Froedtert

I went for my annual check-up at the hospital's Clinic, located at *** on April 4, 2019. Annual physicals are covered under my insurance policy. During the in-take process, I was presented with a document stating clearly that the check-up would only include "normal" check-up procedures which would include things like a regular blood test, urine sample, etc. If I was there with any kind of medical condition and discuss that and/or receive treatment for that during the annual check-up, any cost related to that medical condition would not be covered as part of the annual check-up and that my insurance company would be billed for that, and I may incur additional out-of-pocket expense as a result. That document is available at the clinic.

The check-up was performed by ***, a physician's assistant for Dr. ***. I am officially Dr. *** patient, and have been since I joined the system in 2012. I only saw Dr. *** once, in 2013. Through all my check-ups and illnesses since then I have only been attended to by various physician's assistants. At the time of the check-up, I was not experiencing gout symptoms, though I had them in the past, usually once or twice a year over the past two or three years. I had been prescribed allopurinol in the past which relieved the gout symptoms. I am not and have not been on a regular allopurinol regiment. I was at the clinic back on March 21, 2019 for gout symptoms. During the course of the check-up on April 4, 2019, *** asked me about my gout condition. I told her that it was fine though not all the pain had disappeared since the March 21, 2019 visit. I also asked her whether it was okay to talk about the gout condition since I was there for the annual check-up. I was not there for the hand pain. *** assured me that it was okay, and that would not be noted as something beyond the regular check-up. She also recommended that I do another blood test for uric acid. I again asked her if that would be counted as part of the regular check-up. Again *** replied yes because it would go under "preventative care", so I consented to the blood test.

A few weeks after the annual check-up, I received some bills for the check-up. A couple of them were for small amounts, which I paid. Then I received one for $336.35, with the notation "Hospital Service". I called the billing department and was informed that the amount was for the uric acid test which my insurance company did not cover. I believe my first contact with the billing department on this matter was back in May or June of 2019. I was told that I had to talk to the clinic to resolve that, since the billing department could not change a bill. I called the clinic, and took a few tries to get to talk to the coder whose first name is *** (possibly incorrectly misspelled by me but I was not given the spelling, nor the last name). *** said she coded the visit according to all the rules, but that she would talk to ***. I told *** the whole story about my exchange with *** during the check-up, that *** told me everything would be part of the check-up, which was why I consented to the uric acid test in the first place. I never heard back from ***. The billing department kept sending me the bill, about once a month. I called billing back to let them know that I had been trying to resolve the issue with the clinic. Finally, in late October or early November, billing told me that since the bill has been outstanding for nine months, they will be sending it to the collectors if it wasn't resolved by the next billing cycle. I called back the clinic, and after many calls and trading of phone messages, I got to talk to *** the coder again, and she said she would talk to the clinic's supervisor. It took a few weeks to get the supervisor to call me, and after a few exchanges of messages, I was able to talk to her in person on the phone. I explained to her the entire situation. The supervisor's name is ***. ***explanation basically was that *** (and any attending physician) may not know what anyone's insurance policy covers. *** left the conversation saying she would talk to her supervisor, who is the director of the clinic, and maybe they would remove the charges. The director's name is ***. A few weeks later, *** informed me via phone that she had spoken with *** and the conclusion was that the billing was accurate, and that I am responsible for the $336.35. Thereupon I informed *** that I will be filing an official complaint. She acknowledged that she understood my position on the matter. A couple of days ago (today is 1/14/2020), I received another bill from the billing department for the $336.35 amount. I have not yet heard from any collector.

The next page asked for specific dates of complaints to the business. I had been contacting both the billing department and the clinic since May 2019. My last contact with billing was on 1/2/2020; the person I spoke with was ***. I informed her of the result of my phone conversation with ***, and that I will be filing an official complaint. *** informed me that she has noted that in my records, and that I will be receiving another bill, and that after that the matter will be sent to a collector.

I believe the charges were the result of a policy of systematic deceptive practices, ordering tests which are not necessary, giving patients inaccurate information, then hiding behind a setup of bureaucratic run-around which took months to get to talk to anyone, and then threatening the patient with collection agency hand-off. *** initiated the conversation about my hand pain, told me it was part of the check-up, then recommended another uric acid test, and told me that too was part of the check-up. The idea that she did not know what my insurance company would cover is completely beside the point. *** is an experience PA. She had been my attending many times over the years for these check-ups. I am sure she has done many check-ups, and unless she is incompetent and not knowledgeable (which I don't believe she is), she has to know what is part of a regular check-up and what is not. She also knows from my records that over the recent years when I started having occasional gout symptoms, and did many uric acid tests, I had never tested positive for uric acid. That included the March 21, 2019 visit and blood test. Dr. ***, in my opinion, is complicit in the scheme for the unnecessary test because, as I was informed, he was the one who ordered the test because *** in her capacity as PA could not submit such an order. Dr. ***, as my physician, has full access to my medical records and should know that I had never tested positive for uric acid. He should also have know that for the annual check-up the uric acid test was not necessary. *** and *** are part of this complaint because they, after hearing my side of the story and consulting with the parties involved, came down on the side of defending the deceitful practice.

There is a related complaint. From the April 4, 2019 annual check-up, the clinic charged my insurance company for two vaccination shots for tetanus. My medical record online, which was updated by the clinic, noted that I received one shot. Meanwhile, the fact is that I received none. During the check-up, prior to the consultation with ***, the nurse who came to check my pulse and do other "prelims" asked me if I wanted the vaccination; she said it was optional, and I said no. I received no vaccination during that visit. The Froedtert billing department confirmed that the billing showed two tetanus shots. I told *** the coder about it on the phone. I also told ***about it on the phone. I noted that besides being charged for something I did not get, now my medical records are incorrect. Last I checked (which is today) my medical records still show I got the shot, which is inaccurate. I have not yet checked with my insurance company but I am almost certain they did not get refunded the money for the two shots they paid for and I did not get. This action on Froedtert's part is not deceitful. It's fraudulent. While I did not incur out-of-pocket expense on those shots, these fraudulent acts contribute to the high cost of our insurance policies.