ComplaintsforAscension Health Inc

• Initial Complaint

  07/26/2024

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  The desired settlement is that Ascension re-code my son ******************************* medical visit as an "annual visit" and that our insurance be re-billed for this correct medical visit as ***'s annual well visit. Months in advance I had scheduled an annual medical visit for my minor age son ***************************. Near to the time of the appointment, the Ascension Doctor cancelled without stating why. I called Ascension and asked for another annual well visit for my son with his medical doctor and nothing was available for months. So then I asked Ascension for an annual medical visit with another medical doctor and again they said none was available for months. Ascension then offered a nurse instead for the annual visit. I scheduled it and then later called back and cancelled it. Even so we got a call asking us to confirm an appointment with a nurse for our son. My husband and I exchanged looks and decided to get our son ***'s annual well visit done with this nurse. Annual well visit was completed on Friday, May 31, 2024. In early June 2024 I got the bill and was upset that ***'s annual well visit had been charged as an office visit and they wanted us to pay $124.51 after our medical insurance "discount" of $12.49 had been applied. I tried calling them and couldn't get any relief anywhere I called. Frustrated, I went to the actual medical office and after talking with multiple staff was still frustrated. Their billing department has now in succession opened multiple cases "to review" the case and they keep pushing back the date when their "review" will be completed. Initially they said it would take 30 days and now it's ***** days. Now that I've written down a reference number B11452C3 I'm hoping they will complete their "review". I think this review is bogus.

  Customer response

  07/26/2024

  Completed HIPPA Form

  Customer response

  07/26/2024

  Completed HIPPA Form

  Business response

  07/31/2024

  **********************************,

  Thank you for bringing your experience to our attention so that we could resolve it and work to improve our experience for all patients. Our ***************** reviewed your request to refile your sons office visit as an annual visit. The ***************** reviewed the chart notes for the date of service and confirmed the appropriate office was charged. The provider did not perform an annual exam at this visit. It is noted that the visit was for the patient to obtain a referral to a specialist. 

  The Customer ******************** contacted you on 07/30/2024 and informed you of the coding review response. It was explained that there will be no changes made to your son's account at this time, as the office visit charge is correct. You are responsible for the remaining balance of $124.51 that was applied to your deductible.

  Additionally, thank you for your feedback on the experience attempting to resolve this issue with our **************************** It is our goal to always provide our patients with an excellent experience and we fell short here. Thank you for providing the feedback for us to address your concerns and to improve our experience for all those we serve. 

  If you have any additional questions, please feel free to reach out. Thank you for allowing us to serve you.

  Customer response

  08/01/2024

  Complaint: 22044432
  
  I have reviewed the business' response and am rejecting it because:
  
  1) I had clearly booked an annual medical exam. I had booked an annual with **** doctor ****** in advance and shortly before the appointment was to occur, the doctor cancelled. I had called Ascension told them of the doctors cancellation and asked for another appointment and nothing was available in the near term, same when I asked for an appointment with another doctor, again nothing available in near term. Instead Ascension offered an annual exam with one of their nurses. Appointment was to be for an annual exam . I have never heard of a medical office this situation in my 57 years for a medical office to charge for a medical referral. Ascension staff has stated that a referral request for them automatically means an office visit is charged no matter what. I have had two As ensign staff members tell me that. This is aberrant for my lifetime of experiences with doctorss offices. Normally as long as you are a regular patient there, the office will create a referral, no extra charge and no extra office visit. Normally medical offices will take about 1 week to get a patient a medical referral. Here with Ascension they are literally charging a fee for a medical referral by insisting an office visit be charged. This is abnormal. I noticed on ****** reviews that other patients were also complaining about this irregular Ascension LLC medical practice of charging patients for medical referrals. To me it looks like fraud. My family should not be charged a fee for a medical referral. The nurse incorrectly coded this as an office visit instead of an annual well visit only because Ascension LLC wants to bill patients for medical referrals. 2) I have also observed in my two ascension annual well visit that the medical provider, examining doctor or nurse practitioner spends bulk of time with patient offering / selling additional medical services; theyve stopped actually physically examining patients. Other patients have complained about this on ****** reviews. One lady who requested what used to be a normal physical exam , was charged an office visit instead of an annual well visit; she too was frustrated dealing with Ascension LLC. I think my sons visit should count as his annual 2024 well visit. 

  
  
  Sincerely,
  
  *****************************

  Customer response

  08/01/2024

  More Complaint: 22044432??I have reviewed the business' response and am rejecting it because:??1) I had clearly booked an annual medical exam. I had booked an annual with **** doctor ****** in advance and shortly before the appointment was to occur, the doctor cancelled. I had called Ascension told them of the doctors cancellation and asked for another appointment and nothing was available in the near term, same when I asked for an appointment with another doctor, again nothing available in near term. Instead Ascension offered an annual exam with one of their nurses. Appointment was to be for an annual exam . I have never heard of a medical office this situation in my 57 years for a medical office to charge for a medical referral. Ascension staff has stated that a referral request for them automatically means an office visit is charged no matter what. I have had two As ensign staff members tell me that. This is aberrant for my lifetime of experiences with doctorss offices. Normally as long as you are a regular patient there, the office will create a referral, no extra charge and no extra office visit. Normally medical offices will take about 1 week to get a patient a medical referral. Here with Ascension they are literally charging a fee for a medical referral by insisting an office visit be charged. This is abnormal. I noticed on ****** reviews that other patients were also complaining about this irregular Ascension LLC medical practice of charging patients for medical referrals. To me it looks like fraud. My family should not be charged a fee for a medical referral. The nurse incorrectly coded this as an office visit instead of an annual well visit only because Ascension LLC wants to bill patients for medical referrals. 2) I have also observed in my two ascension annual well visit that the medical provider, examining doctor or nurse practitioner spends bulk of time with patient offering / selling additional medical services; theyve stopped actually physically examining patients. Other patients have complained about this on ****** reviews. One lady who requested what used to be a normal physical exam , was charged an office visit instead of an annual well visit; she too was frustrated dealing with Ascension LLC. I think my sons visit should count as his annual 2024 well visit. 
  ??Sincerely,??*****************************

