanswered:

  The business failed to respond to the dispute.

  Unpursuable:

  BBB is unable to locate the business.

  TImberlake Respiratory Care and Home Medical Equipment frequently ships the wrong and/or wrong sized equipment. I have contacted them multiple times in order to obtain the *****************, and one more than one occasion, the replacement equipment that they sent has been wrong as well. I have not been able to find a corporate office contact for the Timberlake, so I would like the BBB's assistance in getting into contact with them.

  Business Response

  Date: 04/25/2023

  Leadership is reaching out to the patient to confirm the correct supplies to send and will update the patients file accordingly for future orders. 

  Customer Answer

  Date: 05/01/2023

   
  Better Business Bureau:
  
  I have reviewed the response made by the business in reference to my concern, and find that this resolution is satisfactory to me.
  
  *****, who is in a supervisory/managerial role with Timberlake, directly reached out to correct the recent  inaccuracies. ***** patiently listened to the situation, but I would like to note that every staff member I have spoken to about previous orders have been professional and confirmed the accuracy of the items in the desired resupply order. Thus, I am unsure of the root cause resulting in these past discrepancies.
  

• Initial Complaint

  Date:04/21/2023

  Type:Service or Repair Issues
  Status:

  ResolvedMore info

  Complaint statuses

  Resolved:

  The complainant verified the issue was resolved to their satisfaction.

  Unresolved:

  The business responded to the dispute but failed to make a good faith effort to resolve it.

  Answered:

  The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.

  Unanswered:

  The business failed to respond to the dispute.

  Unpursuable:

  BBB is unable to locate the business.

  Every year I have a lab test done as part of my annual physical exam. The lab test and the physical exam are considered preventative, and therefore are covered by my insurance company. On September 16, 2022 I had my lab test for 2022. As usual, it was billed as preventative and covered by my insurance company. However, the doctor noticed an anomaly with one part of the lab test. She said this is a typical anomaly that is normally associated with lab error, and asked me to get a second lab test. On September 30, 2022 I got a second lab test, and sure enough, the results were normal. However, Sutter Health coded the second lab test as elective, and thus my insurance did not pay it. I have talked to Sutter Health multiple times about this and gotten nowhere. All they will do is send the bill "back for review", and then I receive a letter saying "everything was billed properly", when, in fact, it was not billed properly. I should NOT need to pay for their error. Also note that when the doctor asked me to get the second lab test done, the doctor did NOT say that I would need to pay for the second test. The uncovered amount is $33.60, and Sutter Health has now sent the bill to a collections agency. So, in summary, Sutter Health is (a) expecting the patient to pay for their own sloppy lab work, (b) failing to provide transparency in their billing, and (c) failing to provide any reasonable communications channel for patients to dispute incorrect charges.

  Business Response

  Date: 05/05/2023

  A Sutter Representative reviewed this concern and spoke with the patient. The 9/30/22 lab charges have been reversed from collections and adjusted.  

  Customer Answer

  Date: 05/05/2023

   
  Better Business Bureau:
  
  I have reviewed the response made by the business in reference to my concern, and find that this resolution is satisfactory to me.

  Thanks very much for your help!

  
  

• Initial Complaint

  Date:04/21/2023

  Type:Product Issues
  Status:

  AnsweredMore info

  Complaint statuses

  Resolved:

  The complainant verified the issue was resolved to their satisfaction.

  Unresolved:

  The business responded to the dispute but failed to make a good faith effort to resolve it.

  Answered:

  The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.

  Unanswered:

  The business failed to respond to the dispute.

  Unpursuable:

  BBB is unable to locate the business.

  Dates of Transaction: 1-18-2022, 2-15-2022 out of pocket expenses: $102.72 for each prescription: a total of $205.44 I did not file a complaint earlier because I believed I would be able to resolve this with Sutter. On January 1, 2022, I transferred my health coverage from ****** Permanente to Sutter Health/********* Medical Foundation in **************. Sutter was experiencing a staff shortage, and I would have to wait two months to see my doctor. During that period, Sutter would not refill a prescription I had for a controlled substance. Acting on Sutters advice, I had the refills written by my old ****** doctor, which meant filling them at ****** Pharmacy in Scotts Valley. Because that is an out-of-network pharmacy, I paid full price, assuming that Sutter would reimburse me. Not only has Sutter refused to reimburse me, Sutter/PAMP wont even let me talk to anyone of authority. I have been communicating with Sutter/PAMF since April of 2022, by letter, phone, emails, and through the patient relations app on their website.I even visited what I was told was the Patient ***************** No one was there. It has shut down in March of 2020. I have appealed to Alignment Health and to ********* I have asked repeatedly to be allowed to talk with a supervisor, or a manager, or an ombudsman. But my requests are either denied or simply ignor*** In January I received a letter stating I would not be reimbursed, and sayingThis concludes our review or your concern. In the same letter, the writer makes clear that she had not read any of my previous attempts to communicate: Please ensure that you coordinate with your insurance prior to picking up medications in the future to ensure they will be cover *** I request that Sutter/PAMF reimburse me for the cost of two prescriptions I bought at ******. I attached receipts. I will send copies of all my communications if requir***

