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CB Hospitals and Clinics Review of Northwestern Memorial Hospital
Northwestern Memorial Hospital

Northwestern Memorial Hospital review: Deceptive, unfair, misleading billing practices.

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4:01 pm EDT
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My family and I are using NMH for thirty years and I rate five stars for Northwestern medical care, and zero or negative numbers for deceptive, unfair, misleading Northwestern Hospital billing practices.
Since 09/2019 I have disputed illegal charge of $250 copay for same day surgical procedure. This charge applied for the use of a hospital room at treatment Epidural Steroid Injection (ESI) CPT® Code - 62321 that I had at Northwestern Hospital Anesthesiology/Pain Medicine Center on 07/26/2019.
My Aetna insurance Open Access Plan (OAP) Coverage & Benefits has clear definitions.
of copayments I am responsible for: $30 copay. This charge applies for Doctor Specialist Office Visit; $250 facility. This charge applies for Same Day Surgical Procedure for the use of a hospital room or surgical suite. Everything else 100% covered by Aetna.
My medical record is the legal evidence, that I did not have outpatient surgery and did not stay in the hospital room, recovery / observation rooms on 07/26/2019. My medical record show that treatment I had 07/26/2019 Epidural Steroid Injection, was in doctor office, Overall length of this appointment is less than an hour. Therefore, this treatment matched definition of Specialist Office visit by My insurance Open Access Plan (OAP) Coverage & Benefits, $30 my copayment for this appointment I already paid. Clerk who checked me in at Northwestern Anesthesiology/Pain Medicine Clinic 07/26/2019 requested $30 my copayment for office visit. She did not mention anything about any other clinic/room facility charges. Previously in 06/05/2019 I received the same treatment in Northwestern Anesthesiology / Pain Center as I had at 07/26/2019 and was charged $30 copayment for office visit.
All the above confirmed that Northwestern Hospital billing department is committed fraud by billing me $250 copay for hospital outpatient facility that was not provided in 07/26/2019.
I got information that I responsible for $250 facility fee copay from bill I received in September 2019. Since that I have disputed this illegal charge with Northwestern Hospital, and Aetna my insurance carrier, without any success.
Northwestern declines all my complaints and insists that I was billed based on the explanation of benefits provided to hospital by insurance.
However, the insurance declines my appeal and insists that claim for service at 07/26/2019 processed according to provider's Northwestern Hospital reported services, and insurance unable to modify the provider's submission.
In January 2021 I sent complains about this matter to Illinois Attorney General Health Care Bureau Consumer Protection Division. Since that I received 2 letters the Office of General Counsel Fellow Northwestern Memorial Hospital. I did not accept the Office explanations. Because the Office of General Counsel for NMH did not present any satisfy explanations. I even sent the bill of the same procedure that I did on 06/05/19 and was charged only $30.00. Office did not respond. I am not sure anybody in the office actually read my compliance at all.
Instead, Northwestern sent my case to collection bureau, forced me to pay illegal charge I currently disputed. My dispute case not over. There is no answer to my letter from 03/29/2021, there is no final dispute resolution on my case from Illinois Attorney General Health Care Bureau Consumer Protection Division. Therefore, Northwestern Hospital do not have any rights to send my case to collection bureau. By the Illinois Fair Patient Billing Act, NMH billing department must send me 30 days' notice letter before sending my case to collection bureau. They did not do this. This is violation of Illinois Fair Patient Billing Act, rules, and regulations.
All the above proofed of deceptive, unfair, misleading Northwestern Hospital billing practices.
Northwestern Hospital billing violate of Illinois Fair Patient Billing Act, and applicable rules and regulation.
Attention of all Northwestern Memorial Hospital patients, everyone can become a victim of fraud, deceptive, unfair, misleading billing practices.

Desired outcome: Remove my case from collection, and remove illegal charge $210.

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