Unethical Medical Billing Practices

Unethical Treatment From Penrose Hospital

Unethical Medical Billing Practices

Back in May of last year, my daughter needed eye surgery in both eyes to correct the muscles that keep her eyes aligned. The surgery took place at St Francis Medical Center, which in Colorado Springs is part of the Penrose Hospital, St Francis Heath Services of Centura Health.

The hospital told us that we needed to pay in full the balance of what the insurance company would not cover prior to the surgery. On the day of the surgery, we came prepared to pay in full, which we did. We checked our daughter in and had a short meeting with the surgeon who told us that the surgery would take about 15 minutes for each eye and after a short observation period in the recovery room, we would be able to take our daughter home that same day.

At the end of the surgery, the surgeon came out and said she couldn’t be happier; the surgery went exactly as planned. Each eye took about 15 minutes and after a short observation in recovery, we were on our way home.

About a month later, I received a bill from the hospital for $1,259. I was a bit shocked seeing as I was told we were paying in full the day of the surgery, and the surgery had no complications. I figured that this must be a mistake. I tried to compare the bill to the estimate the hospital gave us, but their estimate is so vague, that I could not make since of it. It only shows what the max the insurance company would pay and what the patient responsibility is, and none of the numbers where the same.

I called the number on the bill in an attempt to find out what was going on. The lady that answered the phone told me that she does not have that information, and I would have to email their disputes department. Which I did, and after 30 day I did not get a response from them but I did get another bill in the mail.

With the new bill in hand I tried to contact them again, but this time I added a step and printed out my email, wrote a letter to the billing department and mailed both to them. Thirty days go by and no response to my email, and no response to the letter I mailed to their billing office. Yet I did get another bill, this one was different, it said in a very abrupt red ink fashion that I have failed to make any attempt to contact them to make arrangements to pay the bill.

Now this just down right pissed me off, as I have indeed tried multiple times, and on multiple levels to contact them to resolve the situation. With my frustration mounting I figured I should go right to the source and call the hospital and talk to the CEO, she of course was not in at the time so I wrote her a letter and sent it certified mail, signature required. In my letter, I explained that I felt the bill was in error, and expressed my frustration for getting the run around.

The CEO of course was too busy to talk to me but she did have one of her minions call me. I received a voice-mail from the Patient Financial Rep. In her voice-mail, she left several possible reasons why the bill was off and that she needed a few days to look into it and would call me back in a week.

One week went by and no call, 30 days went by and still no call. However, I also did not receive any additional bills in the mail, so I figured she had found the mistake fixed it and moved on to other business. 9 months went by and I still had not heard back from the Patient Financial Rep, and I had not received any more bills in the mail. That is until a letter from Medicredit Inc. a collection company showed up to collect on the bill, and my wife started receiving phone calls from the collection company while she was trying to work.

“Ignore their complaint, don’t call them back, and send them to collections”

I don’t know about you but that has to be one of the most unprofessional, and unethical things to do to a client. Ignore their complaint, don’t call them back, and send them to collections instead of working it out like decent human beings.

After picking myself up off the floor and calming down a bit, I decided to file a complaint with the BBB (Better Business Bureau). It took the hospital administration almost 3 weeks to respond to the complaint. I received a voice-mail from the HBA at the hospital, She explain that the error was in how the deductible was handled and that when everything is processed that I should get a $1000 credit back from the surgeons office.

This just didn’t seem right to me, it has been over a year since the surgery and they think that there are still things to be processed. I called the surgeons office and their office manager said that they are blowing smoke up my butt, that everything has been processed and they do NOT have a $1000 credit. I then called the insurance company asking if they have processed everything and when they would be crediting the surgeon’s office the $1000. The insurance company explained that, that is not how a deductible works. Once it is paid, it is paid, and I would be only responsible for my percentage of the bill that they don’t cover.

I called back the HBA, and told her that the surgeon didn’t have a credit for me, and that the mistake must be something else. We went round and round and she still insisted that I would be getting a credit from the surgeon. I must have tired her out as she said she would have her boss call me.

The next day I received another voice-mail from the Director of Finance, it was almost the exact story I got from the HBA I talked to the day before. She insisted that I would be getting a credit from the surgeon. I called her back later that afternoon, and we went round and round again. I was nowhere closer to determining if the bill was an error or not. I finally stopped her and gave her this analogy.

