I am rejecting this response because: The Sutter Alhambra Surgery Center continues to try and distract from the most problematic aspect of their billing practicesIt is certainly true that the amount pre-billed to me was an estimateHowever, somehow the Center chose to bill me an additional amount for the exact same procedure code estimated, and cannot explain why that amount increased between billingsMoreover, the amounts they charged for the single implant and supplies so far exceed the range, that it raises suspicion of inflated billing The document the Center attached reads in full as follows, “All estimates are based on the procedure(s) scheduled and your final bill will be based on the procedure(s) performed Additional procedures, implants and or supplies will be billed after your insurance processes your claim.” The Center pre-billed me $for CPT codes and These are the exact same procedure codes billed in the subsequent billingHowever, while the pre-billing estimated $6,total, the subsequent billing on those exact same CPT codes somehow became $8,That’s a $increase, which represents an almost 30% increase in costNowhere on the pre-billing form submitted by the Center does it indicate that billed procedures, which remain the same, can increase in cost“All estimates are based on the procedure(s) scheduled and your final bill will be based on the procedure(s) performed.” The CPT codes indicate that the same procedure scheduled was the procedure performedWhen I called and spoke with the Center, no one could articulate to my why there should be a 30% increase in the estimateIt is not enough to the Center to hide behind that statement that “this is just an estimate” to force additional costs onto unsuspecting patients The Center entirely ignored this aspect of the billing increase, and instead focused on their assertion that “[a]dditional procedures, implants and or supplies will be billed after your insurance processes your claim.” Here, they are relying on CPT codes Cand Athat were added to my billCindicates a cost for an anchor/screw for opposing bone-to-bone or soft tissue-to-bone (implantable) Although the Center could not explain what screw was used or what it cost, the charge was $Almost $for what I know was a single surgical screw of less than a half inch in lengthWhile pricing information for surgical materials is frustratingly hard to access, I have to ask that the Center provide data for how it reached its billing cost because they have failed to be transparent on other issuesIn addition, Aindicates costs for miscellaneous surgical supplies, which warranted a cost of $1,081.00, over 15% of the total cost of the procedure as estimatedAgain, I think my insurance company and I require a detailed billing of the supplies used and how those supplies amounted to a cost of $ I submitted this supporting documentation with my initial complaint and will attempt to do so with this responseBut I urge the Revdex.com to question the Center’s practice of dramatically increasing the cost of identical CPT codes between estimated billing and the final billingIn addition, I will further say that I attempted to dispute these charges with the Center – and I believe that the bill was actively in dispute, when the Center referred the bill to collectionDoing so is an illegal intimidation tactic designed for force me to pay for a bill that was, at best, unexplained and unsubstantiated, and, at worst, full on insurance fraud
Please see attached The patient was informed by our verifications department prior to the surgery that her payment amount was an estimate, that there may be additional costs due to the number of additional supplies or implants (plates, screws, drill bits for example), that can not be fully determined until during the time of the surgical procedure After the procedure, phone calls to the patient have been attempted by the regional business office prior to submitting the bill to collections, per policy The patient's insurance coverage is 85%, where the patient is responsible for the remaining 15% of the allowed amount, hence the added charges to the patient that her insurance did not cover Sutter Alhambra Surgery Center is strictly regimented in ensuring proper billing protocols per policy We billed the patient accordingly to the insurance plan she signed up for, ensuring that the Surgery Center is following the policy and protocols of both the hospital group and her insurance company The estimates provided during verification (prior to services rendered) are only an estimate based on how the procedure(s) is scheduled by the surgeon We provide this information as a courtesy to our patients to assist with understanding their benefits and being prepared On the attached Pre-Payment Agreement it clearly states the following: "Additional procedures, implants, and or supplies will be billed after you insurance processes your claim." "This is only an estimate." "The amounts provided prior to surgery are estimates only Actual benefits, to include patient responsibility, cannot be finalized until your insurance company completes processing your claim You will be responsible for any difference." This form was signed by the patient and a facility witness on 06/04/ A large part of the difference in this case is due to implants and supplies being billed We cannot know all implants and supplies that will be used during a procedure before the services are rendered This is why we state clearly on the Patient Pre-Payment Agreement explained to and signed by the patient that, "Additional procedures, implants, and or supplies will be billed after your insurance processes your claim." Ultimately this is a decision made by the surgeon based on patient needs during the procedure(s) If you have any further questions please feel free to contact the [redacted]
I am rejecting this response because:
The Sutter Alhambra Surgery
Center continues to try and distract from the most problematic aspect of their
billing practices. It is certainly true that the amount pre-billed to me was an
estimate. However, somehow the Center chose to bill me an additional amount for
the exact same procedure code estimated, and cannot explain why that amount
increased between billings. Moreover, the amounts they charged for the single
implant and supplies so far exceed the normal range, that it raises suspicion
of inflated billing.
