SSM Health

We have apologized to Mr [redacted] for the lack courtesy and understanding expressed in response to his multiple inquiries regarding to his concerns All conversations with Mr [redacted] have been reviewed and utilized by that department for education, training and correction The initial claim that was billed to Mr***s insurance company was missing a charge for an EKG That item was submitted by the Cardiology Department and required an increase in the total charges billed from $to $ Mr***s insurance carrier did not retract the original calculations and payment made for the initial claim - they simply processed the additional charge as an ancillary issue - and to add to the confusion - they processed the added charge at total charges billed rather than at the contractually adjusted rate that should have been used Therefore the payment SSM received from the for that singular charges and the patient responsibility shown were too high Their error was discovered - they requested a refund for a portion of the additional payment they had made but failed to indicate any change in the patient responsibility at the same time That has been reviewed and the additional amount due from the patient based on the "late EKG charges" is $ That amount has been adjusted for Mr [redacted] as a one time customer service adjustmentWe have contacted Mr [redacted] by telephone and he has expressed satisfaction with our response We have forwarded updated information to him regarding all payments we have received and the remaining balance due He has my personal contact information for any additional questions or information

Initial estimated patient responsibility on this account was shown to be which was the remaining deductible for this patient SSM offers a 25% discount for payment of that estimated patient responsibility at the time of service - patient paid and enjoyed a discount of when the claim processed by UHC it was denied as provider responsibility due to "lack of authorization" - however as auth had been obtained that was thought to be in error Patient called multiple times, however Customer Service reps failed to understand the issue and all of them viewed this account as "still in process" and not eligible for patient refund This has been reviewed with those representatives and education has been provided The patient has been refunded her payment of $- issued as a credit to her HPM account 10/21/to expedite the availability of the funds (per her request)

Revdex.com: I have reviewed the response made by the business in reference to complaint ID [redacted] , and find that this resolution is satisfactory to me Sincerely [redacted] I am continuing to try to recover this money for the hospitalI have called my insurance company [redacted] Health Insurance, told them I would call Health and Human Services and have done soMedicare wellness tests are no cost to the patient so I hope to get it corrected thru Health and Human Services so SSM will not be out these costsIf this is a Medicare approved and suggested on a yearly basis I don't know what the Insurance companies' problem isI think Medicare would know if this was an experimental test

Initial Business Response / [redacted] (1000, 5, 2015/07/08) */ SSM Health Patient Liaison, [redacted] resolved [redacted] 's complaint regarding the insurance being billed incorrectlyPer phone call with [redacted] insurance representative the subscriber id provided at time of service was incorrect This is the reason [redacted] did not pay on the claimThe subscriber id# required was listed on the back of the insured's cardI contact subscriber and obtained the correct numberAn email was sent to the Manager of Claims department requesting an update of the subscriber numberThe subscriber number has been updated and a corrected claim requested to [redacted] Called [redacted] , spouse of patient and left a message

Initial Business Response /* (1000, 5, 2016/02/19) */
Contact Name and Title: *** ***
Contact Phone: XXX-XXX-XXXX
Contact Email: ***@ssmhc.com
The account was reviewed for this complaint
Patient states he called numerous times requesting a detailed statement and never received
itAccount review shows the patient did call on the following dates to request a detailed
statement: 1/28/16, 1/30/16, 2/5/(called twice), 2/10/(called
twice) and finally on 2/11/
On 2/11/Mr** *** called and spoke with a customer service representativeHe requested a detailed statement be emailed to him at ***@yahoo.comThe customer service rep stayed on the phone with the patient until he verified the detailed bill had been receivedIn all, it was two weeks to the day from his initial request for a detailed statementA response will be mailed to the patient apologizing for his perception of poor serviceSSM would expect that a request such as this should be completed within one business week, and will address this concern with management to ensure all requests are completed in a timely manner
A detailed statement will be included with the letter to the patient