• Initial Complaint

  07/22/2024

  Complaint Type:

  Billing Issues

  Status:

  Resolved

  More info

  I gave birth at Ascension ************** on 2/7. I currently have an account balance of $2,782.85 which is not correct. A payment was made from my health fund (also managed by my insurance) on March 29th, which included the deductible of $2,782.85. The trace number for the payment is ***************. The discrepancy is driven by an accounting error on Ascension's part which does not write off enough based on the negotiated rate with the insurance. I provided two EOBs from my insurance and the payment details that include the $2,782.85. My insurance company also provided this information. It has been several months, and this issue has still not been resolved. I continue to be harassed to pay the amount I've already paid. They need to write-off the $2,782.85 so I do no continue to receive bills.*********************** ************

  Customer response

  08/07/2024

  Per your request, I have revised the "to" from Ascension ****************************************. Please let me know if you need anything further. Thank you. 

  Customer response

  08/07/2024

  Not sure if I included my account number in the original complaint, but it's SA0038136156

  Business response

  08/09/2024

  ***************************,

  Thank you for sharing your recent experience with us and giving our team the opportunity to resolve your concern and improve the experience for all those we serve. We have reviewed your account concerns. We spoke originally on 5/6/2024 regarding your visit onoh, 2/7/2024. Per review, of your account your insurance was rebilled on 5/6/2024. At that time, we were showing a balance of $2,782.85. On 6/6/2024 we found the claim was already billed/adjusted and paid by primary
  insurance, so the claim was denied as a duplicate. 

  After further follow up with your insurance we found the claim was filed to Aetna for charges $24,249.17 and was split into two different charges, the charges $10,410.90 was paid on 04/03/2024 by ***** leaving a patient responsibility of $2,782.85 as Deductible. We were able to locate the payment of $2,782.85 paid by your Health Savings account and had it posted to your account. As of 8/7/2024, your account has been adjusted to a zero-dollar balance. 

  Additionally, we thank you for your feedback about your experience attempting to resolve this issue with our **************** team. Your concerns have been relayed to leadership and we are working with our team to re-educate on escalations, so we can resolve concerns more quickly. It is our goal to always provide our patients with an excellent experience and we fell short here. 

  Thank you for allowing us to serve you.

  Customer response

  08/12/2024

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

• Initial Complaint

  07/03/2024

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  Doctors visit 2/14/2024. Received text asking for copay. Told them to send me a bill, because twice I paid a copay in the office during online check-in for other providers and later found out there was no copay. Never received a refund, just a run around. I vowed never to pay during check in again. I received a paper bill mid March and paid through online checking on 3/29/2024 after verifying the account number was the same. Received a past due notice on 4/13/2024. I called and spoke with ******* who told me when it's paid online, it gets credited right away, but if it's a check it sits in a pile for a long time. He told me to send proof of payment to ****************************** I did this on 5/8 and received another past due notice on 5/18 and a "final notice" on 6/22. I work at Ascension and this same thing happened a year ago and my manager was able to find me some one in the hospital financial area who was able to resolve it. I found that person again and was told they are no longer able to deal with billing issues. Another example of how bad the billing system is at Ascension: I have been paying bills for my elderly mother for the last 9 years. Every time I paid a bill for her, they would send another bill 4-5 months later. It took me paying one bill three times before I realized it was the same amount sent out of her online bill pay account. I only got a refund after taking it to my in-house financial people. To me this seems fraudulent. I wonder how many people just pay with out thinking. I started asking for itemized bills for her, before I paid them and have never received one, even though there is a phone tree where you can request one. More fraud?

  Customer response

  07/05/2024

  SOMEHOW A SCREEN SHOT OF SOMETHING ELSE WAS SENT WITH THE ORIGINAL COMPLAINT.  DISREGARD THAT AND USE THESE.

  Customer response

  07/06/2024

  The screenshot on the original complaint was sent by accident.  I resent 4 copies of bill and payment info, but I don't see the new ones, just an original screenshot.  Did you get it, or do I need to resend?

  Customer response

  08/03/2024

  On 7/25/24 I received a voice mail message to call ******* at ******* billing.  I have called ************** almost every day since and keep getting a message that says:  "******* has no voicemail. I'm not sure what to do now.

  Business response

  08/09/2024

  Our billing team has completed three outreach attempts to ******************** but has been unable to connect with her to obtain additional required information to investigate her concerns.. The proof of payment sent to our teams does not provide the check # and date the payment cleared her account. We have left several voicemails advising ******************** to contact the leader investigating her concern directly to get information to research the missing payment.
  
  
  
  
  
  
  
  

  Business response

  08/20/2024

  ************************************,

  Thank you for bringing your experience to our attention so that we could resolve it and work to
  improve our experience for our future patients. Our *************************** reviewed your
  complaint related to the missing $30.00 payment. Unfortunately, we have been unable to locate
  the payment with the information provided.

  The ***************************** has tried reaching you multiple times with no success.
  ******* received your return call on Saturday 8/3/24, although no voicemail was left *******
  returned your call on 8/5/24 upon review of missed calls from her call log. ******* was not able
  to leave a voicemail at this time due to the ****** Assist call screening tool. An additional
  outreach was attempted again 8/16/24 and no voicemail option was available due to the ******
  Assist call screening tool. To move forward with researching the missing payment in question,
  we need the check number and date the check cleared your account. Please reach out to us at
  your earliest convince in order to resolve this issue.

  Additionally, thank you for your feedback on the experience attempting to resolve this issue with
  our **************************** It is our goal to always provide our patients with an excellent
  experience. Thank you for providing the feedback for us to address your concerns and to
  improve our experience for all those we serve.

