Complaints

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• Initial Complaint

  Date:08/22/2023

  Type:Billing 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.

  Surprise billing practices - Disputing part of my bill for an ultrasound done on 5/22/2023 at Wellspan, Waynesboro PA. I previously had the same test completed in October of 2021, ordered by the same doctors office and was not billed for such a high amount over the provided estimate. This time an additional cpt code of ***** has been added to the billing. The estimate provided to me on 5/12/2023 did not include this cpt code. I have also noticed that an addendum was added to the test result on 6/27/2023 after my insurance placed the claim "under review". Something seems very suspicious with the whole situation. I will not pay for something that was not ordered by my doctor. I was not aware of the additional charges prior to being billed. As well as, nothing different was done on 5/22/2023 compared to 10/2021. Below is the breakdown of the cpt codes that I will pay for this bill. ***** - billed 886.00 insurance paid 217.96 ***** - billed 592.00 insurance paid 145.63 My part remaining after insurance 1114.41 I paid 1000.00 on 5/22/2023 I paid the remaining 114.41 on 8/18/2023 This is surprise billing practices. I'm not paying for this additional cpt code ***** being billed to me. I was not aware of the costs and would have refused the service if I was.

  Business Response

  Date: 09/01/2023

  CONFIDENTIAL PEER REVIEW
  
  September 1,2023
  
  Better Business Bureau
  1337 North Front Street
  Harrisburg, PA  17102
  Phone:************
  Fax:************
  
  RE: *****************************
  DOB:06/02/1976
  Complaint ID: ********
  Date of Service: 05/22/2023
  
  Dear ******************,
  
  I am responding on behalf of WellSpan Waynesboro Hospital to your letter of August 23,2023, regarding a potential concern involving the above-identified patients financial statement from WellSpan.
  
  First, please be assured that WellSpan ********** Hospital and other WellSpan Health providers are very committed to providing safe, high-quality care to all their patients, including the financial aspects of care. It is of utmost importance that we collaborate with the patients we serve. I also understand that **. ************ filed a similar complaint with the ************ Office of the Attorney General.
  
  The specific patient identified in your letter indicated concerns relative to a CPT code associated with an ultrasound study, and concerns of “surprise billing.” WellSpan Waynesboro Hospital understands that the Better Business Bureau is requesting information regarding these concerns.  A confidential financial investigation on *** ******’s concerns was conducted.  The investigation determined that:
  1.  *** ****** presented to the WellSpan ********** Hospital Imaging Service – Ultrasound for imaging ordered by her provider on May 22, 2023.  The ordering provider ordered this procedure per the Hospital’s ultrasound imaging protocol.
  2.  The indication for the imaging was “pain”.
  3.  Upon registration, *** ****** was advised of the Hospital’s treatment and billing practices, as well as her rights and responsibilities as a patient. Although *** ******’s concern does not constitute balance billing (sometimes referred to as “surprise billing”), she was advised of her rights and protections against surprise medical bills. Objective evidence demonstrating this advice, and her acknowledgement via signature.
  4.  Because of *** ******’s clinical presentation and imaging indication (pain), and the presence of additional abnormal findings, a duplex was performed to rule out any acute medical emergencies that might require immediate surgical intervention, consistent with the Hospital’s ultrasound imaging protocol that was ordered and approved by the ordering provider.
  5.  The additional CPT code in question was generated as a result of the above.
  6.  Relative to *** ******’s concern that the additional imaging was performed without a provider’s order, investigation indicated that the CPT code was appropriately applied consistent with CMS ordering guidelines due to meeting criteria as described above.
  
  As a result of the above outlined investigation, WellSpan will not be adjusting any outstanding bills for service as the investigation has revealed that the account was appropriately billed.
  
  Thank you for bringing this matter to our attention and providing us with the opportunity to investigate and respond.
  

  Sincerely,
  
  *************************
  Regional Director, Patient Experience
  Phone: ************

  Customer Answer

  Date: 09/02/2023

  [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:
  
  They are stating that additional testing was done. Nothing additional was done in comparison to the ultrasound I had done in October of 2021. 

  I went to the Dr due to the pain I was experiencing. If there was any chance that "additional" testing would be done why was it not included in the estimate?

  Concerning me "signing" anything, when checking in at outpatient you are to sign for them to "bill the insurance" is how it is stated to you. I was not agreeing to have anything more done then what was presented to me in the estimate.

  This billed needs adjusted and is still consider as surprise billing pratices in my book. I refuse to pay anything more on the bill.

  Regards,
  
  *****************************

  Business Response

  Date: 09/11/2023

  CONFIDENTIAL PEER REVIEW
  
  September 11,2023
  
  Better Business Bureau
  1337 North Front Street
  Harrisburg, PA  17102
  Phone:************
  Fax:************
  
  RE: *****************************
  DOB:06/02/1976
  Complaint ID: ********
  Date of Service: 05/22/2023
  
  Dear ******************,
  
  I am responding on behalf of WellSpan ********** Hospital to your last correspondence, regarding a potential concern involving the above-identified patient’s financial statement from WellSpan.
  
  Our previous response contained detailed information regarding our review of this case.  I am including this thorough analysis again below by way of review:
  
  The specific patient identified in your letter indicated concerns relative to a CPT code associated with an ultrasound study, and concerns of “surprise billing.” WellSpan ********** Hospital understands that the Better Business Bureau is requesting information regarding these concerns.  A confidential financial investigation on *** ******’s concerns was conducted.  The investigation determined that:
  *** ****** presented to the WellSpan ********** Hospital Imaging Service – Ultrasound for imaging ordered by her provider on May 22, 2023.  The ordering provider ordered this procedure per the Hospital’s ultrasound imaging protocol.
  The indication for the imaging was “pain”.
  Upon registration, *** ****** was advised of the Hospital’s treatment and billing practices, as well as her rights and responsibilities as a patient. Although *** ******’s concern does not constitute balance billing (sometimes referred to as “surprise billing”), she was advised of her rights and protections against surprise medical bills. Objective evidence demonstrating this advice, and her acknowledgement via signature.
  Because of *** ******’s clinical presentation and imaging indication (pain), and the presence of additional abnormal findings, a duplex was performed to rule out any acute medical emergencies that might require immediate surgical intervention, consistent with the Hospital’s ultrasound imaging protocol that was ordered and approved by the ordering provider.
  The additional CPT code in question was generated as a result of the above.
  Relative to *** ******’s concern that the additional imaging was performed without a provider’s order, investigation indicated that the CPT code was appropriately applied consistent with CMS ordering guidelines due to meeting criteria as described above.
  
  As a result of the above outlined investigation, WellSpan will not be adjusting any outstanding bills for service as the investigation has revealed that the account was appropriately billed.
  
  *** *******, our review brings us to the same conclusions and, therefore, we stand by our previous statements as noted above.  Our finance department has already expressed its willingness to work out a payment plan with the patient, as well as to explore other means of assistance. 
  

  Sincerely,
  
  *************************
  Regional Director, Patient Experience
  Phone: ************

  Customer Answer

  Date: 09/11/2023

  [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 stated previously, I presented to my Dr in pain and if there was a chance of additional diagnosis tests this should have been provided in the estimate. All wellspan is doing is repeating their previous response. I have yet to be given an explanation as to why the test result was amended with this additional diagnostic imaging over a month after the ultrasound was preformed. Ultrasound was completed on 5/22 test result was amended on 6/28. Also, when I checked in for the ultrasound I signed for the "insurance to be billed" is how it was said to me. 

  I have paid for the testing that I was aware of, provided in estimate. I will not pay for the additional code.
  
  Regards,
  
  *****************************