Initial Business Response /* (1000, 7, 2015/09/17) */
Contact Name and Title: *** ***
Contact Phone: XXX-XXX-XXXX
Contact Email: ***@ssmhc.com
The patient states he was overcharged for services
Mr*** was scheduled for a CT Scan and Chest X-Ray (two views)per physicians
order on May 27, A clinical audit was completed by Clinical Nurse Auditor *** ***, RNIt was verified the services were performed with test results documented in the medical recordThe charges are correct as billed
The total charge for the service was $Aetna insurance was billed and applied $due to an unmet deductible as patient responsibility
On 6/30/the patient called customer service and requested a detailed statementThe statement was printed and mailed on that dateThe detailed statement showed the two charges on the account - Chest X-Ray $& CT Scan of Abdomen W/O Contrast $
The patient contacted our billing office on 8/31/to discuss payment optionsHe discussed the six month payment plan with the rep, which would have been a monthly payment of for months He then stated his wife had been to the hospital for a previous date of service and was offered a 25% discount if she paid her estimated liability at that timeThe hospital offers two Prompt Pay Discounts - 25% on the estimated liability at time of service and 15% if the balance is paid within days of the first statementThe rep explained the deadline for receiving the discount had passed, and he no longer qualifiedMr*** became upset and ended the conversation without finalizing the payment arrangement
He is requesting to pay $744.75, which would be a 25% discount off of the current balance of $
As a patient satisfier, the 25% discount will be applied to the account, leaving a balance of $Mr *** will be notified by letter mailed 9/17/that the discount is a onetime offer, and to receive this discount the balance will need to be paid in full by October 25, If payment in full is not received by 10/25/the discount will be reversed and the full amount billed to the patient
A letter explaining this discount and payment offer is being mailed today, along with a detailed statement showing all charges (2) and reflecting the updated balance of $

Initial Business Response /* (1000, 7, 2015/09/04) */
September 4,
Mr*** G *** III
*** *** **
Centralia, IL XXXXX
Dear Mr***,
Account number: XXXXXXXXXXX
Date of service: July 13,
SSM Health has received your concern regarding the billing issues that you
reported to the Revdex.com case #XXXXXXXWe thank you for bringing this issue to our attention, so that we may address your concernsIt is our goal to provide an exceptional patient experience at all times
A review of your account shows that a clinical audit was completedPlease see the attached addendum containing the audit results completed by our Clinical Auditor
Our registration staff does not have the ability to quote prices, and determine if costs are reasonable or unreasonableThere are many factors that play a part in determining the cost of a procedure/service
The account balance of $is your deductible per your benefits with *** *** *** *** of IllinoisWe can apply a 25% adjustment to the account balance, which brings the patient liability to $If the adjustment is acceptable please contact me directly at XXX-XXX-XXXXWe also have payment options available
We apologize for the inconvenience that this might have caused youWe appreciate the opportunity to address your concern
Sincerely,
*** ***
Patient Business Services
SSM Health
Through our exceptional health care services, we reveal the healing presence of God

Initial Business Response /* (1000, 5, 2015/10/06) */
October 6,
Ms*** D***
*** *** **
Warr Acres, OK XXXXX
Dear Ms***,
Account number: XXXXXXXXXXX
Date of Service: June 8,
Revdex.com Complaint #XXXXXXX
SSM Health has received your concern
regarding the billing issues that you reported to the Revdex.comThis concern was expressed to SSM Health - Customer Service Department, as wellWe thank you for bringing this issue to our attention, so that we may address your concernsIt is our goal to provide an exceptional patient experience at all times
A review of your account shows a refund of $was issue to you, in error, on August 8, Since this refund was issued by SSM Health, we are adjusting the account balance of $236.08, as a one time courtesy adjustmentEnclosed for your records is a detailed statement
We apologize for the inconvenience that this might have caused you
Sincerely,
*** ***
Corporate Patient Liaison - Patient Financial Operations
SSM Health

I contacted your office today at *** and provided the correct contact person and email address to review this complaintThe *** Clinics are billed through the SSM Physicians OrganizationTheir Director is *** *** and her email address is ***@ssmhealth.com
Please foreward this complaint to her address for review and response Thank You, *** ***