  If you have any additional questions, please feel free to reach out.
  ***************************** Office Phone Number ************
  Alternate ************************* Office Phone Number ************
  
  Thank you for allowing us to serve you.

• Initial Complaint

  06/25/2024

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  I went to Ascension all Saints hospital urgent care on 7/17/23. It was initially billed wrong as emergency room visit. This results of me overpaying the bill by $168 with the payment plan. Once the billing was corrected, the Hosptial never credit me back on the overpaid amount. I had called 3x and spoke with different associates without any result. I finally filed a complaint online and was contacted by Ascension custom service on 4/15/24 by the name of ******. She insured me that this will be review and contact me back. She never did. I did got hold of her on the phone on 4/23/24. She agreed I should have receive credit to the other account. I have not see any credit applied to my account. I called on 5/6/24. 6/13/24 and 6/14/24. Left vm with no call back. I just want what I overpaid credit to the other charge. It has been very difficulty to get hold of anyone, let alone to get anything done with this healthcare ***

  Business response

  07/26/2024

  **************,
  
  Thank you for sharing your recent experience with us and allowing our team to resolve your concern and improve the experience for all those we serve. Our **************** team reached out to you concerning three payments totaling $600.00 allocated to your clinical accounts with physicians' billing. 
  
  The initial account, date of service 7/17/2023, is currently pending insurance processing for correct total charges. The payments made on 10/3/23, 10/25/23, and 11/25/2023 were posted to this account causing an incorrect credit balance. The payments were transferred to your clinical accounts as there were open balances. Per our conversation dated 7/25/2024, payments will remain on the accounts.
  
  Additionally, thank you for your feedback about your experience attempting to resolve this issue with our Customer Resolution **********************. There was an opportunity to escalate and resolve payment escalation sooner. We are working with our team to re-educate on escalations, so we resolve concerns more quickly. It is our goal to always provide our patients with an excellent experience and we fell short here. 
  
  Thank you for allowing us to serve you.

• Initial Complaint

  06/24/2024

  Complaint Type:

  Billing Issues

  Status:

  Resolved

  More info

  March 10, 2024, I had occasion to visit Ascension St Vincent *************, **. April 15, 2024 I received a bill that was created reflecting the cost affiliated with that service. All but $166.13 was covered by insurance. I paid the amount due May 4, 2024 by check # ****. .June 5, 2024, I received an explanation of benefits from my supplement carrier, Cigna, showing that they did in fact cover the amount of $166.13 due for the service. I then initiated contact with Ascension ****************** to claim a refund. To my dismay I was connected to a person in another country who requested copies of documents supporting my refund claim. I emailed the documents to the address provided and was told at the time to call back in 7-10 business days( time required for them to receive same). 6-17-2024 I contacted them again. They advised me that they received my documents but 1 page was blank. I feel that I am getting push back for no reason. my account should reflect the payment made as it was cashed May 15, 2024. They told me my records showed no payment,I was told by the Evansville BBB that I should contact you for issue with Ascension which I am doing.I want the $166.13 refunded.

  Business response

  07/31/2024

  ******************,

  Thank you for sharing your recent experience with us and giving our team the opportunity to resolve your concern and improve the experience for all those we serve. Our Customer Service team attempted to reach you on 07/26/24, 07/29/24, 7/31/24 to communicate the details below. 

  Per review, your secondary insurance did make a payment but the account is not showing as a patient credit. You called into the *************************** regarding your patient refund on 06/17/24, 06/17/27, 07/16/24, and 07/26/24. The agent did advise you that in order to receive a refund they would need proof of payment and gave you the email address where you can send the documentation, *************************** Once your proof of payment was received, the information was escalated to our *********************** who was able to locate your payment, post, and
  request a refund for you. Unfortunately, due to the Ascension cyberattack system outage caused a delay in posting your payment. 

  Additionally, thank you for your feedback about your experience attempting to resolve this issue with our Customer Resolution **********************. There was an attempt to communicate the final resolution but unsuccessful on 05/16/2023 we will continue to reach out. It is our goal to always provide our patients with an excellent experience and we fell short here. Thank you for allowing us to serve you.

  Customer response

  08/03/2024

  Complaint: 21894031
  
  I have reviewed the business' response and am CONDITONALLY rejecting it because: I have not yet received the refund. Once the refund is received we will gladly accept the resolution. 
  
  
  
  Sincerely,
  
  *************************

  Customer response

  08/12/2024

  The complaint has been resolved.  They sent us a check.  

• Initial Complaint

  06/18/2024

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  On 12/11/23, I received medical care for an ultrasound and an ***. Subsequently, I was billed $2,024.30 for the services rendered. Upon receiving this bill, I was shocked and dismayed by the apparent discrepancy between the expected cost and the actual charges levied by Ascension ****************. Not only do these charges seem to vastly exceed typical rates for such services, but they also appear to be inconsistent with the prevailing healthcare pricing standards in our region. In particular, the charges for the ultrasound and *** strike me as inflated and not reflective of fair market prices. To illustrate, the healthcare bluebook states a fair price in this area for an ultrasound is $167, I was charged twelve times higher than this amount. The healthcare bluebook states a fair price for an *** in my area is $657 for an *** and I was charged five times higher than this amount. Moreover, my husband recently underwent an *** procedure at SunCoast Diagnostic Imaging in the same area, for which the charge amounted to $1,899. In ***** contrast, the fee for my *** was more than double this figure. Such a discrepancy leads me to believe that these prices are excessively inflated.When I contacted Ascension Sacred Heart Bay's billing department to discuss the unfair pricing of the *** and ultrasound bills, I was informed that my insurance company determines the costs for the imaging services, not the hospital. Despite my attempts to resolve this matter directly with the hospitals billing department, my concerns have not been adequately addressed. Moreover, I have been informed that failure to pay the disputed amount could result in my account being turned over to a collections agency.