  Business Response

  Date: 05/02/2023

  A Grievance and Appeals Specialist at ********* Medical Foundation reviewed this concern on several occasions and stand behind our determination that charges remain the patients responsibility. It is not a part of our process to reimburse for outside charges. 

  Customer Answer

  Date: 05/05/2023

  I am rejecting this response because:  Sutter /PAMF has never said directly why my request for reimbursement was denied, but I believe it was because I bought two prescriptions at a pharmacy that was not in the network. 

  What Sutter/PAMF fails to consider is that I was forced to buy my prescriptions at a non-network pharmacy by Sutter/PAMF itself. Although I was a paid member of Sutter/PAMF, the organization declined to fill my prescription for Adderall until I had seen my new primary care physician, ************************. But because of a staff shortage at Sutter/PAMF, they were unable to give me an appointment to see ******************** for nearly two months.  A REPRESENTATIVE OF SUTTER HEALTH/PAMF, DIRECTED ME TO HAVE  PRESCRIPTIONS FOR ADDERALL WRITTEN BY MY FORMER DOCTOR AT ******, UNTIL SUCH TIME AS I COULD SEE *********************  My former doctor kindly agreed, which he certainly didn't have to. It was quite a favor to ask. But he had to write it for a ****** Pharmacy. There was only so far he go to make up for Sutter/PAMF's lack of staff and inability to supply me with my medication. 

  Sutter Health/PAMF's inability to secure me a new patient appointment with my assigned primary care physician made it impossible for me to have these prescriptions for ******* and February filled at an in-network pharmacy.

  ***** asked if I couldn't have seen an urgent care doctor, and the answer is no.  I was told I needed to see my primary care physician. She also suggested that I could have just waited until late February for a prescription. It is not my responsibility to wrack my brain making up for Sutter's short falls. I signed a contract with Sutter and paid my premium. The contract I signed stipulated that they would provide me with my prescriptions.  They could not. They broke their contract, but now Sutter refuses to take responsibility. 

   

   

  
  

• Initial Complaint

  Date:04/18/2023

  Type:Billing Issues
  Status:

  ResolvedMore info

  Complaint statuses

  Resolved:

  The complainant verified the issue was resolved to their satisfaction.

  Unresolved:

  The business responded to the dispute but failed to make a good faith effort to resolve it.

  Answered:

  The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.

  Unanswered:

  The business failed to respond to the dispute.

  Unpursuable:

  BBB is unable to locate the business.

  Account number : ******** Patient Name : ******************************* December 19, 2022, my daughter (*********************) showed flu symptoms and in an emergency, the original ******* *** I wanted to meet with ***************** to check it out, but the reservation was full, so I was introduced to another Pediarics and tested for the flu. And I got a fee, and I was charged $397.80 as an attachment. As a result of inquiring the insurance company about this, the full cost of pediatric flu test was added. Also, in a situation where the original doctor could not make an appointment, he met with another doctor to do only the flu test, but the doctor's consultation cost was fully charged by registering a new patient. How can a pediatric flu test cost close to $400? Why Sutter Health can add high costs without notifying these costs in advance, which can be seen as an act of deceiving consumers.

  Business Response

  Date: 05/02/2023

  A Sutter Representative reviewed this concern. It was sent for coding review. The level of service was corrected to a lower level of service and a corrected claim was billed to insurance. The Sutter Representative spoke to patients father, and he verbalized satisfaction with the outcome. 

  Customer Answer

  Date: 05/03/2023

   
  Better Business Bureau:
  
  I have reviewed the response made by the business in reference to my concern, and find that this resolution is satisfactory to me.
  
  

• Initial Complaint

  Date:04/17/2023

  Type:Customer Service Issues
  Status:

  AnsweredMore info

  Complaint statuses

  Resolved:

  The complainant verified the issue was resolved to their satisfaction.

  Unresolved:

  The business responded to the dispute but failed to make a good faith effort to resolve it.

  Answered:

  The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.