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

SSM Health ** *** *** has been in contact and working with patient to resolve this issue. Unfortunately it has taking longer to complete to patient's satisfaction. A 2nd review was completed and results given to pt, by phone, on April 18, 2018. Patient is still not
agreeing to results. Patient is emailing a disputed letter regarding the conversation he had with emergency room staff members on date of service, January 25, 2018. Received email from patient on April 20, stating he is working on disputed letterPatient did thank SSM Health Patient Liaison for assistance

Initial estimated patient responsibility on this account was shown to be 2660.35 which was the remaining deductible for this patient.  SSM offers a 25% discount for payment of that estimated patient responsibility at the time of service - patient paid 1995.26 and enjoyed a discount of...

665.08.  when the claim processed by UHC it was denied as provider responsibility due to "lack of authorization" - however as auth had been obtained that was thought to be in error.  Patient called multiple times, however Customer Service reps failed to understand the issue and all of them viewed this account as "still in process" and not eligible for patient refund.  This has been reviewed with those representatives and education has been provided.  The patient has been refunded her payment of $1995.26 - issued as a credit to her HPM account 10/21/16 to expedite the availability of the funds (per her request)

This service as ordered was "allowed' BY [redacted] but processed under pt Hi Tech diagnostic benefits (per his ins) which made the rate pt responsibility - his max copay is 250.00 and the rate is 109.51 so that was shown as his portion.  SSM made multiple calls to [redacted] - we...

were advised that the authorization in place should process under either CPT code [redacted] or [redacted] (we billed the latter) as they are synonymous - we spoke with the physicians office and were supplied with an updated order adding diagnosis code Z12.2 Encounter for screening for malignant neoplasm of respiratory organs in addition to the original code Z87.891 Personal history of nicotine dependence.  This updated claim was rebilled to [redacted] 07/05/2016.  Mr. [redacted] was notified by letter that the account was rebilled.  It was denied by [redacted] as a "duplicate" 07/14/16 - we continued to follow this claim which was reprocessed again as a final issue 07/28/16 once again showing 109.51 as pt copay.  per my telephone call today with [redacted] at [redacted] they will not review this account again.  Decision is final - they show the patient is responsible even though we have made updates and rebilled the claim.   SSM will adjust the balance as a Customer Satisfaction issue - the account balance is now zero as of08/17/16 and pt has been called with request for return call to me directly at [redacted]

SSM Health has a robust Customer Complaint resolution process which begins with entering all complaints into our tracking database.  They are then assigned to a leader in the department where the complaint originated.  The leader then contacts the customer and works on resolution.This...

customer has never contacted us to file any complaints, therefore no complaint investigation has been started.  I will enter this complaint today and we will work through our normal process according to policy to determine a resolution.  This will include contacting the customer for clarification of the issues. Thank you for the opportunity to respond.

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID [redacted], and find that this resolution is satisfactory to me.
Sincerely [redacted] I am continuing to try to recover this money for the hospital. I have called my insurance company [redacted] Health Insurance, told them I would call Health and Human Services and have done so. Medicare wellness tests are no cost to the patient so I hope to get it corrected thru Health and Human Services so SSM will not be out these costs. If this is a Medicare approved and suggested on a yearly basis I don't know what the Insurance companies' problem is. I think Medicare would know if this was an experimental test.