  Business response

  08/09/2024

  August 9, 2024
  
  Ms. ***********************
  ****************************************************************************
  
  ****************,

  Thank you for taking the time to connect and share your concerns. At Ascension Bay Medical *********************, we are committed to always listening to those we are privileged to serve and to delivering compassionate, personalized care. Our leadership team takes your feedback
  seriously and we have thoroughly reviewed your concerns. 

  You are concerned about the billing for an ultrasound and MRI that were performed on 12/11/23. You feel that there was a discrepancy between the expected cost and the actual charges from Bay Medical. You noted that not only do these charges seem to vastly exceed typical rates for such services, but they also appear to be inconsistent with the prevailing healthcare pricing standards in our region. You feel that the charges are inflated and not reflective of fair market prices.

  Price transparency is a perennial issue in healthcare. On behalf of our team, I would like to offer our sincere apology for any miscommunication regarding billing for these hospital-based services. The billing for your services are accurate; hospital-based charges are typically higher than free-standing MRI facilities (as noted in your comparison to ************************************************************* are held to different regulatory and quality requirements and also incur higher inherent costs for these services. While we understand that this outcome was unexpected, please know that our team did everything they could to provide the best care and treatment.

  Thank you for giving our team at Ascension Bay Medical ********************* the important opportunity to review our process and resolve your concerns. Please contact me if you have any additional questions or concerns. I can be reached at ******************************************** or ************. 

  Sincerely,
  *************************
  Consumer Experience Manager
  Ascension *******

  Customer response

  08/19/2024

  Complaint: 21866788
  
  I have reviewed the business' response and am rejecting it because:

  The business has not provided an explanation for why their MRI prices are six times higher and their ultrasound costs are twelve times higher than the fair prices listed by the Healthcare Bluebook for this area.  

  
  
  
  Sincerely,
  
  ***************************

• Initial Complaint

  06/18/2024

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  On October 31, 2023, I underwent a routine *************************, a straightforward 45-minute procedure with no complications, I was discharged from the Hospital in less than 24 hours. My surgeon confirmed that the procedure did not qualify as a Level 5 surgery. However, I was billed as such, resulting in charges that are six times the standard cost for this procedure in ******, ******The discrepancies in the bill include repetitive charges and an overall amount that does not align with the nature of the procedure. Despite assurances from hospital staff that an audit was conducted and a revised bill would be issued, my requests for an itemized breakdown and formal explanation have been ignored.I have reached out to the hospital's billing department over a dozen times since December, speaking with various representatives, even sent a certified mail letter to the hospital CEO, the letter was received and signed by his office on May 10th but have yet to see any resolution. This situation has caused significant distress and anxiety, impacting my family's well-being.I am deeply disappointed with the lack of urgency and transparency in addressing my concerns. I urge potential patients to be cautious and aware of potential billing issues with this institution. I am now left with no option but to escalate this matter further if it is not resolved promptly.

  Business response

  08/12/2024

  Mr. **** ******, 

  Thank you for sharing your recent experience with us and giving our team the opportunity to resolve your concern and improve the experience for all those we serve. Our Customer Service team reached out to you on 03/06/2024 to confirm there are no duplicate charges for your 10/23/2023 date of service. It was determined the correct surgery level 5 classification billed under OR services, is for the use of the Operating Room including set up and tear down time; number of staff need for the procedure including nurses and OR technicians. In addition, your case required the use of robotic equipment, other specific equipment, and supplies that are not billed separately.

  The self-pay discount of $18,178.87 was applied to your account leaving a patient responsibility $42,417.38. On 12/05/2023 we received a payment of $5,000.00 leaving a remaining balance due of $37,417.38. On 07/03/2024 we spoke your patient advocate ********* ******, who was advised the hospital does not offer a pay in full discount, however the details of our financial assistance option were discussed. ******** advised our representative that you would be going online to fill out that application. 

  Additionally, thank you for your feedback about your experience attempting to resolve this issue with our Customer Resolution **********************. It is our goal to always provide our patients with an excellent experience and we fell short here. Thank you for allowing us to serve you.

  Customer response

  08/14/2024

  Complaint: 21866309
  
  I have reviewed the business' response and am rejecting it because:

  The continued lack of follow-through and transparency regarding the billing errors for my surgical procedure is unacceptable. The surgery took place on October 31, 2023, not on October 23, 2023, as misstated by your team and the hospital's response to the Better Business Bureau. This discrepancy is just another example of how disorganized and untrustworthy your handling of my situation has been
  
  A representative named Kuana assured me that my account was under review and that I would receive updates and necessary documentation about the billing audit and pricing structure. Despite these assurances, I have not received any further communication or documentation, which raises serious concerns about the fairness and transparency of your billing practices.
  
  Hospitals are legally required to provide clear pricing information under both Texas and federal laws, including the Hospital Price Transparency Rule. The failure to provide this information undermines the integrity of your billing process and my ability to make informed decisions about my care.
  
  This unresolved issue, combined with the suggestion that I apply for financial aid, implies an acceptance of inflated charges, which may be in violation of state and federal laws. I insist on receiving all missing documentation, a detailed explanation of discounts applied, and a commitment to a resolution timeline.
  
  I remain open to clear communication to resolve this matter.
  
  Sincerely,
  
  **** ******

  Business response

  08/27/2024

  Mr. **** ******,

  Thank you for sharing your recent experience with us and giving our team the opportunity to resolve your concern and improve the experience for all those we serve. Our Customer Service team reached out to you on 03/06/2024 to confirm there are no duplicate charges for your 10/31/2023 date of service. It was determined the correct surgery level 5 classification billed under OR services, is for the use of the Operating Room including set up and tear down time;
  number of staff need for the procedure including nurses and OR technicians. In addition, your case required the use of robotic equipment, other specific equipment, and supplies that are not billed separately.

