Geisinger Health System

December 5, 2014Dear [redacted]:
Your letter referencing Case ID [redacted] was referred to my office for review. The letter refers to a patient billing concern for services rendered at Geisinger Clinic - Shamokin on August 4, 2014.
As previously communicated, the patient’s record was reviewed and the services in question were deemed valid and appropriately billed to the insurance carrier. At no point did Geisinger Health System force the patient to submit to unwarranted tests or treatment. Patients are involved in their healthcare decisions and can openly discuss their options and any concerns with their provider so that informed decisions are made.
At any time, patients can request an estimate of their out-of-pocket expense by asking a Financial Counselor or visiting our website @ www.geisinger.edu. Patients are expected to understand their benefit coverage levels with their insurance carrier.A patient obligation of $369.20 remains for the services provided on 8/4/14.
Should you need any additional information, please feel free to contact me at [redacted].Diane A

We have received and reviewed the attached letter and customer experience form. Amember of our billing team has reviewed the charges in question and is reaching outto the patient to discuss this matter. Our records cun’ently show thc patient owes asignificantly lower out-of-pocket amount than the...

disputed amount listed on theattached complaint. This may have been an issue of health insurance payment timing,but our billing team representative will clarify the issue with the patient when contactis made.Thank you for bringing this mater to our attention, and we are happy to be able topromptly resolve this issue.Sincerely,[redacted]Operations Manager—Primary Care

August 4, 2015Dear [redacted]:
This letter is in response to a complaint filed with your office by one of our Members, [redacted].
[redacted] is requested a refund of an over-charged premium in the amount of $2825.21.
The Health Plan's Appeal Coordinator initiated...

a first level pre-service complaint on 7/27/2015 on behalf of the Member. The Appeal Coordinator forwarded the Member's complaint to the Plan's Accounts Receivable department for a response to be provided to the Member. The Member was sent a letter acknowledging his appeals via USPS on 7/27/2015.As you may be aware, the PA Department of Insurance mandates a 30-day timeframe for a disposition to be made and a response sent to the Member. This case's deadline date is 8/26/2015.
We will continue to investigate this case and provide a response within the required timeframe.
Please feel free to contact me with any additional questions you may have regarding the above information. I can be reached at ###-###-####.
Sincerely,
Elizabeth W. RN,
CPC Manager, Appeals Department

November 10, 2014Dear [redacted]:Your letter referencing Case ID [redacted] was referred to my office for review. The letter was in regards to a patient bill for services rendered at Geisinger Clinic - [redacted] on August 4, 2014.
The patient’s medical record was reviewed for...

confirmation and validity of the services in question. Our review found that the patient had requested the lab work in question, stating he had intentionally lost weight over the past year and wanted to See if it made a difference in his cholesterol number.The testing was completed per the patient’s request. The total charges for the office visit and the lab was $649.00. The patient’s insurance covered $279.80, leaving a patient obligation of $369.20. The services rendered were appropriately billed and processed by the patient’s insurance company. The balance of $369.20 remains due from the patient.
Should you need any additional information, please feel free to contact me at [redacted].
Sincerely,
Diane A

[To assist us in bringing this matter to a close, you must give us a reason why you are rejecting the response. If no reason is received your complaint will be closed Administratively Resolved]
 Complaint: [redacted]
I am rejecting this response because:           I dont feel this claim by geisinger was correct, the next thing I plan on doing is typing a new complaint letter that will be sent to both you and the geisinger board. I have records and names of all the people I spoke with when I talked to geisinger customer service, geisinger complaint board and my insurance carrier, I will cover all tracks of what transpired and why I dont feel obligated to pay for blood work that was presented to me in a fashion that was like it was forced on me. That day of the appt. Dr. T[redacted] expressed it to me saying she had noticed that I lost weight recently and she strongly recommended that I should perform blood testing, so I said yes due to the fact thinking that because of the medicine im on that it would be routine to have this type of blood testing and they would cover it since Dr. T[redacted] was concerned about the effects of the medicine, that she really just rushed me into it and insisted that I complete this work, I had no problem getting the work done but I feel that it was wrong of them to not inform me that it most likely would not be covered due to it being considered an unroutine/extra service. However I will go more into that in my letter that you will see from me soon.
Regards,
Bradley Matto