The document the Center
attached reads in full as follows, “All estimates are based on the procedure(s)
scheduled and your final bill will be based on the procedure(s) performed. …
Additional procedures, implants and or supplies will be billed after your
insurance processes your claim.” The Center pre-billed me $932 for CPT codes
28045 and 28296. These are the exact
same procedure codes billed in the subsequent billing. However, while the pre-billing
estimated $6,213.00 total, the subsequent billing on those exact same CPT codes
somehow became $8,040.00. That’s a $1827 increase, which represents an almost
30% increase in cost. Nowhere on the pre-billing form submitted by the Center
does it indicate that billed procedures, which remain the same, can increase in
cost. “All estimates are based on the procedure(s) scheduled and your final
bill will be based on the procedure(s) performed.” The CPT codes indicate that
the same procedure scheduled was the procedure performed. When I called and
spoke with the Center, no one could articulate to my why there should be a 30%
increase in the estimate. It is not enough to the Center to hide behind that
statement that “this is just an estimate” to force additional costs onto
unsuspecting patients.
The Center entirely ignored this aspect of the
billing increase, and instead focused on their assertion that “[a]dditional procedures, implants and or supplies will be billed
after your insurance processes your claim.” Here, they are relying on CPT codes
C1713 and A4649 that were added to my bill. C1713 indicates a cost for an
anchor/screw for opposing bone-to-bone or soft tissue-to-bone (implantable).
Although the Center could not explain what screw was used or what it cost, the
charge was $982.00. Almost $1000 for what I know was a single surgical screw of
less than a half inch in length. While pricing information for surgical
materials is frustratingly hard to access, I have to ask that the Center provide
data for how it reached its billing cost because they have failed to be
transparent on other issues. In addition, A4649 indicates costs for
miscellaneous surgical supplies, which warranted a cost of $1,081.00, over 15%
of the total cost of the procedure as estimated. Again, I think my insurance
company and I require a detailed billing of the supplies used and how those
supplies amounted to a cost of $1081.00.
I submitted this supporting documentation
with my initial complaint and will attempt to do so with this response. But I
urge the Revdex.com to question the Center’s practice of dramatically increasing the
cost of identical CPT codes between estimated billing and the final billing. In
addition, I will further say that I attempted to dispute these charges with the
Center – and I believe that the bill was actively in dispute, when the Center referred
the bill to collection. Doing so is an illegal intimidation tactic designed for
force me to pay for a bill that was, at best, unexplained and unsubstantiated,
and, at worst, full on insurance fraud.
department prior to the surgery that her payment amount was an estimate, that there may be additional costs due to the number of additional supplies or implants (plates, screws, drill bits for example), that can not be fully determined until during the time of the surgical procedure. After the procedure, phone calls to the patient have been attempted by the regional business office prior to submitting the bill to collections, per policy. The patient's insurance coverage is 85%, where the patient is responsible for the remaining 15% of the allowed amount, hence the added charges to the patient that her insurance did not cover. Sutter Alhambra Surgery Center is strictly regimented in ensuring proper billing protocols per policy. We billed the patient accordingly to the insurance plan she signed up for, ensuring that the Surgery Center is following the policy and protocols of both the hospital group and her insurance company.
The estimates provided during verification (prior to services rendered) are only an estimate based on how the procedure(s) is scheduled by the surgeon. We provide this information as a courtesy to our patients to assist with understanding their benefits and being prepared. On the attached Pre-Payment Agreement it clearly states the following:
"Additional procedures, implants, and or supplies will be billed after you insurance processes your claim."
"This is only an estimate."
"The amounts provided prior to surgery are estimates only. Actual benefits, to include patient responsibility, cannot be finalized until your insurance company completes processing your claim. You will be responsible for any difference."
This form was signed by the patient and a facility witness on 06/04/15. A large part of the difference in this case is due to implants and supplies being billed. We cannot know all implants and supplies that will be used during a procedure before the services are rendered. This is why we state clearly on the Patient Pre-Payment Agreement explained to and signed by the patient that, "Additional procedures, implants, and or supplies will be billed after your insurance processes your claim." Ultimately this is a decision made by the surgeon based on patient needs during the procedure(s).