  The self-pay discount of $18,178.87 was applied to your account leaving a patient responsibility $42,417.38. On 12/05/2023 we received a payment of $5000.00 leaving a remaining balance due of $37,417.38. On 07/03/2024 we spoke to your patient advocate ********* ******, who was advised the hospital does not offer a discount, however the details of our financial assistance option were discussed. ******** advised our representative that you would be going online to fill out that application. 

  The following outreach attempts have been made to reach you to provide additional updates.
  ? 8/22/2024 @ 4:00pm EST ************ a voicemail message was left for you to call direct to discuss account details. Your Guarantor left a voicemail message at 5:47pm EST after business hours.
  ? 8/23/2024 @3:42pm EST a voicemail was left for you at ************ advising you to call direct to discuss account details.
  ? 8/26/2024 @ 11:51am EST a voicemail message was left for you, asking to call back to discuss account details. You left a voicemail at 12:00pm EST.
  ? 8/26/2024 Returned your call to ************@ 3:31pm EST I left a voicemail message to call direct to discuss account details.
  ? 8/27/2024 I spoke with you, Mr. **** ******, I advised we have revised the BBB complaint response to include the correct dos. I also sent another financial assistance application. I advised all coding and pricing has been reviewed by our audit team, after reviewing it has been determined that all coding and pricing is correct and supported by your medical records.

  Additionally, thank you for your feedback about your experience attempting to resolve this issue with our Customer Resolution **********************. It is our goal to always provide our patients with an excellent experience. Thank you for allowing us to serve you.

  Customer response

  08/30/2024

  Complaint: 21866309
  
  I have reviewed the business' response and am rejecting it because:

  Your response fails to address the essential documentation and explanations I have repeatedly requested. These documents are crucial for verifying the charges applied to my account. To date, I have not received the detailed audit findings or a comprehensive price list, which are fundamental to justifying the charges billed.
  
  Additionally, I must express my concern regarding the hospital's failure to provide a satisfactory explanation for the charges applied to my account, which are approximately six times higher than the average cost of a ************************* in ******, *****. According to Healthcare Bluebook, the average price for this procedure ranges between $7,000 to $13,000. It is important to note that ************************* is not new technology; it has been the preferred method for this type of surgery for decades. The lack of a clear justification for such a substantial deviation from standard regional costs raises serious questions about the billing practices and transparency of your institution.
  
  Furthermore, the numerous phone calls mentioned in your response, while noted, have not been productive. I have consistently returned each missed call as you've stated in your message and even suggested scheduling a specific time for a discussion to avoid further back-and-forth communication. Scheduling calls ahead of time would significantly streamline this process, accommodating my work commitments and ensuring that we can discuss these matters without unnecessary delays. This structured approach would facilitate a more effective and efficient resolution, which is in the best interest of all parties involved.
  
  Moreover, your message indicates that a financial assistance application was sent; however, I have not received any such email or mail correspondence. The lack of this information, coupled with the mention of potentially sending my account to collections, adds significant stress and urgency to an already distressing situation.
  
  It is particularly concerning that despite my direct letter to the CEO and numerous follow-ups, the hospital has not escalated my case to the administration level where more substantive decisions might be considered. According to ******, a liaison from your team, only a review of the BBB complaint might trigger such escalation. This approach seems to circumvent a genuine resolution and focuses merely on minimal engagement to avoid negative reviews, rather than addressing the heart of the issue.
  
  Despite numerous attempts to resolve this matter amicably and transparently, your recent communications have not adequately addressed the critical points raised in my previous correspondence, nor have they moved us closer to a resolution. Given these circumstances, I must insist once again on the following immediate actions:
  
  Provision of all requested documentation, including audit details and a pricing list, to substantiate the billing.
  Copies of your hospital's written policies on patient billing disputes and communications. This documentation is crucial for understanding your procedures and ensuring that they are followed correctly.
  A scheduled call, at a mutually agreeable time, to discuss this matter thoroughly with someone who has decision-making authority.
  Direct escalation of my case to the administration level to explore all possible resolutions.

  Please understand, the resolution of this matter is of the utmost urgency. 
  
  I look forward to your prompt and decisive action on this matter.
  
  Sincerely,
  
  **** ******

  Business response

  09/11/2024

  Mr. **** ******,

  Thank you for sharing your recent experience with us and giving our team the opportunity to resolve your concern and improve the experience for all those we serve. Our **************** team reached out to you on 03/06/2024 to confirm there are no duplicate charges for your 10/31/2023 date of service. It was determined the correct surgery level 5 classification billed under OR services is for the use of the Operating Room including set up and tear down time and the number of staff needed for the procedure including nurses and OR technicians. In addition, your case required the use of robotic equipment, other specific equipment, and supplies that are not billed separately.

  A self-pay discount of $18,178.87 was applied to your account leaving a patient responsibility of $42,417.38 initially. On 12/05/2023, we received a payment of $5,000.00 leaving a remaining balance due of $37,417.38. On 8/1/2024, $13,331.17 was adjusted, resulting in a new balance of $23,027.51. You spoke to our Customer Relations Liaison on 9/4/2024 and were advised of the $23,037.51 balance; the Liaison also advised of financial assistance options available from Ascension to address the remaining balance and sent a financial assistance application to your address on file.

  As of 9/10/2024, an additional adjustment of $6,976.78 was applied to your account leaving a patient responsibility balance of $16,060.73. Our Customer Relations Liaison spoke with you on 9/10/2024 to communicate the updated balance.

  Please note that due to the Ascension cybersecurity outage, there will be a delay in receiving an updated patient statement reflecting this $16,060.73 amount, however your balance is not aging. In the meantime, please expect to receive to your mailing address on file an itemized statement including a breakdown of all charges, discounts, and adjustments as well as the final total patient responsibility balance as of 9/10/24 of $16,060.73 for your records.

  After you have received and have an opportunity to review that itemized statement, should you have any further questions on the charges or overall balance, please feel free to reach back out to the Customer Relations Liaison whom you spoke with most recently to address any further questions or concerns. 