If you take your car to the mechanic and he says, the problem is with the alternator and it will cost you a $1000 to fix it. You tell him fine let’s do it. You come back to pick your car up and he hands you a bill for $5000, saying I can’t really explain what happened but it is how our billing software works and there was a mistake so you owe us $5000. If that happened to you, you would expect him to do the right thing and honor the original estimate, and if he didn’t you would tell him to go pound sand, right? She said, “Yes absolutely!” So I ask her why don’t you do that here. The surgeon’s office says you are wrong, the insurance company says that’s not how deductibles work. It is the right thing to do, you give me an estimate and the estimate is wrong, you should honor the original estimate.

“how convenient is that? You have a law that prevents you from doing the right thing”

She said that she can’t do that. There are anti-kickback laws that prevent them from forgiving a bill. Wow, I thought to myself, how convenient is that? You have a law that prevents you from doing the right thing.

I tell her I need to understand how all these numbers where figured, your bill is vague and has no, to little information on it. I want to see a breakdown of how it was created.

Day three rolls around I get another voice-mail from the Patient Financial Rep. This is the same person that was supposed to call me back in a week, nine months ago, but didn’t. She leaves me a similar message that the error is in the deductible and I should be getting a credit from the surgeon’s office, and that she is waiting for one piece of information from one of her auditors and with that info, she would be able to explain it all to me.

Fine, at this point I just want to resolve this situation. I have spent the last three days looking for a legitimate reason why I owe this money, they have provided none, and has just given me the run around yet again.

I turned back to the BBB and through their website, I asked for a resolution. I tell them I will pay the bill if they are willing to stop pursing me through collections, and stop pursing to collect on this bill until the surgeon’s office makes available the $1000 dollar credit.

I felt that this was a reasonable solution. I’m a furniture maker, and for me to come up with that kind of money takes a lot of swings with the mallet to the chisel. For a large company like theirs $1300 is just a drop in the bucket. After all, they are the ones insisting that I will be getting a credit from the surgeon’s office.

“Once I thought, we were close to a resolution they change their story to something completely different.”

I received another voice-mail from The Director of Finance saying that the deductible wasn’t the actual cause of the discrepancy and that she wanted to meet me in person to explain what had happened.  Once I though, we were close to a resolution they changed their story to something completely different.

At this point, I don’t know what to think, so I left her a voice-mail saying I would like them to respond through the Better Business Bureau. It has been over a week and as of the date I wrote this post, they have not responded.

Even if they do respond, I don’t know I would believe them. They have lost all credibility with me. During all our conversations, they never once offered up a sincere apology, not even a sorry I forgot to call you back nine months ago. Their only focus was to talk me into paying a bill that I think is an error.

After they changed their story, would you believe anything else they say?

After they changed their story, would you believe anything else they say?
Sadly, I’m sure this happens to many people, and they don’t know what to do so they just pay the bill. A quick look at their reviews on Google it seems I am not the only one that has been treated so poorly from Penrose.  Just within the last year I found 2 reviews from Eric and Martin that have had similar issues.

1 star google review penrose hospital

1 star google review penrose medical centerWhat we need is our politicians to quite arguing and make a bipartisan effort to write a bill that force healthcare providers to have transparent billing practices. People should be able to understand what they are being billed for, and be able to tell whether or not it is correct.

In my case, it took three administrators and an auditor at the hospital to figure out why I was being billed an additional $1,300, and even then, they changed their story. Their initial estimate seems to be intentionally vague, so vague in fact that you can’t use it to compare to the actual bill they send in the mail.
I feel like they are a large corporate bully, that has unlimited resources and they can just force you to pay what ever bill they make up. It just doesn’t seem ethical, does it?

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Comments: 2

  1. Ellie Skinner says:

    I heard terrible things about them… I think local authorities must intervene

  2. Bethany says:

    That is outrageous! Things like that are not supposed to happen in America. The health system should finally be reformed. Until then patients will continue to be treated as walking purses and not human beings. Americans are made to believe that the social health system is something evil. Well, come in UK and see for yourself. I’m now living in Milton Keynes (close to London) and our hospital is just great – free healthcare, brought by highly skilled and motivated doctors. Been there couple of times and was treated just the way a suffering human being should be treated.

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