North Fulton Hospital North Fulton Hospital engages in a deceptive billing practice called bundling

Benton, Illinois 0 comments
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The North Fulton Hospital engages in a deceptive billing practice commonly used by a lot of hospitals, called bundling (at end of thread is URL's on subject). It is when a hospital attempts to hide errors or over charges by grouping chunks of charges into broad and generic categories like Laboratory Services or Imaging.

Below is an outline of my experience with North Fulton Hospital in dealing with this deceptive practice for a bill of $11,695.40. But before I proceed, I just want to say that this complaint is only focused on the business office of North Fulton Hospital, not the medical staff. I have always found their service excellent and very professional, and they have my great appreciation for their care and service.

7/18: Admitted to North Fulton Hospital emergency room for possible food poisoning.

10/11: Received 1st bill for + $11,000. I followed up with phone call to billing department requesting an itemized bill.

10/27: Received second bill for $11,695.40, was not itemized, but grouped as shown below (and you will note, the below does not add up to the 11,695.40 but only 9958.3):

Laboratory Services $1,362.60

Diagnostic/Therapeutic Imaging $6,066.30

Emergency Room $2,426.90

Supplies $103.40

I called Billing Department again (and followed up with a fax) with following two requests:

1. Escalate this issue to his supervisor (they would not let me speak to her directly).

2. Unbundle charges into a true itemized bill (What specific drugs am I being charged for? , What specific lab tests am I being charged for?, What specific supplies am I being charged for? And what is "Imaging"?)

11/4: I received a call from N Fulton Hospital Business Office asking how I wanted to pay my bill. I Advise that I could not discuss payment options until hospital had provided sufficient backup /itemization to prove charges were both accurate and at fair value. I followed up with a third fax requested that they unbundle my expenses and provide an itemized bill.

11/9: A representative from the Department of Community Health called me and advised me she had followed up to my complaint on North Fulton Hospital business practices of expense bundling. She told me Billing Manager for North Fulton Hospital stated two itemized bills had been sent to me. I advised her that this was not correct and read the billing they gave me and offered to send her a copy of each bill. I was advised that based upon the word of N Fulton Hospital, they were dropping the investigation (she followed up this statement with a letter to me – so much for expecting unbiased assistance from them)

11/9: I sent a fax to North Fulton Hospital and informed them they had not sent an itemized bill. With my fax I attached a bill I had received from another medical organization that was itemized, as an example to North Fulton Hospital on what a true itemized medical bill was.

11/11 AM: Reviewed North Fulton Hospital 2nd bill in detail, even though it was not itemized. I found 5 major errors in this bill, North Fulton Hospital billing department did not even follow its own stated billing breakdown & procedures (which they list on page 3 of their bills). I documented this in a letter which I faxed to N Fulton Hospital, with another request to unbundle their bill and correct the errors on the bill. Copied the CFO of N Fulton Hospital.

11/11 PM: Received response to complaint which I had sent to Better Business Bureau (BBB) on North Fulton Hospital. Below is a cut and paste of their response:

"Complaint: Hospital refuses to provide an itemized bill for services." Request hospital provide "a copy of this fax to your supervisor today for follow up: I requested a detailed and itemized bill. The purpose of providing a detailed itemized bill with codes is so that the following questions can be answered." What specific drugs am I being charged for? What specific lab tests am I being charged for? What specific supplies am I being charged for? What imaging was done and what am I being charged for (please note, I have already paid a separate bill for a similar procedure. how do I know I am not being double billed on your invoice for this same procedure?) What specific services am I being charged for? What specific expenses has my insurance company already paid for?

Hospital Response: Due to the concerns expressed, our office has reviewed Mr. Xxxxx's account. The aforementioned account results from services rendered by North Fulton Regional Hospital. The Conditions of Services (COS) signed by Mr. Xxxxx at the time of service is the contract where he agreed to accept financial responsibility for any charges incurred resulting from medical services rendered.