If you have any further questions please feel free to contact the [redacted]
I am rejecting this response because: The Sutter Alhambra Surgery Center continues to try and distract from the most problematic aspect of their billing practicesIt is certainly true that the amount pre-billed to me was an estimateHowever, somehow the Center chose to bill me an additional amount for the exact same procedure code estimated, and cannot explain why that amount increased between billingsMoreover, the amounts they charged for the single implant and supplies so far exceed the range, that it raises suspicion of inflated billing The document the Center attached reads in full as follows, “All estimates are based on the procedure(s) scheduled and your final bill will be based on the procedure(s) performed Additional procedures, implants and or supplies will be billed after your insurance processes your claim.” The Center pre-billed me $for CPT codes and These are the exact same procedure codes billed in the subsequent billingHowever, while the pre-billing estimated $6,total, the subsequent billing on those exact same CPT codes somehow became $8,That’s a $increase, which represents an almost 30% increase in costNowhere on the pre-billing form submitted by the Center does it indicate that billed procedures, which remain the same, can increase in cost“All estimates are based on the procedure(s) scheduled and your final bill will be based on the procedure(s) performed.” The CPT codes indicate that the same procedure scheduled was the procedure performedWhen I called and spoke with the Center, no one could articulate to my why there should be a 30% increase in the estimateIt is not enough to the Center to hide behind that statement that “this is just an estimate” to force additional costs onto unsuspecting patients The Center entirely ignored this aspect of the billing increase, and instead focused on their assertion that “[a]dditional procedures, implants and or supplies will be billed after your insurance processes your claim.” Here, they are relying on CPT codes Cand Athat were added to my billCindicates a cost for an anchor/screw for opposing bone-to-bone or soft tissue-to-bone (implantable) Although the Center could not explain what screw was used or what it cost, the charge was $Almost $for what I know was a single surgical screw of less than a half inch in lengthWhile pricing information for surgical materials is frustratingly hard to access, I have to ask that the Center provide data for how it reached its billing cost because they have failed to be transparent on other issuesIn addition, Aindicates costs for miscellaneous surgical supplies, which warranted a cost of $1,081.00, over 15% of the total cost of the procedure as estimatedAgain, I think my insurance company and I require a detailed billing of the supplies used and how those supplies amounted to a cost of $ I submitted this supporting documentation with my initial complaint and will attempt to do so with this responseBut I urge the Revdex.com to question the Center’s practice of dramatically increasing the cost of identical CPT codes between estimated billing and the final billingIn addition, I will further say that I attempted to dispute these charges with the Center – and I believe that the bill was actively in dispute, when the Center referred the bill to collectionDoing so is an illegal intimidation tactic designed for force me to pay for a bill that was, at best, unexplained and unsubstantiated, and, at worst, full on insurance fraud
Please see attached The patient was informed by our verifications department prior to the surgery that her payment amount was an estimate, that there may be additional costs due to the number of additional supplies or implants (plates, screws, drill bits for example), that can not be fully determined until during the time of the surgical procedure After the procedure, phone calls to the patient have been attempted by the regional business office prior to submitting the bill to collections, per policy The patient's insurance coverage is 85%, where the patient is responsible for the remaining 15% of the allowed amount, hence the added charges to the patient that her insurance did not cover Sutter Alhambra Surgery Center is strictly regimented in ensuring proper billing protocols per policy We billed the patient accordingly to the insurance plan she signed up for, ensuring that the Surgery Center is following the policy and protocols of both the hospital group and her insurance company The estimates provided during verification (prior to services rendered) are only an estimate based on how the procedure(s) is scheduled by the surgeon We provide this information as a courtesy to our patients to assist with understanding their benefits and being prepared On the attached Pre-Payment Agreement it clearly states the following: "Additional procedures, implants, and or supplies will be billed after you insurance processes your claim." "This is only an estimate." "The amounts provided prior to surgery are estimates only Actual benefits, to include patient responsibility, cannot be finalized until your insurance company completes processing your claim You will be responsible for any difference." This form was signed by the patient and a facility witness on 06/04/ A large part of the difference in this case is due to implants and supplies being billed We cannot know all implants and supplies that will be used during a procedure before the services are rendered This is why we state clearly on the Patient Pre-Payment Agreement explained to and signed by the patient that, "Additional procedures, implants, and or supplies will be billed after your insurance processes your claim." Ultimately this is a decision made by the surgeon based on patient needs during the procedure(s) If you have any further questions please feel free to contact the [redacted]
I am rejecting this response because:
The Sutter Alhambra Surgery
Center continues to try and distract from the most problematic aspect of their
billing practices. It is certainly true that the amount pre-billed to me was an
estimate. However, somehow the Center chose to bill me an additional amount for
the exact same procedure code estimated, and cannot explain why that amount
increased between billings. Moreover, the amounts they charged for the single
implant and supplies so far exceed the normal range, that it raises suspicion
of inflated billing.