  Additionally, thank you for your feedback about your experience attempting to resolve this issue with our Customer Resolution **********************. It is our goal to always provide our patients with an excellent experience and we fell short here.

  Thank you for allowing us to serve you.
  

  
  

  Business response

  09/30/2024

  Mr. **** ******,

  Thank you for sharing your recent experience with us and giving our team the opportunity to resolve your concern and improve the experience for all those we serve. Our **************** team reached out to you on 03/06/2024 to confirm there are no duplicate charges for your 10/31/2023 date of service. It was determined the correct surgery level 5 classification billed under OR services is for the use of the Operating Room including set up and tear down time and the number of staff need for the procedure including nurses and OR technicians. In addition, your case required the use of robotic equipment, other specific equipment, and supplies that are not billed separately.

  A self-pay discount of $18,178.87 was applied to your account leaving a patient responsibility of $42,417.38 initially. On 12/05/2023, we received a payment of $5,000.00 leaving a remaining balance due of $37,417.38. On 8/1/2024, $13,331.17 was adjusted, resulting in a new balance of $23,027.51. You spoke to our Customer Relations Liaison on 9/04/2024 and were advised of the $23,037.51 balance; the Liaison also advised of financial assistance options available from Ascension to address the remaining balance and sent a financial assistance application to your address on file.

  As of 9/10/2024, an additional adjustment of $6,976.78 was applied to your account leaving a patient responsibility balance of $16,060.73. Our Customer Relations Liaison spoke with you on 9/10/2024 to communicate the updated balance.
  

  On 9/13/2024, Ascension received an additional rejection from the BBB on your behalf. After scheduling time to speak with you on 9/16/2024 to better understand the rejection, our Customer Relations Liaison and Customer Relations Director communicated that a request would be made to Ascension leadership to consider an administrative adjustment to the $16,060.73 remaining balance in order to bring the remaining patient responsibility balance closer to the $7,000.00 - $13,000.00 price range expectation mentioned in your BBB rejection letter as located on the Healthcare Bluebook website.
  

  On 9/27/2024, we received a determination via email from the Ascension Seton *************** Officer and the Ascension Seton President stating that an additional discount would not be applied to the remaining $16,060.73 patient responsibility amount. Our Customer Relations Liaison spoke with you on 9/27/2024 to communicate this outcome.
  

  Per your request to the BBB, the following documentation has been provided to support the pricing in
  question:
  ? Financial Assistance Application mailed to your mailing address on file (*********************************************************) on 9/04/2024
  ? Pricing List mailed to you at your mailing address on file (******************************
  78738) on 9/10/2024
  ? Audit Details sent to you via email *********************** on 9/20/2024 in a PDF titled
  744886104 ************************** Patient Billing Disputes/Communications Written Policy sent to you via email
  *********************** on 9/20/2024 in a PDF titled ***** Patient Rights & Responsibilities
  

  Please note that due to the Ascension cybersecurity outage, there will be a delay in receiving an updated patient statement reflecting this $16,060.73 amount, however your balance is not aging. As previously communicated, once you receive your patient billing statement for the $16,060.73 amount, Ascension offers both Financial Assistance if qualified as well as interest-free payment arrangements which can be set up with our **************** team over the phone or via the Ascension Seton website.
  

  Additionally, thank you for your feedback about your experience attempting to resolve this issue with our Customer Resolution **********************. It is our goal to always provide our patients with an excellent experience and we fell short here.
  

  Thank you for allowing us to serve you.

  Customer response

  10/02/2024

  Complaint: 21866309
  
  I have reviewed the business' response and am rejecting it because after reviewing the provided documentation, I would like to highlight a few ongoing concerns and request additional clarification.
  
  1. Audit Lacked Depth and Transparency:
  The audit document I received was brief and largely focused on recalling the timeline of our conversations and audit requests rather than providing significant answers to my concerns. It consisted of only one page and did not offer a thorough analysis or breakdown of the charges, particularly regarding the classification of the surgery as a Level 5 procedure.
  
  As I mentioned previously, my surgeon indicated that the surgery should have been categorized at a lower level, and this discrepancy has not been adequately addressed in the audit. I believe a more in-depth explanation is necessary, particularly concerning the specific factors that led to the surgery being classified at Level 5, including the equipment and staff used. Simply confirming the charge as valid without a clear explanation leaves my concerns unresolved.
  
  2. Pricing List Provided Was Unhelpful:
  Regarding the pricing list, I was directed to a link where I had to enter my procedure and location to receive an estimate. Interestingly, while several types of laparoscopic procedures were listed, I was unable to find the specific procedure for an appendectomy. Moreover, the list provided includes procedure codes that are difficult for a regular patient to interpret, making it challenging to identify the correct service or estimate.
  
  This lack of clarity and accessibility only added to my confusion. As a patient, I expect transparent and easy-to-understand pricing information, and this process was not helpful in addressing my concerns about the final costs. A direct, clear explanation of the specific charges related to my case, without relying on confusing codes or requiring patients to conduct their own research, would have been far more effective.
  
  3. Surgery Classification (Level 5 vs. Level 1):
  I understand that the Level 5 classification was applied based on the use of the Operating Room, setup and teardown time, and the number of staff involved (including nurses and OR technicians). However, given my surgeons initial assessment, I still believe a more detailed justification for the Level 5 classification is warranted. If robotic equipment and other specialized supplies were included in this classification, I request a clear itemization of how these additional factors contributed to the overall cost.
  
  4. Financial Assistance and Adjustments:
  I appreciate the financial adjustments made, including the reduction of my patient responsibility balance to $16,060.73. However, in our last call, you mentioned that the hospital leadership will not consider any additional price reductions. Based on industry-standard pricing for this procedure (as referenced in the Healthcare Bluebook), I believe the final amount should fall closer to the lower end of $7,000 to $13,000 range. Given this pricing discrepancy between the standard rates and the final billed amount, I believe a further review is necessary to reconcile the remaining balance with industry-standard expectations.
  