We have apologized to Mr. [redacted] for the lack courtesy and understanding expressed in response to his multiple inquiries regarding to his concerns.  All conversations with Mr. [redacted] have been reviewed and utilized by that department for education, training and correction.  The initial...

claim that was billed to Mr. [redacted]s insurance company was missing a charge for an EKG.  That item was submitted by the Cardiology Department and required an increase in the total charges billed from $2986.73 to $3338.33.  Mr. [redacted]s insurance carrier did not retract the original calculations and payment made for the initial claim - they simply processed the additional charge as an ancillary issue - and to add to the confusion - they processed the added charge at total charges billed rather than at the contractually adjusted rate that should have been used.  Therefore the payment SSM received from the for that singular charges and the patient responsibility shown were too high.  Their error was discovered - they requested a refund for a portion of the additional payment they had made but failed to indicate any change in the patient responsibility at the same time.  That has been reviewed and the additional amount due from the patient based on the "late EKG charges" is $50.99.  That amount has been adjusted for Mr. [redacted] as a one time customer service adjustment. We have contacted Mr. [redacted] by telephone and he has expressed satisfaction with our response.   We have forwarded updated information to him regarding all payments we have received and the remaining balance due.  He has my personal contact information for any additional questions or information.

Unfortunately when a patient checks into any office for Medical Care the decision for a patient to receive an immunization cannot be made until they are seeing the provider face to face.  The provider must ask many questions prior to actually giving the order for the immunization due to...

possible health risk.  The front desk personnel cannot make those decisions.  I understand that the patient did receive the immunization elsewhere that day, but that decision was made by a different provider.  We are very sorry that the patient had to wait to find this information out but they arrived at a busy time in the clinic. The patient did see the provider and this triggered a charge in the system.  This has been removed from the account and I do apologize for this situation.

Initial Business Response /* (1000, 5, 2015/07/08) */
SSM Health Patient Liaison, [redacted] resolved [redacted]'s complaint regarding the insurance being billed incorrectly. Per phone call with [redacted] insurance representative the subscriber id provided at time of service was incorrect....

This is the reason [redacted] did not pay on the claim. The subscriber id# required was listed on the back of the insured's card. I contact subscriber and obtained the correct number. An email was sent to the Manager of Claims department requesting an update of the subscriber number. The subscriber number has been updated and a corrected claim requested to [redacted]. Called [redacted], spouse of patient and left a message.

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID [redacted], and find that this resolution is satisfactory to me.
Sincerely,
[redacted]

Complaint: [redacted]
I am rejecting this response because:
SSM Health is selectively documenting the "facts" for this case. At no time was I ever offered to have an "escalated concern team" review the case. SSM has repeatedly dodged communications from myself on this matter. After emailing multiple times and sending a letter, I was forced to send a registered letter in order to get them to acknowledge the complaint. I am including a screenshot of the record of that letter being accepted by SSM Health on October 5th. Even after being presented with the registered letter, they still tried to deny the communication. There were no letters sent without stamps as claimed by SSM: this is a lie. My family has a credit score of 700+ (can provide that proof if necessary), and we did not get there by playing "stamp" games with our creditors. Instead, SSM forced me under threat of collections to enter into their payment plan. I was told by them that they would continue to review my situation while payments were being made. They obviously never had any intention of reviewing the facts, and have failed to acknowledge what I have communicated.Contrast that treatment with Madison Emergency Physicians, who immediately put the account on hold to investigate. They were prompt, communicated well, and after briefly looking into the situation reduced their bill from roughly $1759 to $400: they understood that a "mistake" mistake was made.Contrast that treatment with the fact that the Attorney's General's Office of Minnesota also agreed that the charges were way out of line when presented with the evidence that I am including here. The "response" that the Minnesota Attorney General's Office received from SSM, was simply the same nurse's notes that were sent to me in November.These "contrasts" document how unreasonable the SSM organization is: they will not admit when they are wrong.For further proof of their fabricated scenario, I am attaching a picture that I took of myself while in "critical condition" at the facility. It clearly documents that not only was I not "unconscious", on the verge of death, with "unfavorable indicators", but there are no hives or swelling (which would normally indicate a more serious condition). I have been through this scenario multiple times and am quite familiar with what the normal protocols are for treatment. The nurse that "documented" this scenario is lying, and the SSM organization is simply trying to extract funds based on that lie. This is a dishonest organization that blatantly overcharges patients, blatantly dodges attempts at any reconciliation, and attempts to force payment through threat of being sent to collections.    
Sincerely,
[redacted]