Monday, December 19, 2011

When a hospital deceives a patient: My complaint to the Better Business Bureau

Note: Names have been changed to protect confidentiality

Filed against :
University of Illinois Medical Center

Complaint Description:

This complaint has to do with two sectors of the Medical Center: the Family Medicine Center (FMC) and Physician Group billing office (BO). First, I went to the FMC on 3/14/11 to get a shot from the nurse. When I gave my insurance information, I reached into my wallet to pay my office co-pay, I was told that I would not need to pay a co-pay since I was not seeing a doctor. The same was true when I returned on 4/4, 4/26, 5/24, 6/09, and 6/28. After this time, I found an alternative form of medication, so I did not return for shots. However, on in late July, I received a bill for four of these services, totaling $88. Concerned, I called Carol at the BO on 8/1. She said that these were "capitation charges", and that I do not have to pay them. So, when I received another bill for these charges on 8/14, I ignored it. When I got yet another bill from 9/18, this one for $106, I became concerned, so I called Carol back. She was not there, so I left a message and kept calling her. She never responded, but I received a bill on 10/16 for the same amount, telling me that my account was past-due, and that I would be referred to a collection agency if I did not pay in 15 days. Since I hate threats and because I was told that I do not pay the charges, I contacted the BO again, on 10/20, this time talking to Sally. I explained the issue to her, and she said that she would investigate matter and confer with FMC. She said to disregard the bill until then. Since I have not received a call from the BO for the rest of the month or in November, I thought for sure the matter was resolved and that I would be left alone. But then, on 12/14, I was sent another bill, this time for $132, saying that my account was seriously past due and that my account would be referred to a collection agency if I did not pay. I called the BO 12/19, this time speaking to Susan the supervisor. She told me that I indeed owe the entire amount. When I told her what her office and the FMC told me, she replied that her agents are supposed to say that we do not pay capitation charges because if the clinic fees are less than the co-pay from insurance, they try to get the insurance company to swallow the cost, which is why patients are not charged co-pays. Apparently, my insurance company denied the claims, and my capitation charges were reversed. In other words, both the BO and the FMC lied to me. The FMC lied to me by saying that I did not have to pay any co-pay, and the BO lied to me by saying that I did not have to pay the capitation charges. Furthermore, I think it is reprehensible that the FMC would assume that an insurance company would pay their fees in lieu of the co-pays and an insult to wait 3 months to bill for a service. I have the right to be billed for something within a month of the service.

Your Desired Resolution:

Since I must pay this amount to prevent being further harassed by billing agents, even though I was deceived by both mentioned parties, I want the following things to happen:
1.For the Family Medicine Center to apologize for lying to me.
2. For the UIC Medical Center to agree in a written statement to bill all patients within a month of service, to just let the patients pay the co-pays or office fee at the time of service, and then credit them later--if possible.
3. For the Physicians Group to apologize for lying to me.
4. For the Physicians Group to agree in a written statement to make their bills easier to understand, to not tell patients things that are not necessarily true, to return phone calls, to inform clients of the results of investigations instead of sending bills with threatening letters, and to try to care more about patients and less about their money.
5. For the Physicians Group to return all of my hard-earned $132 posthaste.

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