  5. Next Steps:
  To resolve this matter, I request a final review of my case by either an internal team specializing in medical billing or an independent third-party auditor. This would ensure the charges, including the surgery classification and bundled items, are accurate and appropriately applied according to industry standards. 
  
  Thank you again for your time and for working with me to resolve this issue. I look forward to your response and hope we can come to a mutually satisfactory resolution.
  
  Sincerely,
  **** ******

• Initial Complaint

  06/17/2024

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  Date of services 1/27/2024 after L/D at Ascension Seton Central. Account numbers, Child (***********************-JP) ********* and my (*************************) *********. My insurance BCBS TX with subscriber ID ************. Jaymies plan, BCBS TX with subscriber ID ************. Secondary for first 30 days of life is mine. ******: Contacted their billing department on 3/27 at **************, updated my childs insurance to add my spouses insurance policy while keeping my insurance told it would take ***** days. Called again on 3/28, 4/5 and 4/15/2024 my insurance as secondary had not been billed. I called on 5/1/2024 and 5/9 to ask about a PAST DUE statement reflecting a balance of ~1700 but still not sent to my ************** I was told to not worry about it since in their system it was shown as attempting to bill to secondary insurance. I sent three separate electronic inquiries, still not sent to secondary insurance. For Mine (******): Called for my account on 3/27 and 4/15/2024, 5/1/2024, 5/7. Every time I am told I do not have a finalized statement to pay my bill. First, they billed another insurance I did not auth to bill violating HIPPA. Then I call and they have three insurances on my account with one of them being my daughters account number. After asking, was told they did not offer a prompt discount. As I am on the call, I check Ascensions Financial Assistance Policy (attached) and they do. I questioned the **** he lied, spun a narrative of only certain ascension seton hospitals offering it. They do, its on the same policy. The last time I called I was told they do not have a finalized statement, that my insurance with BCBS needed to send an EOB. My insurance has processed it as of February of 2024. He denies this. I call my insurance, they confirm it. My insurance called them, and they denied having it, then admit to having but could not give them a timeframe as to how long it would take to provide finalized statement until their system has updated.

  Customer response

  06/26/2024

  I attempted to reach out again about *********************** account and received misleading information. Attached is the info from the *** stating they submitted the claim to her secondary insurance on 5/1/2024, then they state 6/3/2024. When asked what date on a separate message there is no date and I have to ask them to clarify to which they respond it was sent on 5/1/2024 but due to a cyberattack it is taking longer to process. This does not make sense to me in that there is no record it has gotten to the secondary insurance which wouldnt be affected with the cyberattack. I am given misleading, false information with no clear answers. 

  Customer response

  06/26/2024

  I attempted to reach out again about *********************** account and received misleading information. Attached is the info from the *** stating they submitted the claim to her secondary insurance on 5/1/2024, then they state 6/3/2024. When asked what date on a separate message there is no date and I have to ask them to clarify to which they respond it was sent on 5/1/2024 but due to a cyberattack it is taking longer to process. This does not make sense to me in that there is no record it has gotten to the secondary insurance which wouldnt be affected with the cyberattack. I am given misleading, false information with no clear answers. 

  Business response

  07/26/2024

  *****************,

  Thank you for sharing your recent experience with us and giving our team the opportunity to resolve your concern and improve the experience for all those we serve. You reached out to our customer service department to informed us that you wanted to have your daughters account sent to your secondary insurance company. We made an outreach attempt which resulted in a voicemail on 7/22/2024 and spoke to you on 7/25/2024 regarding your account. You were advised of the following below. 

  A claim was sent for your account to the secondary insurance company for processing on 7/22/2024. Please allow ***** days for its completion, at which time you will be sent a bill to reflect the patient responsibility. 

  Additionally, thank you for your feedback about your experience attempting to resolve this issue with our Customer Resolution **********************. There was an opportunity to escalate and resolve billing concerns sooner, but we did not execute on that. We are collaborating with our team to re-educate on escalations, so that we can resolve concerns more quickly. It is our goal to always provide our patients with an excellent experience and we fell short here. 

  Thank you for allowing us to serve you.

  Customer response

  07/29/2024

  Complaint: 21862907
  
  I have reviewed the business' response and am rejecting it because:

  I received a call on Monday at about 2pm stating my insurance denied the claim due to subscriber not enrolled but active at the time of service but there is no record of this from my insurance. They stated the insurance reported it was denied. I contacted my insurance, and they have no record of this. They have no record of any of the claims Ascension has stated they have previously submitted. At this time there is no record of the denial only a verbal communication from Ascensions billing department and this is not appropriate given there should be a claim attached with an explanation of benefits if it was indeed denied. My insurance is stating my daughter is active on the policy, auto enrolled and active for dates of service 1/27-1/29. 

  What is the reason this is not being sent to my insurance?

  
  
  
  Sincerely,
  
  ***********************

  Customer response

  07/29/2024

  Additionally, this response does not address the full complaint. It does not address my account and the status of the account and how I can go about making payment arrangements.

  Business response

  08/22/2024

  *****************, 

  Thank you for sharing your recent experience with us and giving our team the opportunity to resolve your concern and improve the experience for all those we serve. You reached out to our customer service department to informed us that you wanted to assistance on your account and how you can make a payment. Additionally, you wanted to have your daughter's account sent to your secondary insurance company. We made an outreach attempt on 8/16/2024 and spoke to you regarding your account. You were advised of the following below.   

  A claim was sent for your daughter's account to the secondary insurance company for processing on 7/22/2024. After further review it was realized that the claim had not been successfully transmitted electronically. On 8/15/2024 a request to have the claim sent as a paper claim was submitted. Please allow ***** days for its completion, at which time you will be sent a bill to reflect the patient's responsibility.  Regarding your account, you confirmed receipt of the itemized statement, and a request was submitted for a financial assistance form to be mailed.

