Advocate Illinois Masonic Medical Center / advocate masonic medical center billing department commit fraud by charged me co-payment $250 for outpatient surgery that were not performed.
I am writing to dispute a charge on my bill from Advocate Illinois Masonic Medical Center.
At 06/08/2016, I had the office visit appointment with Dr. Candido, in Anesthesia Pain Management center. Co-payment amount I am responsible for doctor office visit $30, but I got a bill $250. My medical record must prove what doctor did not do me any surgical procedures; I did not use any hospital outpatient clinic facility such as hospital beds in preparation, and recovery rooms at 06/08/2017. I have been billed for services did not receive.
Claim # [protected] detail chart, printed from Coventry Health Care Insurance web site, and showed this mistake. Billing clerk, who checked me in, prior the appointment at 06/08/2016 instead of using a billing code for doctor office visit, enter billing code for hospital outpatient clinic visit.
By medical billing laws, she must verify reason for visit, detail about my insurance coverage, and let me know about co-payment, I am responsible for this appointment, and other insurance coverage problems, in advance. She did not do it. If I had the information that I had been checked in for hospital outpatient and responsible for $250 co-payment, prior the appointment, I would cancel this appointment, or dispute it promptly, and easily solved this problem, before incorrect claim submitted to my insurance. I got this information at May 2017, when I received incorrect bill, and started the investigation.
Therefore front desk billing clerk, who checked me in prior the appointment fully responsible for this error. I even suspect she use billing codes that cost me ten time more that I have to pay, to increase hospital profitability.
At 01/16/2014, I had similar office visit appointment with Dr. Candido at the same location, I had the same Coventry State of Illinois OAP insurance plan as in 2016, lumbar epidural injection was done, I paid $30 my co-payment for this visit.
Explanation from Claim # [protected]:
Procedure code: HCPC/G0463 Hospital Outpatient Clinic Visit at 06/08/2016.
Claim amount was $280.
From June 2017 when I received this incorrect bill first time, I have had numerous phone conversations with Advocate Illinois Masonic Medical Center Billing Department and Coventry Health Care Insurance. Billing department sent me to the insurance company, insurance to billing department; both of them refuse to fix this billing error.
At 6/12/17, I had conversations with Coventry Health Care Insurance Representative Joana, wasting 35 min on the hold, while Joana called to Advocate Masonic Medical Billing Department, she finally told me that Advocate Masonic Medical Billing Department, will fixed the error, and send the new claim and it takes 30 days. Moreover, 07/07/217 I received the same bill $250. When I called insurance company, they told me Advocate Masonic Medical Billing Department refused to fix this error.
I had several calls to Advocate Masonic Medical Billing Department [protected]
wasting 20 min on the hold each time, but no body answered.
At 07/18/2017, I faxed appeal letter to Advocate Masonic Medical Billing Department to dispute incorrect charge $250, with Claim# [protected] that proved billing error. However, nobody responded to this letter, and 08/08/2017 I again received the same bill for $250.
At 08/11/2017, I had a second conversation with Advocate Masonic Medical Billing Department rep. Nadia, she again told me to call my insurance company, on my request to speak with supervisor, she told me supervisor is out of office; and she will call you as soon as she will come back. However, nobody called me and at 09/11/2017, I again got the same bill for $250.
At 09/12/2017 I was finally be able to spoke with Masonic Medical Billing Department supervisor Sharon, she refuse to fixed this error, she requested that I call insurance at 9/13/2017 and three of us had a conference call to discuss this problem. I did this, but insurance rep. refuse to connect to conference call, she put me on hold for 25 min, spoke with Sharon by herself, and told me it is impossible to correct this problem and connected me to her supervisor Caroline. One-hour conversation with Caroline did not solve the problem. I figured out that neither insurance nor billing department willing to fix this error. They both told me it is impossible.
Advocate Masonic Medical Billing Department commit fraud by charged me co-payment $250 for outpatient surgery that were not performed. Please investigate this matter and help me to correct the billing error. Enclosed are copies of claim details supporting my position?