[To assist us in bringing this matter to a close, you must give us a reason why you are rejecting the response. If no reason is received your complaint will be closed Administratively Resolved]
 Complaint: [redacted]
I am rejecting this response because:I find this claim to be dishonest, I feel that all they are doing in this entire case is trying to use there manipulative power and continue to lie about what transpired that day. Please ask yourself this question and lets be logical why would patient even want to have bloodwork for an unnecessary reason, the reason I committed and accepted the bloodwork to be performed is that day at the office Dr. T[redacted] put it to me as if was neccessary because of the medication that I am on, I am not a professional doctor or pharmicist sir I dont know deep info about medications, side effects or if your supposed to have routine bloodwork or not, in reality that is the whole reason why I visit a professional doctor, I make doctors visit because they are supposed to be experts. So with that being said I hope you can understand my point when I mentioned about being manipulative. I feel that I am being taken advantage of with this case, I will admit I know nothing in deep about pharmaceutical medication, and what I think went down on that day was they took me and realized that I was an easygoing patient (because that's what I am) that shows no in deep knowledge of medication and were gonna tell him that he needs bloodwork and we will put it to him as if it is routine, but in the long run were gonna process it to his insurance carrier as unroutine and we can stick him with a bill so we can make extra money. I think they are continuing to be dishonest with you guys because they are trying to cover there own backs and taking advantage of me in the meantime, I reported this matter to geisinger a couple times before I opened a case with you guys, and they always chose to not respond and completely blew me off everytime, I really don't want this bill to damage my credit history also sir, especially if it was an unnecessary charge in the first place!
Regards,
[redacted]

February 12, 2015Dear [redacted]:
Your letter referencing complaint ID [redacted] was referred to my attention for review and response. The letter references an outstanding patient balance due to Geisinger Wyoming Valley Medical Center. The patient feels he should not be liable...

for charges not paid by his insurance carrier, [redacted] Insurance Company ([redacted]).Geisinger Wyoming Valley Medical Center does not contractually participate with [redacted] and therefore the expected payment for services rendered to [redacted] patients equals the total charges billed. Although the patient may have satisfied his calendar year deductible, [redacted] did not pay the full charges billed by Geisinger Wyoming Valley Medical Center.
After all [redacted] payments received, the patient owed a total of $413.69; $373.69 for date of service May 17, 2014 and $40.00 for date of service June 3, 2014. The $40.00 patient obligation incurred was not related to a “newly arrived charge” as the patient noted. This residual patient balance was the result of the [redacted] payment received on December 12, 2014, related to the June 3 service.
As of today, the patients outstanding balances have been satisfied via a payment of $413.69 received on February 6, 2015.
If you should have questions or need additional information, please do not hesitate to contact me.
Sincerely,
Diane A.
Revenue Cycle Supervisor

Please review and get back to me.  I'm not sure what the complaint is regarding.  There is no patient information and it looks to be about health insurance enrollment.  If anything further is needed on our part, please advise.
 
Thanks,
Diane A[redacted]

Review: I have health insurance that covers maternity care at 100%. I gave birth at the Geisinger Lewistown Hospital. The Geisinger Lewistown Hospital is billing me for maternity services that I do not owe and they are threatening to turn the bill over to a Professional Collection Agency.Desired Settlement: Please work with my insurance company and stop sending bills to me for services covered by insurance. Please do not turn the account over to a Professional Collection Agency.

Business

Response:

We have received and reviewed the attached letter and customer experience form. Amember of our billing team has reviewed the charges in question and is reaching outto the patient to discuss this matter. Our records cun’ently show thc patient owes asignificantly lower out-of-pocket amount than the disputed amount listed on theattached complaint. This may have been an issue of health insurance payment timing,but our billing team representative will clarify the issue with the patient when contactis made.Thank you for bringing this mater to our attention, and we are happy to be able topromptly resolve this issue.Sincerely,[redacted]Operations Manager—Primary Care

Review: The sent a bill to collections. I called to dispute this, because I had paid it. I was able to provide the check that I received back from the bank after it was cashed. I provided them the PDF proof of payment. They are aware the bill is currently in collections. Despite the urgency of the situation, I have not been contacted in 7 days, including 5 business days, since all of the evidence of payment was provided to them. In addition, they were e-mailed 5 days ago for an update on the status, and have no replied to my inquiries for an update.Short Version: I paid them, I have the proof I paid them. They sent the bill to collection by mistake, and are being unresponsive.Desired Settlement: Primarily, I'm making public record of their poor service. I would like to warn other customers, and make a record for anyone else who pursues issues with them to let them be aware of similar occurrences that may form a pattern of behavior.Ideally, they'd apply some kind of credit for the hassle, and poor service. For now, I'd settle with notifying the credit agencies, collection company, and acknowledging payment on my account.

Review: I received maternity care from [redacted] (midwife) at a Geisinger facility on 7/22/14. My insurance covered maternity care at 100%. Geisinger failed to bill the insurance company correctly, which caused the claim to be denied. Geisinger continued to try to collect the denied amount from me even though I repeatedly told them to resubmit to the insurance company. They have now turned the bill over to Medicredit without warning or correctly billing my insurance company.Desired Settlement: Resubmit the bill correctly to the insurance company i.e., bill under the correct in-network provider and let Medicredit know you sold them this debt in error.

Business

Response:

I Thank you for your letter informing us of a patient concern. It is always our intention to thoroughlyinvestigate patient concerns and make every attempt to rectify these issues in a manner that is satisfactoryto the patient. Geisinger Health System has reviewed this particular case and in an effort to promote apositive patient experience has removed the charge in question front the patient’s account. Thank you formaking us aware of this opportunity.