• Report: #661658

Complaint Review: North Fulton Hospital

  • Submitted: Sat, November 13, 2010
  • Updated: Wed, November 17, 2010

  • Reported By: Mike — Atlanta Georgia U.S.A.
North Fulton Hospital
3000 Hospital Blvd Roswell, Georgia United States of America

North Fulton Hospital North Fulton Hospital engages in a deceptive billing practice called bundling Roswell, Georgia

*Author of original report: Follow up from Georgia Department of Community Health, Healthcare Facility Regulation Division

*Author of original report: HCPCS: Hospitals required by law to use this breakdown

*Author of original report: Follow up to Question

*Consumer Comment: Question

*Author of original report: Follow Up to Comment OK

*General Comment: ok

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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 URLs 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 a delegation 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


 


This report was posted on Ripoff Report on 11/13/2010 06:14 PM and is a permanent record located here: http://www.ripoffreport.com/r/North-Fulton-Hospital/Roswell-Georgia-30076/North-Fulton-Hospital-North-Fulton-Hospital-engages-in-a-deceptive-billing-practice-calle-661658. The posting time indicated is Arizona local time. Arizona does not observe daylight savings so the post time may be Mountain or Pacific depending on the time of year.

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Updates & Rebuttals

#1 Author of original report

Follow up from Georgia Department of Community Health, Healthcare Facility Regulation Division

AUTHOR: Mike - (U.S.A.)

UPDATE : to 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.

 

Note I had loaded the below on this thread, and it was on the site yesterday, but it is gone today. So I have reposted it again. Rip off Report is usually pretty good about posting and not removing/censoring posts, so not sure what happened. I might have violated their 8 hour rule. So I have reposted as support to my above update.

 (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.

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#2 Author of original report

HCPCS: Hospitals required by law to use this breakdown

AUTHOR: Mike - (U.S.A.)

Healthcare Common Procedure Coding System (HCPCS)  Hospitals are required to use this breakdown by law, so why did N Fulton Hospital not just provide this breakdown at first request?

I think what Stacey - Dallas (, U.S.A.) Medical representative was referring to was HCPCS. Below my response is a cut and paste on what this is (http://en.wikipedia.org/wiki/HCPCS). Readers should note, that this type of breakdown and categorization is required by law, so there is no reason why a itemize bill would take over 4 months to obtain they are required by law to code all their bills this way and keep this type of information on file. One can only speculate it is either incompetence or bad faith - by purposely stonewalling and hiding billing facts (or perhaps a mixture of both.)

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.

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#3 Author of original report

Follow up to Question

AUTHOR: Mike - (U.S.A.)

Response to Stacey - Dallas (, U.S.A.) Medical representative

Based upon you initial answer, I thought you worked for the Medical field.

So Stacy, as a representative of the medical billing profession, help us non professionals unbundle that acronym CDM and tell us what it is, so we can also understand the complexity of hospital billing.

Explain to us why in a free market system, one company, in the same city, using the same machine that was bought at the same price as everyone else (and both are run by contractors - possible the same contractors, not employees) - can charge $1,650 for a procedure (i.e., Georgia West Imaging) and other charges $6,000 (North Fulton Hosptial)  where the only difference, that I can see, is that the typical customer for the $1,650 location is not faced with an emergency (and possible in pain and / or a life threating position) and the other is not.

In other markets, where the staff do not wear white coats and use official sounding names and acronyms, but cheap suites and use phrases like Lowballing and The Lapdog Trick this would be called out for what it really looks like when you strip away that professional veneer predatory pricing. It is a big reason why we have a medical cost crisis in the US right now.

and what is the comment about a social worker?  If someone gets ripped off by a used car dealer, or a predatory lender, the resolution usually does not involve a social worker. That response seemed more reflection of the real issue.

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#4 Consumer Comment

Question

AUTHOR: Stacey - (U.S.A.)

Do you have health insurance?? If you got a any type of scan you cannot compare prices because every Hospital charges according to the CDM. I know because I work in the Healthcare field.


You can do this - call the Social Worker who works for the Hospital and ask that person these questions. 


Good luck

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#5 Author of original report

Follow Up to Comment OK

AUTHOR: Mike - (U.S.A.)

Stacy

Thank you for your comment, but your statement about what an image is - that it could be an X-ray, MRI, Cat Scan, Ultrasound etc etc. was exactly my point it could be any one, or a combination of these The bill does not say. It is difficult to identify you have been overcharged for something if you do not know what it is which is why hospital bundle bills in the first place.

Again the issue is not if I owe money, I do. The issue is how much I own and making sure it is fair and reasonable and how much is it due to hospitals seeing an opportunity of taking advantage of a sick person in extreme pain.

For example say they are charging me for an Abdominal CT Scan the median cost for this procedure in Atlanta is around $1,950 (based upon newchoicehealth.com). The range is between $1,650 and $6,800. North Fulton Hospital charges $6,000 if my excel spreadsheet is correct - that is in the 90 percentile for Atlanta medical facilities, or in other words, North Fulton Hospital charges more than 90% of all other medical services in Atlanta for this same procedure. Said another way - North Fulton Hospital charges over double what most medical facilities do for this same proceedure. Is it a coincidence that these patients do not have the luxury to first shop around for a better deal, because of the circumstance they find themselves in?

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#6 General Comment

ok

AUTHOR: Stacey - (U.S.A.)

Diagnostic/Imaging refers to anything that a Physician needs to see inside your body ie: X-ray, MRI, Cat Scan, Ultrasound etc etc.


If you go through the ER for any visit you are expected to pay for those expenses - If you think you are overcharged call you State Health and Human Services Department and file and complaint.

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