  Unanswered:

  The business failed to respond to the dispute.

  Unpursuable:

  BBB is unable to locate the business.

  I received a letter from the State controller asking me to claim my property from Sutter Bay Hospitals in the amount of $196. I called the phone # indicated in the letter and followed the instructions from the customer service representative. Furthermore, it says if I do not contact the business before 5/30/2023, the business is required to send the property to the ************************** I emailed them the information on 1/19/2023 and to this day I have not heard back from them and they are not responding to my emails.

  Business Response

  Date: 04/19/2023

  Thank you for reaching out regarding this issue. A Sutter Representative contacted the Sutter Unclaimed Property team asking them to confirm if the information you emailed on 1/19/23 was received and if it was in process. They confirmed that they did receive your letter in the S3 UCP email inbox and will submit a check request today to get the funds reissued. This will take approx. 1 week to process and mail out. 

• Initial Complaint

  Date:04/17/2023

  Type:Customer Service Issues
  Status:

  AnsweredMore info

  Complaint statuses

  Resolved:

  The complainant verified the issue was resolved to their satisfaction.

  Unresolved:

  The business responded to the dispute but failed to make a good faith effort to resolve it.

  Answered:

  The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.

  Unanswered:

  The business failed to respond to the dispute.

  Unpursuable:

  BBB is unable to locate the business.

  On 9/27/22, I had my annual wellness check up with a new PCP assigned to me by PAMF, where ***************** ordered blood work and a routine mammogram. A few days later, I received a bill from PAMF for $930 on 11/12/2022, which was unexpected as I thought the tests were part of the wellness check up. On 10/28/22, I called PAMF to dispute the bill because it was unexpected. At this point, they initiated a coding review & reported in Nov 2022 that coding was correct & I still owed them $930. On 12/12/22, I received an increased bill from PAMF for $1105 & then on 2/10/23 for $1389, all for the wellness checkup of 9/27/22 (and several lab bills from Quest Diagnostics). The last bill of $1389 included a charge for mammogram, which is fully covered by insurance. I called PAMF again on 2/13/23 and 3/8/23 to dispute the bill. When I specifically highlighted the mammogram as an example of an incorrect charge, I was told it was for the follow-up image Radiology asked me to come back for that was not covered by insurance. I explained to them that I failed to understand why I was liable to pay for the follow-up image which could have been because their technician didnt get it right the first time. During my final call with PAMF on on 3/18/23 to dispute the charges, they offered me no help to resolve this dispute or respond to these fraudulent charges. I explained to them that as a consumer, I had no visibility or choice in the process from when the doctor called in the tests to me now being liable for bills. PAMF did not provide me any indication of costs or a good faith estimate and this unexpected bill violates the No Surprises Act, passed by the legislation in January 2022 to protect consumers like myself. Looking at BBB reports, this does not seem to be an isolated case of incorrect billing from PAMF. Please help with this situation with PAMF & related bills from Quest Diagnostics and take it out of debt collection.

  Customer Answer

  Date: 04/19/2023

  Desired resolution: inaccurate charges from PAMF and Quest Diagnostics are dropped.

  Business Response

  Date: 05/02/2023

  A Sutter Representative reviewed this concern, specifically the following charges have been reviewed. Action taken is noted below.
  
  Date of Service 9/27/2022 - Annual exam billed with office visit
  Discussion of symptoms with workup is not considered preventive and is separately billable and the charge is appropriate. After further review we did adjust the office visit charge off as service recovery  as we could have communicated better with the patient regarding a potential office visit charge.  
  
  Date of Service 9/29/22 - Labs ordered as part of annual
  Some of the labs were rebilled with a primary dx as preventive, but insurance still processed toward deductible. Insurance may deem the lab itself not to be preventive, but patient would need to further dispute regarding the labs with their insurance. Education has been provided to the patient. Some labs are still subject to the deductible/out-of-pocket even when coded as preventive. Balance stands.
  
  Date of Service 10/1/2022 - *************** completed
  These labs were not ordered as part of the physical but appear to have been ordered after the initial lab results were abnormal. Education provided to patient and balance stands.
  
  Date of Service 10/28/2022 - Repeat lab due to abnormal result, not preventive
  
  Date of Service 10/6/2022 - Routine mammogram paid in full
  
  Date of Service 11/6/2022 Follow-up diagnostic mammogram
  Callback due to finding seen on the screening, but not indicated as something went wrong with original mammogram. There needed to be additional further view done, which is considered diagnostic.
  Since we could have communicated better with the patient in educating why she needed to return for additional mammogram and that this would not be a preventive, balance was adjusted as service recovery.
  