  Thank you for allowing us to serve you.

• Initial Complaint

  06/11/2024

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  I am a patient at PHS Internal Medicine. My ************ doctor is *********************, MD. I am pleased with this doctor. He is very helpful. I have a difficult time refilling my prescriptions at PHS Internal Medicine Room 312. There are times when it is necessary for FEP Pharmacy - BlueCross Blue Shield, CVS Caremark and sometimes CVS Pharmacy local to communicate with the doctor when refilling my prescriptions. When these companies have trouble with PHS Internal Medicine responding to them when they contact them, they will call me and ask me to call the doctor's ****** hoping that both of us can speed up the process. Sometimes it takes us two or almost three months to get a prescription refilled. This should be a simple process. For me it is frustrating, stressful and anxiety producing. I have often gone without my medicine for a period of time. This has been happening for years. I need to know what can be done so that I can get my prescriptions filled in a timely manner.

  Business response

  07/17/2024

  ****************,

  Thank you for sharing your recent experience with us and allowing our team to resolve your concern and improve the experience for all those we serve.
  
  Based on your email correspondence with ***********************, she followed up with the practice manager and the staff was re-educated on the medication requests from a patient, pharmacy, and insurance specific to the proper procedure to handle each request promptly. The provider was briefed about the complaint from the patient for awareness and process improvement as needed.
  
  It is our goal to always provide our patients with an excellent experience and we fell short here.
  
  Thank you for allowing us to serve you.

• Initial Complaint

  06/10/2024

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  I am writing to express my deep dissatisfaction with the service I received during my recent visit to Ascension St. Vincents ************ ****** for TB testing and a hepatitis B test. Unfortunately, my experience has been marred by a series of communication failures, billing discrepancies, and unprofessional conduct by your staff.Before my visit, I inquired about the procedure codes so I could verify coverage with my insurance company. Shockingly, I was informed that your office only had the codes available in the clinic, and an employee resorted to looking up a code online. This lack of preparedness and reliance on internet sources is concerning, especially in a medical setting.Subsequently, I received two bills, one for the initial tests and another for a retest due to an alleged positive TB result, which later turned out to be negative. Despite contacting my insurance company and being advised to address the matter with your office, I encountered significant obstacles. I was repeatedly informed that billing and claims matters were handled on Fridays and they were experiencing delays, and upon follow-up, I was treated as if I were a burden to them. As a patient, I deserve to know what I am being charged for and explanations when I am confused.Moreover, when attempting to discuss the billing discrepancies and seek resolution, I encountered outright rudeness and dismissiveness from their receptionist, *****. Instead of addressing my concerns with empathy and professionalism, she refused to listen and threatened to transfer me to another department without addressing the core issues. She talked to me like I was a child.It is unacceptable that your office failed to rectify billing errors or explain the bills when asked what the I am paying for. I felt belittled and disrespected throughout my interactions with your staff. This type of behavior is not acceptable as it is a doctor's office's duty to help patients and address their concern with empathy.

  Customer response

  07/20/2024

  After sending the initial claim, I tried contacting the office through their patient portal regarding my pending bill and why I am being billed for a repeat TB test that proved the first TB showed a false positive result. I sent the message on 6/17/2024 regarding this bill and why I am being billed and I was told that they refiled with a different diagnosis code and that it will take some time. I received a letter from the Director of Consumer Experience of this facility on 6/26/24 saying that the clinical manager has communicated to me through the process. Although the only communication I received was that they refiled the claim. After almost 2 weeks, on 7/1/24, I messaged again to see if there were any updates regarding the claim. I was told the person handling billing was out of town until the end of the week and once she is back we will have to wait a few days. After 10 days, I inquired again and received no response. It is now 7/20/24 and I have not been contacted about any updates or suggestions of what I need to do. I keep receiving bills from LabCorp saying my bill is past due. I am afraid I will get sent to collections over the two bills hence why I am trying to get a definitive answer as to why I am being billed for a repeat TB Test that shows the first one was a false positive, possibly resulting from a lab error. I have reached out to ******** about this situation and asked them if they can leave a note in my account or a hold as I am trying to figure this out with the doctor's office. I have attached screenshots of the messages, along with the letter from the Director of Consumer Experience. I hope to receive information on the next steps soon. Whether it is the doctor's office telling me why I am responsible for paying for both TB tests when the first was a false positive resulting from a lab error and I need to pay this or being told that the second bill will be removed since it was in fact a lab error.

  Business response

  08/20/2024

  Dear ****,

  On behalf of our Ascension St. Vincent Primary Cares leadership team, thank you for taking the time to connect with us and share your recent experience. We have received your concerns and are reviewing your concern with our leadership team. We are committed to always listening to those we are privileged to serve and to delivering compassionate, personalized care.

  I am sorry our service did not meet your expectations. Please know that we take all feedback seriously. Thank you for giving us the opportunity to fully understand and address your concern. Specifically, the concerns regarding our personnels behavior and the frustrations caused due to inquiries regarding the billing process.

  In regards to your specific concerns, I would like to ensure your questions and concerns have been addressed. We will be working with our team to ensure they are properly educated on handling these types of inquiries. In addition, we will make sure all our associates are demonstrating our service commitments and extending kindness while listening to understand at all times. 

  As for the billing questions, our **************** team reached out to you on 08/07/2024 to discuss charges related to the need for lab tests to be retested due to a false positive result.  Upon discussion you advised the dispute in question is for statements received from LabCorp for your 04/12/2024 date of service for $355.95 and $264.00. We advised due to this being an outside billing entity, our Ascension Medical Group **************** team does not have
  access to the LabCorps billing system. In addition, you expressed concerns that no one from the providers office returned your call. We sent the patient information to the providers office, to notify them of the patients escalation request.

  Please contact our office at ************ if you want to share more or if you have additional questions.
  

*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. ↩