The document the Center
attached reads in full as follows, “All estimates are based on the procedure(s)
scheduled and your final bill will be based on the procedure(s) performed. …
Additional procedures, implants and or supplies will be billed after your
insurance processes your claim.” The Center pre-billed me $932 for CPT codes
28045 and 28296. These are the exact
same procedure codes billed in the subsequent billing. However, while the pre-billing
estimated $6,213.00 total, the subsequent billing on those exact same CPT codes
somehow became $8,040.00. That’s a $1827 increase, which represents an almost
30% increase in cost. Nowhere on the pre-billing form submitted by the Center
does it indicate that billed procedures, which remain the same, can increase in
cost. “All estimates are based on the procedure(s) scheduled and your final
bill will be based on the procedure(s) performed.” The CPT codes indicate that
the same procedure scheduled was the procedure performed. When I called and
spoke with the Center, no one could articulate to my why there should be a 30%
increase in the estimate. It is not enough to the Center to hide behind that
statement that “this is just an estimate” to force additional costs onto
unsuspecting patients.
The Center entirely ignored this aspect of the
billing increase, and instead focused on their assertion that “[a]dditional procedures, implants and or supplies will be billed
after your insurance processes your claim.” Here, they are relying on CPT codes
C1713 and A4649 that were added to my bill. C1713 indicates a cost for an
anchor/screw for opposing bone-to-bone or soft tissue-to-bone (implantable).
Although the Center could not explain what screw was used or what it cost, the
charge was $982.00. Almost $1000 for what I know was a single surgical screw of
less than a half inch in length. While pricing information for surgical
materials is frustratingly hard to access, I have to ask that the Center provide
data for how it reached its billing cost because they have failed to be
transparent on other issues. In addition, A4649 indicates costs for
miscellaneous surgical supplies, which warranted a cost of $1,081.00, over 15%
of the total cost of the procedure as estimated. Again, I think my insurance
company and I require a detailed billing of the supplies used and how those
supplies amounted to a cost of $1081.00.
I submitted this supporting documentation
with my initial complaint and will attempt to do so with this response. But I
urge the Revdex.com to question the Center’s practice of dramatically increasing the
cost of identical CPT codes between estimated billing and the final billing. In
addition, I will further say that I attempted to dispute these charges with the
Center – and I believe that the bill was actively in dispute, when the Center referred
the bill to collection. Doing so is an illegal intimidation tactic designed for
force me to pay for a bill that was, at best, unexplained and unsubstantiated,
and, at worst, full on insurance fraud.
Please see attached.
The patient was informed by our verifications...
department prior to the surgery that her payment amount was an estimate, that there may be additional costs due to the number of additional supplies or implants (plates, screws, drill bits for example), that can not be fully determined until during the time of the surgical procedure. After the procedure, phone calls to the patient have been attempted by the regional business office prior to submitting the bill to collections, per policy. The patient's insurance coverage is 85%, where the patient is responsible for the remaining 15% of the allowed amount, hence the added charges to the patient that her insurance did not cover. Sutter Alhambra Surgery Center is strictly regimented in ensuring proper billing protocols per policy. We billed the patient accordingly to the insurance plan she signed up for, ensuring that the Surgery Center is following the policy and protocols of both the hospital group and her insurance company.
The estimates provided during verification (prior to services rendered) are only an estimate based on how the procedure(s) is scheduled by the surgeon. We provide this information as a courtesy to our patients to assist with understanding their benefits and being prepared. On the attached Pre-Payment Agreement it clearly states the following:
"Additional procedures, implants, and or supplies will be billed after you insurance processes your claim."
"This is only an estimate."
"The amounts provided prior to surgery are estimates only. Actual benefits, to include patient responsibility, cannot be finalized until your insurance company completes processing your claim. You will be responsible for any difference."
This form was signed by the patient and a facility witness on 06/04/15. A large part of the difference in this case is due to implants and supplies being billed. We cannot know all implants and supplies that will be used during a procedure before the services are rendered. This is why we state clearly on the Patient Pre-Payment Agreement explained to and signed by the patient that, "Additional procedures, implants, and or supplies will be billed after your insurance processes your claim." Ultimately this is a decision made by the surgeon based on patient needs during the procedure(s).
If you have any further questions please feel free to contact the [redacted]