  All balances have been reversed from collections. The Sutter Representative discussed the account in detail including the importance and responsibility of knowing benefits and verifying out of pocket costs prior to services being rendered. Account balance reflects as $583.60.  
  

• Initial Complaint

  Date:04/12/2023

  Type:Service or Repair Issues
  Status:

  AnsweredMore info

  Complaint statuses

  Resolved:

  The complainant verified the issue was resolved to their satisfaction.

  Unresolved:

  The business responded to the dispute but failed to make a good faith effort to resolve it.

  Answered:

  The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.

  Unanswered:

  The business failed to respond to the dispute.

  Unpursuable:

  BBB is unable to locate the business.

  Service date - 15 Jan (see EOBs attached) Patient Name - *************************** - DOB - May 4, 2018 Issue - Visited to get a prescription for vomiting control medicine for kid We were provided prescription for vomiting medicine. A urine test was done which we did not request. Total appointment time with doctor was around 10 mins.Billing - Sutter health facility we visited was not transparent with billing. They did not disclose bill and chose to bill 580 USD for service. After numerous complaints it was brought down to *******. They also double bill tests (there was a lawsuit on sutter, but practice has not stopped). This is an OUTRAGEOUS amount for such a small prescription Issue - In such cases, a ***** billing code is used. Even the costliest of urgent cares will not charge more than 120 USD. Instead, Sutter health does not disclose their rates on Cigna. They have only a cost efficiency rating on Cigna. If you compare average costs on Cigna based on this rating, we should not have more than 150 USD contracted rate at maximum.Medicare billing rates for codes PT CODEMEDICAL DECISION MAKINGTIME LENGTHREIMBURSEMENT RATE (2022)REIMBURSEMENT RATE (2023)*****Straightforward15 - 29 Minutes$80.91$72.86 *****Low30 - 44 Minutes$124.39$112.84 *****Moderate45 - 59 Minutes$185.26$167.40 Other renowned site to check average costs - ********************************************************************************************************************************************************************************************************************************************************** ***** New patient Problem Focused -average fee amount $30 $40 ***** New patient- Expanded Problem Focused average fee amount $70 $80 ***** New patient Detailed average fee amount $80 $110 ***** New patient Moderate Complexity average fee amount $130 $170 ***** New patient High Complexity average fee amount $180 -$210 *****High60 - 74 Minutes$244.99$220.95

  Business Response

  Date: 04/14/2023

  A Sutter Representative reviewed this concern. Coding has reviewed and has determined that documentation supports the corrected level of service. The billed amount is correct and ********* Medical Foundation charges are based upon the usual and customary rates for the region.

  Customer Answer

  Date: 04/19/2023

  I am rejecting this response because:

  1. The coding still is higher than I expect. This is a minimum issue prescription (doctor **** was less than 10 mins with **). 

  2. In spite of multiple class action lawsuits, Sutter has still double billed me on urine test (one via provider and one via them)

  3. I was billed 20% higher rate than I was told. They have noninsured rate and insurance rates in 20% higher. This means I pay more since I use high deductible. I would have chose non insured rate, something I was never told. Why can sutter not use insurance on file and bill me directly now?

  
  

  Business Response

  Date: 05/02/2023

  See responses as follows:
  1. The coding still is higher than I expect. This is a minimum issue prescription (doctor **** was less than 10 mins with **). 
  Response: A ***** OV NEW PT LEV 3 was billed which is used for a moderate to low complexity visit.  The level of visit is not just based on the amount of **** spent with the physician. The **** is the total **** spent on the encounter which would include the **** the physician and nurses spent before and after the visit reviewing the chart and urinalysis results.
  

  2. Sutter has still double billed me on urine test (one via provider and one via them). 
  Response: One Urinalysis billed under the provider was for the urine dip performed during the visit and the second urinalysis billed was for the Urine sample sent to the lab for additional testing.
  

  3. I was billed 20% higher rate than I was told. They have noninsured rate and insurance rates in 20% higher. This means I pay more since I use high deductible. I would have chose non insured rate, something I was never told. Why can Sutter not use insurance on file and bill me directly now? 
  Response: Per policy discounts are not offered to patients within network insurance.  If the patient were to choose to not bill their insurance the patient would be responsible for the full charge.  These charges have already been billed to the patients insurance and applied to their deductible.  The patient is not paying more than what their insurance would have paid, but due to them not meeting their deductible as of yet the patient is paying the amount their insurance would have paid which is then being subtracted from their outstanding deductible for the year.