The primary insurance carrier presented at the time of service processed the claim. The total charges are $11,695.40, the provider discount is $1,584.31, and the insurance company assigned $1,302.31 as the covered amount and paid $1,041.85 which is 80% of the covered amount, leaving Mr. Xxxxx's financial responsibility as $9,069.24.

Please refer Mr. Xxxxx to the Explanation of Benefits from his insurance carrier for more details. According to the insurance carrier the claim exceeded the amount outlined in Mr. Xxxxx's plan description. If Mr. Xxxxx feels there is a discrepancy with the amount assigned to him by his insurance carrier, please have him contact them directly. The outstanding balance on this account is $9,069.24.

CONSUMER REBUTTAL TO BUSINESS RESPONSE : (The consumer indicated he/she DID NOT accept the response from the business.) The desired result was a detailed & itemized bill explaining what the $11,695 charge was for. This is a basic & ethical business practice, and it is my legal right in the state of Georgia. If you buy groceries, you get a detailed list of what you purchased; if you get your car repaired, you get an itemized list of what parts were installed and a breakdown of the labor that was incurred to provide this service. I doubt the N Fulton Hospital employee who responded to this complaint would write out a check for $11,000 to his Mercedes repair shop, regardless of what he signed in advance - if that Mercedes dealer simply said it was for $8,000 for parts and $4,000 for labor and nothing else. He or she would demand, as is his right, for a list of the parts and labor behind that bill.

Nowhere in the N Fulton Hospital response does it address WHAT the bill is for - This person just continue to repeat past demands that I should just take their word for it that it is correct and just pay it. The signing of the Conditions of Services (COS) does not give N Fulton Hospital carte blanche to charge anything they want, they are still obligated to provide an itemization of these expenses. Nowhere have I stated I will not pay, I simply ask 1) an itemized bill of what the $11,695.40 is for and 2) that these charges are fair and reasonable (i.e., not charging me $25 for aspirin or $ 15 for one Band-Aid) . As of today, after 3 phone calls and 4 letters, I have yet received an itemized bill explaining what this $11,695 was for. So no - not only has N Fulton Hospital not addressed the issue in my complaint - but from the response this employee gave you, it appears they did not even read it. 11/12: Faxed to CFO of North Fulton Hospital. Again stressed that the issue was not that I was refusing to pay, I just wanted to 1) Know what I was paying for - an itemized bill 2) make sure the expenses were fair and reasonable.

http://moneycentral.msn.com/content/insurance/insureyourhealth/p74840.asp

http://moneycentral.msn.com/content/insurance/insureyourhealth/p79883.asp

http://transcripts.cnn.com/TRANSCRIPTS/0501/16/sm.01.html

http://www.wjactv.com/news/10309357/detail.html

Follow Up Note:

UPDATE : Georgia Department of Community Health, Healthcare Facility Regulation Division – Just got their letter in follow up to my complaint

Not only did they not check to see if the bill North Fulton Hospital sent to me was in compliance with the Health Insurance Portability and Accountability Act (see below) – but from their letter, they did not even seem to know about it. They just called North Fulton Hospital, and took whatever they said as gospel and dropped my complaint.

If this is the support and protection we currently get from the government agencies, with their cozy relationships with big money, medical providers –where they do not even enforce – or even acknowledge, the current law to protect consumers and keep cost down, what it the world will it be like after Obama care, where the government will have an even bigger control of these situations.

(http://en.wikipedia.org/wiki/HCPCS).

"The Healthcare Common Procedure Coding System (HCPCS, often pronounced by its acronym as "hick picks") is a set of health care procedure codes based on the American Medical Association's Current Procedural Terminology (CPT). The Healthcare Common Procedure Coding System (HCPCS) was established in 1978 to provide a standardized coding system for describing the specific items and services provided in the delivery of health care. Such coding is necessary for Medicare, Medicaid, and other health insurance programs to ensure that insurance claims are processed in an orderly and consistent manner. Initially, use of the codes was voluntary, but with the implementation of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) use of the HCPCS for transactions involving health care information became mandatory."

Review about: Billing Department.

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